Statistical Studies on the Mortality Rates and the Causes of Death among the Opium Addicts in Formosa

Abstract

The author, a member of the Pharmacological Institute of the National Taiwan University, Taipeh (Formosa), has been collecting data since 1928 on the opium used in Formosa. He sets forth in the present article, with detailed statistics from the years 1923 to 1933, the repercussion of opium addiction on morbidity and mortality rates and concludes that the mortality rate is much higher for the inveterate opium addicts.

Details

Author: Tsungming Tu
Pages: 9 to 11
Creation Date: 1951/01/01

Statistical Studies on the Mortality Rates and the Causes of Death among the Opium Addicts in Formosa

Professor Tsungming Tu

The author, a member of the Pharmacological Institute of the National Taiwan University, Taipeh (Formosa), has been collecting data since 1928 on the opium used in Formosa. He sets forth in the present article, with detailed statistics from the years 1923 to 1933, the repercussion of opium addiction on morbidity and mortality rates and concludes that the mortality rate is much higher for the inveterate opium addicts.

There is no exact statistical study available about the influence of habitual opium or morphine use upon any race or other subdivision of mankind as a whole. For an investigation of this problem, the conditions, as they exist in Formosa, are especially favourable, perhaps more favourable than anywhere else in the whole world, because on the one hand stringent official control has been exercised over the habitual users and the suppliers of opium, and on the other hand a complete census of the population has been effected and is always brought up to date at regular intervals. Thus the question is important not only from the toxicological point of view, but also from that of social sanitation.

Since 1928 the author has been collecting data as they became available, and has already published many reports dealing with various aspects of the problem of the consumption of opium in Formosa, and especially the following: the changes in the number of opium addicts during the last 38 years and in the quantity of prepared opium consumed during that time; the age at which opium smoking was started; the motives leading to opium smoking; the degrees of addiction; certain physical peculiarities of the addicts; the rates of childbirth by female addicts, and by nonaddicted wives of male addicts; the annual death rate; the occupation, education, criminality, etc. of the addicts.

Today's communication has, as its main object, the mortality of all the Formosan licensed opium addicts during the ten years between the end of 1923 and the end of 1933, examining it under various conditions and establishing comparisons among the various components.

The results obtained so far may be given in outline as follows:

  1. In 1897 the Government of Formosa took on a policy of gradual abolition of opium smoking and opium eating, and since then the number of opium addicts has greatly decreased. Taking their number in September 1900 as the starting point, we find the following reductions: September 1900, number of addicts 169,064, percentage to the whole population, 6.3, index 100; end of 1929, number of addicts, 24,626, percentage of the whole population, 0.6, index 15; end of 1937, number of addicts, 11,960, percentage to the whole population, 0.23, index 7. The quantity of prepared opium sold by the Formosan Monopoly Bureau decreased from 200,927 kilograms in 1900 to only 16,020 kilograms in 1937, but the average dose allowed to individual addicts remained between 3 and 4 grams per day. In 1941, we began the treatment of the licensed opium addicts,removing their addiction completely, and in 1946 this work was completed and the Government Central Hospital for Opium Addicts in Taihoku was closed.

  1. The average yearly death rate of the licensed opium addicts in the whole island for the 35 years from 1901 to 1935 was 65.5 per 1,000 of the addict population, while that of the general population amounted to 26.1. If the annual changes of the two rates are compared, the figures for the general population show a tendency to diminish, whereas those for the addicts are constantly increasing.

  2. In order to compare the mortality rates as depending on age and sex, the licensed addicts living during the 10 years from the end of 1923 were classified according to their number of years, starting with 15 and reaching the highest figure with 90 years. For this purpose the arithmetic mean of x years of life at the beginning and the end of each calendar year was used Considering this as the nearest practically attainable approximation to the actual age of the addicts.

At the end of 1923 the number of licensed addicts in Formosa was 40,981, comprising 35,189 males and 5,792 females. During the ensuing 10 years the number of deaths registered among the licensed addicts amounted to 19,212, of which 16,497 were males, 2,715 females.

  1. From this data it may be seen that the total mortality rate per 10,000 of the population was 596.1 for the 19,212 licensed opium addicts, deceased during the 10 years and 197.7 for the general population over 20 years of age during the same period. Among the 18 groups the highest rate, i.e., 165.6 for the addicts against 51.8 for the general population, was occupied by diseases of the respiratory system. Also in the six groups infectious and parasitic diseases, diseases of the digestive system, diseases of the genito-urinary system, senility, diseases of the circulatory system, diseases of the nervous system and the special sense organs, the rates for the addicts were much higher than those for the general population. Only slightly higher rates for the addicts than for the general population appear in the following four groups: Cancer and other tumours, death from external causes, rheumatic diseases, etc., alcoholism, etc. In the group, diseases of the skin and the subcutaneous tissue, the rate for the addicts is equal to that for the general population. In the group pregnancy, etc., the number of deaths among the addicts was only two, with a mortality rate of 0.4, against 66 for the general female population.

