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Pooled EU cohorts
– implications of
age differences in
mortality
Marcis Trapencieris1
Isabelle Giraudon, Albert Espelt, Martina Pejak-Markelic, Robert
DeBono, Thomas Clausen, Andrei Botescu, Jozica Selb, Janusz
Sieroslawski, Marcel Buster, Joao Matias
For presentation at EMCDDA DRD expert meeting
October 17, 2013. Lisbon, Portugal
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Aim of this study
� To investigate age differences in mortality in
a pooled EU multisite cohort of treated
opioid users
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Methods
� Descriptive statistics
� Feasibility for age-period-cohort analysis
� APC models with aggregated vs individual data
� Hierarchical Age-Period-Cohort (HAPC) Models
� Mixed effects models or hierarchical linear models (HLM)
� Cross-classified random effects models
� Accelerated Longitudinal Panel Designs, e.g. Growth Curve
Models might be interesting
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APC analysis
� Impossible to obtain meaningful estimates of the clear
contributions of age, time, and cohort to study mortality
or:
� conducting of APC analysis is an esoteric art that should be
left to a handful of skilled mathematicians
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So. What about the EU pooled
mortality cohort data?
Cohort
Age (Time)
Period – available but …
Cohort – available but …
Age – available but …
Country effect
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Year of entry
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Length of follow-up
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Year of birth
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Age at entry
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Differences in age at entryOldest drug
users: NL, NO, ES
Youngest drug
users: RO, MT, LV
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Length of follow-up
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Age at death
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Person years of life lost*Per person ES RO NL MT LV CR SI NO
PL
Mean 26.8 37.3 18.9 34.0 34.9 30.7 29.7 25.1 32.5
Median 26.9 38.1 19.1 35.3 36.3 32.9 31.3 25.4 35.6
25th 21.7 34.2 13.1 30.3 31.3 24.4 22.9 19.5 24.7
75th 32.5 41.7 24.2 41.3 40.1 37.2 37.1 30.7 40.6
* Assumed 65 years of age
Per country
/cityES RO NL MT LV CR SI NO PL
Sum (in 1000s) 24.0 4.1 6.6 1.6 14.6 7.1 3.9 5.3 16.1
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CMR by country by year of
entry
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Cohort-periodMost common cohort
CohNo.
Year of birth
Age at start
Age at end
ES 12 ‘66-’68
RO 16 ‘78-’80
NL 10 ‘60-’62
MT 14 ‘72-’74
LV 17 ‘81-’83
CR 15 ‘75-’77
SI 16 ‘78-’80
NO 10 ‘60-’62
PL 16 ‘78-’80
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Limitations
� The ones Isabelle mentioned earlier
� Not necessarily the first treatment
� A few countries have data, though
� Unable to control for health status when
entering cohort
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Summary� Preliminary analysis
� Mortality rates considerably higher among opioids users as
compared with general population but varies by country and
cohort
� Three countries (ES, NL, NO) with significantly older
cohorts
� Four of the younger cohorts (CR, MT, RO, SI) with
significantly lower mortality rates (CMR or SMR)
� Two of the younger cohorts (LV, PL) with as high mortality
rates as three oldest cohorts
� Mortality figures in some cohorts relatively small and
aggregation criteria might need revision
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Further plans
� Explore use of APC models further in the EU
pooled cohort
� Possibly make comparisons even more
difficult with involving more countries ;)
� «Synthetic» cohorts if data allows
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Thank you!Inputs, suggestions, questions.
[email protected]
