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We calculated crude incidence rates of non\u2010fatal and fatal overdose by dual diagnosis history. Andersen\u2013Gill and competing risks regression were used to examine the association between dual diagnosis and non\u2010fatal and fatal overdose, respectively, adjusting for age, sex, comorbidities, incarceration history, social assistance, history of prescription opioid and benzodiazepine dispensing and region of residence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Of the 921\u2009346 people in the cohort, 176\u2009780 (19.2%), 6147 (0.7%) and 15\u2009269 (1.7%) had a history of mental illness only, SUD only and dual diagnosis, respectively; 4696 (0.5%) people experienced 688 fatal and 6938 non\u2010fatal overdoses. In multivariable analyses, mental illness only, SUD only and dual diagnosis were associated with increased rate of non\u2010fatal [hazard ratio (HR)\u00a0=\u00a01.8, 95% confidence interval (CI)\u00a0=\u00a01.6\u20132.1; HR\u00a0=\u00a09.0, 95% CI\u00a0=\u00a07.0\u201311.5, HR\u00a0=\u00a08.7, 95% CI\u00a0=\u00a06.9\u201310.9, respectively] and fatal overdose (HR = 1.6, 95% CI\u00a0=\u00a01.3\u20132.0, HR\u00a0=\u00a04.3, 95% CI\u00a0=\u00a02.8\u20136.5, HR\u00a0=\u00a04.1, 95% CI\u00a0=\u00a02.8\u20136.0, respectively) compared with no history.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In a large sample of residents of British Columbia (Canada), approximately one in five people had sought care for a substance use disorder or mental illness in the past 5\u00a0years. The rate of overdose was elevated in people with a mental illness alone, higher again in people with a substance use disorder alone and highest in people with a dual diagnosis. The adjusted hazard rates were similar for people with substance use disorder only and people with a dual diagnosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.15580","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T13:08:48Z","timestamp":1621948128000},"page":"129-140","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Prevalence of co\u2010occurring mental illness and substance use disorder and association with overdose: a linked data cohort study among residents of British Columbia, Canada"],"prefix":"10.1111","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4875-1300","authenticated-orcid":false,"given":"Claire","family":"Keen","sequence":"first","affiliation":[{"name":"Justice Health Unit, Melbourne School of Population and Global Health University of Melbourne  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