  2. We also compared the death rates of the opium addicts with those of the general population, both divided according to decades of age and according to 18 groups of diseases. During the first two decades, from 20 to 29 years and from 30 to 39 years of age, no clear-marked differences can be established between the addicts and the general population, because the number of addicts deceased at 40 or below is too small. In the higher decades, however, certain disparities become gradually manifest. Thus in the decade from 40 to 49 years there have been no deaths from senility among the general population, while for the addicts we find a mortality rate of 1.64 per 10,000. In the group diseases of pregnancy, etc., the mortality of the female addicts amounts to 2.07 against 4.22 for the general female population. In the age group from 50 to 59 years the mortality from senility rises to 10.55 for the addicts against only 0.75 for the general population; in the same age group there were no deaths from diseases of pregnancy, etc., among the addicts, but 23 deaths, with a mortality rate of 0.17, among the general female population.

  1. If the mortality rates are given separately for quinquennial age groups among the addicts and the general population, and the influence of the disease of the respiratory system upon those rates is ascertained, we find in general that the trends are identical both for the addicts and the general population, but the rate is clearly much higher in the case of the addicts, the only exception being the age group between 30 and 34 in which the number of addicts and of deaths is low. In the higher age groups the rates are: for the ages between 35 and 39 years, 40.90 per 10,000 addicts against 38.43 per 10,000 of the general population, for the ages from 40 to 44 years, 62.17 against 48.79, for the ages from 45 to 49 years, 86.84 against 55.59, for the ages from 50 to 54 years, 129.14, against 71.93, for the ages from 55 to 59 years, 166.07 against 88.25, and for the ages of 60 and more years, 252.64 against 183.7.

  2. If instead of diseases of the respiratory system only pneumonia is considered, the results do not greatly differ. At the ages from 30 to 34, the figures are too low both in regard to the number of addicts and the number of deaths among them. For the ages from 35 to 39 years and from 40 to 44 years there is no difference between the addicts and the general population. But in all the 5-year groups above 44 years, the addicts show decidedly higher rates than the general population, the range varying between 8 and 27 per 10,000 of the two populations.

  3. If the principal causes of death among the addicts are compared with those among the general population of more than 20 years, the following details may be extracted from diagram no. 1: Among the addicts the most frequent cause of death is pulmonary tuberculosis, with 3,611 deaths during the 10 years, and a mortality rate of 112.04 per 10,000 population; next comes pneumonia, with 1,923 deaths, and a mortality rate of 59.67; the third place is occupied by senility, with 1,708 deaths, and a mortality rate of 53.00. These three diseases are followed by other diseases of the respiratory system (chiefly asthma, but not comprising tuberculosis, bronchitis, pneumonia, pleurisy), bronchitis, diarrhoea plus enteritis, nephritis, cerebral hemorrhage, cancer plus other malignant tumours, decreasing in that order, with mortality rates ranging from 50.30 at the highest to 10.80 at the lowest. Still lower places are occupied by malarial fevers, heart diseases, pleurisy, beri-beri, suicide, with mortality rates decreasing from 8.56 down to 4.44.

    Among the general population over 20 years the most important cause of death is likewise pulmonary tuberculosis, however with a mortality rate of only 28.98 per 10,000; next comes likewise pneumonia with a death rate of 25.96; the third place is occupied by nephritis, with a mortality rate of 13.13. These three diseases are followed by diarrhoea plus enteritis, senility, bronchitis, other diseases of the respiratory system (chiefly asthma, but not comprising tuberculosis, pneumonia, pleurisy), malarial fever, decreasing in that order, with mortality rates ranging from 12.93 to 10.39. The lowest places are occupied by cerebral hemorrhage, heart diseases, cancer plus other malignant tumours, suicide, pleurisy, beri-beri, with mortality rates decreasing from 7.72 down to 1.42.

    The total mortality rate from all causes not specially named in the preceding amounts to 124.45 for the addicts, and to 46.73 for the general population.

Diagram No. 1

Mortality Rates from Principal Causes of Death of Licensed Opium Addicts and of the General Population over 20 years of age

Full size image: 31 kB, Mortality Rates from Principal Causes of Death of Licensed Opium Addicts and of the General Population over 20 years of age
  1. From the above statistics it appears that the evil consequences of the habitual use of opium in relation to the expectation of life do not show at once, inasmuch as during the early years, viz., from 25 to 35, there is no marked difference between the mortality rate of the addicts and that of the general population. But beginning approximately with the ages from 35 to 40, the adverse influence becomes gradually manifest, and above 44 years the rate of mortality is always higher among the addicts. Especially is it worth noticing that between 45 and 92-3 years of age, when the rate of mortality reaches its peak, the mortality rate among addicts increases usually by from 15 to 35, in the most extreme case by 50.77 above the value per 1,000 of the general population considering only the male addicts; but if the female addict population alone is considered, the figures rise by between 20 and 70, in the most extreme case by 92.64 (see diagram no. 2).

Diagram No. 2

Full size image: 26 kB, Diagram No. 2

In conclusion to this report may I be permitted to place special stress upon a few points that, in my opinion, deserve the utmost attention, namely: by far the greatest part of opium smokers start smoking opium in their twenties and early thirties, and then acquire the habit within a few years later, that is, in that part of their lives which is the most valuable not only for each individual, but also for the whole community, if we consider the question from a sociological standpoint. During these earliest years, and for a few years afterwards, the rate of mortality does not seem to be greatly affected; but we need only look at those cases in which the habit has persisted for 10 years or more, and it will become manifest that opium smoking is bound to exercise an injurious, and finally a ruinous influence upon the constitution of the body, raising the mortality rate high above that of the general population.