Association of Tramadol vs Codeine Prescription Dispensation With Mortality and Other Adverse Clinical Outcomes
Authors' conclusion
In this population-based cohort study, a new prescription dispensation of tramadol, compared with codeine, was significantly associated with a higher risk of subsequent all-cause mortality, cardiovascular events, and fractures, but there was no significant difference in the risk of constipation, delirium, falls, opioid abuse/dependence, or sleep disorders.
Study context
- Population
- Adults ≥18 years with ≥1 year of data and new outpatient dispensation of tramadol or codeine, primary care database covering >80% of Catalonia, Spain, 2007–2017
- Participants
- 368,960 adults184,480 matched pairs
- Exposure
- Tramadol vs codeine
- Outcome
- All-cause mortality, CV events, fractures, constipation, delirium, falls, opioid abuse/dependence and sleep disorders
- Follow-up
- Within 1 year after first dispensation
Methodological detailspopulation-based, propensity score-matched
- Population-based
- Propensity score-matched
Main finding
As reported in the abstract
1 year
Tramadol
- All-cause mortality
- 13.00 per 1000 person-years
- CV events
- 10.03 per 1000 person-years
- Fractures
- 12.26 per 1000 person-years
Codeine
- All-cause mortality
- 5.61 per 1000 person-years
- CV events
- 8.67 per 1000 person-years
- Fractures
- 8.13 per 1000 person-years
All-cause mortality
Tramadol13.00 per 1000 person-years
Codeine5.61 per 1000 person-years
CV events
Tramadol10.03 per 1000 person-years
Codeine8.67 per 1000 person-years
Fractures
Tramadol12.26 per 1000 person-years
Codeine8.13 per 1000 person-years
Tramadol vs CodeineHazard ratio (95% CI)
All-cause mortality
2.31(2.08–2.56)
CV events
1.15(1.05–1.27)
Fractures
1.50(1.37–1.65)
Tramadol vs CodeineARD, per 1000 person-years (95% CI)
All-cause mortality
7.37(6.09–8.78)
CV events
1.36(0.45–2.36)
Fractures
4.10(3.02–5.29)
Observational data: associations, not effects.
Original publication
Association of Tramadol vs Codeine Prescription Dispensation With Mortality and Other Adverse Clinical Outcomes. JAMA. Published 19 October 2021. doi:10.
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