{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:59:12Z","timestamp":1785488352697,"version":"3.56.0"},"reference-count":40,"publisher":"Royal College of Psychiatrists","issue":"2","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec id=\"S0007125025103139_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People with opioid use disorder (OUD) have substantially higher standardised mortality rates compared with the general population. However, lack of individualised prognostic information presents challenges in personalisation of addiction treatment delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025103139_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To develop and validate the first prognostic models to estimate 6-month all-cause and drug-related mortality risk for people diagnosed with OUD using indicators recorded at baseline assessment in addiction services in England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025103139_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Thirteen candidate prognostic variables, including sociodemographic, injecting status and health and mental health factors, were identified from nationally linked addiction treatment, hospital admission and death records from 1 April 2013 to 1 April 2022. Multivariable Cox regression models were developed with a fractional polynomial approach for continuous variables, and missing data were addressed using multiple imputation by chained equations. Validation was undertaken using bootstrapping methods. Discrimination was assessed using Harrel\u2019s C and D statistics alongside examination of observed-to-predicted event rates and calibration curve slopes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025103139_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data were available for 236 064 people with OUD, with 2427 deaths due to any cause, including 1289 due to drug-related causes. Both final models demonstrated good optimism-adjusted discrimination and calibration, with all-cause and drug-related models, respectively, demonstrating Harrell\u2019s C statistics of 0.73 (95% CI 0.71\u20130.75) and 0.74 (95% CI 0.72\u20130.76), D-statistics of 1.01 (95% CI 0.95\u20131.08) and 1.07 (95% CI 0.98\u20131.16) and calibration slopes of 1.01 (95% CI 0.95\u20131.08) and 1.01 (95% CI 0.94\u20131.10).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025103139_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We developed and internally validated Roberts\u2019 OUD mortality risk, with the first models to accurately quantify individualised absolute 6-month mortality risks in people with OUD presenting to addiction services. Independent validation is warranted to ensure these models have the optimal utility to assist wider future policy, commissioning and clinical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjp.2025.10313","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T03:11:08Z","timestamp":1751857868000},"page":"164-171","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Prediction of individualised 6-month mortality risk in opioid use disorder"],"prefix":"10.1192","volume":"229","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4152-5570","authenticated-orcid":false,"given":"Emmert","family":"Roberts","sequence":"first","affiliation":[{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London"},{"name":"South London and the Maudsley NHS Foundation Trust"},{"name":"Office for Health Improvement and Disparities"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Strang","sequence":"additional","affiliation":[{"name":"South London and the Maudsley NHS Foundation Trust"},{"name":"Institute of Psychiatry, Psychology and Neuroscience, Kings College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eve","family":"Taylor","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology and Neuroscience, Kings College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Crummy","sequence":"additional","affiliation":[{"name":"Office for Health Improvement and Disparities"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Lowden","sequence":"additional","affiliation":[{"name":"Office for Health Improvement and Disparities"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chioma","family":"Amasiatu","sequence":"additional","affiliation":[{"name":"Office for Health Improvement and Disparities"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Eastwood","sequence":"additional","affiliation":[{"name":"Office for Health Improvement and Disparities"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"S0007125025103139_ref12","unstructured":"12 NHS England. 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Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}