Research Square · Oct 22, 2026
Lung Cancer Incidence and Mortality in a Nationwide 45-year Prospective Cohort of Persons with Opioid Use Disorder
By Wang X, Esposito E, Goedert JJ et al.
Purpose To examine lung cancer (LC) incidence and mortality in persons with opioid use disorder (OUD) in a national prospective longitudinal cohort. Methods Participants (N = 9895) were recruited from US medication-assisted treatment clinics. LC cases and deaths were ascertained through state cancer registries and the National Death Index-Plus. Covariates came from questionnaires and medical records. We calculated standardized incidence ratios (SIRs) and mortality ratios (SMRs) based on general population statistics; survival was estimated using Kaplan-Meier methods. Results There were 245 LC cases (56.7% distant stage at diagnosis) and 186 LC deaths, double the expected rates (SIR, 2.03, 95% CI: 1.78–2.30; SMR, 2.19, 95% CI: 1.88–2.52). Risks were similar among non-Hispanic Whites (N = 3227) and non-Hispanic Blacks (N = 3943), higher than Hispanics. SIR and SMR showed a dose-response trend with increasing smoking frequency. Among tobacco smokers with < 20 pack-years, the increased risk was similar to other pack-year groups. Risks were higher with HIV (N = 2079, SIR = 3.31, 95% CI: 2.43–4.40), for both prevalent and incident HIV. Median LC-specific survival was 76 months, 26 months, and 5 months, with local, regional, and distant stage at diagnosis, respectively. LC was frequently diagnosed at late stage. Conclusion LC incidence and mortality rates were two-fold elevated. Elevated risks with < 20 pack-years of smoking suggest current LC screening criteria may be too stringent for this population. Integrating LC and tobacco-cessation efforts into drug treatment programs, targeting both providers and patients, may reduce LC morbidity and mortality. Further research with larger, diverse cohorts is needed to confirm these findings.