Mortality associated with bacterial and fungal infections and overdose among people with drug use diagnoses

Hospital visits for drug use-related bacterial and fungal infections have increased alongside overdose deaths. The incidence of mortality from these infections and the comparison to overdose mortality is not established. This cohort study examined mortality outcomes among adults with drug use diagnoses who were insured by public and private plans during 2007 through 2018 in North Carolina. We examined bacterial- and fungal infection-related mortality and overdose mortality using cumulative incidence functions. Among 131,522 people with drug use diagnoses, the median age was 45 years (interquartile range: 31–57), 58% were women and 65% had an opioid use disorder diagnosis. The 1-year incidence of bacterial and fungal infection-associated mortality was progressively higher as age increased (35–49 years: 9 per 10,000 people, 50–64 years: 23 per 10,000, 65+ years: 50 per 10,000 people). Conversely, the 1-year incidence of overdose mortality was markedly lower among older adults compared to those under the age of 65 (18–34 years: 34 deaths per 10,000 people; 35–49 years: 47 per 10,000; 50–64 years: 41 per 10,000; 65+ years: 9 per 10,000). Bacterial and fungal infections and overdose were notable causes of death among adults with drug use diagnoses, and varied by age group. •Bacterial and fungal infections are contributors to drug-related mortality.•Infection mortality was highest among older age groups.•Overdose mortality was highest among younger age groups.