Academic journal article Central European Journal of Public Health

Mortality of Cohort of Very Young Injecting Drug Users in Prague, 1996-2010

Academic journal article Central European Journal of Public Health

Mortality of Cohort of Very Young Injecting Drug Users in Prague, 1996-2010

Article excerpt

SUMMARY

Aim: To determine the mortality in a cohort of very young injecting drug users (IDUs), and the factors associated with it.

Design: A database linkage prospective (follow-up) cohort study.

Setting: A convenience sample of clients of 2 low-threshold facilities, 1 drug treatment clinic, and one special facility for children with severe behavioural disorders, who were all younger than 19 and older than 15, was interviewed one or more times in 1996-8 and asked to agree with their being interviewed again after 10 or more years.

Participants: 151 (65 male, 86 female) IDUs recruited in October 1996 - December 1998.

Measurement: Database linkage study compared unique identifiers (IDs) of the recruited subjects with the general register of deaths to determine the life status, and the causes of death of those deceased. Where necessary, we examined the death protocols directly.

Findings: Altogether, 8 deaths were registered between recruitment and 31st December 2008 (1,660 person-years). All the deceased were male, and all their deaths were "unnatural" - that is, caused by drug overdose or accident. This translates into the crude mortality rates for the whole cohort being 4.8 deaths per 1,000 person-years (PY), and into a specific mortality ratio in the males SMR=14.4 with the peak at the age of 15-20 (SMR=60.1), declining to SMR=8.2 at the age of 25-30. Except gender, we found no "predictors of death" in this high-risk cohort.

Conclusion: The overall mortality in the cohort was substantially higher than in the general population; in the male part of the cohort of young injecting drug users it was excessively high in the first three years after recruitment, and caused by external causes exclusively; the mortality in the female sub-cohort was zero, i.e. lower than in the general population of the same age range. Our findings suggest a need to develop targeted prevention of overdoses and other unnatural deaths in young male drug injectors.

Key words: survival analysis; injecting drug use; methamphetamine; heroin; drug abuse; Czech Republic

INTRODUCTION

The mortality of some illegal drugs users, and IDUs in particular, is known to be extremely high when compared with the general population - albeit differing from one group of drug users to another depending on factors such as sociodemography, the availability of specialised services, and others - in most of the "Western world".

A major review that summarised the results of studies on overall mortality of drug users performed in the European Union Member States in the period from the 1960s through to 2007 found a low level of mutual comparability both in terms of the methodologies used and the definitions of the target population (1); however, most of the overall mortality studies studied heroin injectors and almost all of them recruited exclusively "problem drug users" as defined by the European Monitoring Centre for Drug Addiction (EMCDDA), that is, long-term and regular and/ or injecting users of opioids and/or cocaine and/or amphetaminetype drugs (2). The "approximate, modal or typical results" were: crude mortality rate 1-2% annually, with injectors' modus at 3%; overdoses accounted for 20-60% of the overall mortality of drug users in the studies reviewed, and the proportion of 40% seemed to be an "average" figure for fatal overdoses as causes of death in the studies reviewed. Major differences in overall mortality were found between "high-HIV" and "low-HI V" EU countries; in Italy, Spain, Scotland and in some German studies, HIV-related deaths accounted for as much as approximately 40% of the mortality of drug users. The majority of the studies reviewed (1) reported standardised mortality ratios (SMR) to be between 10 and 15.

According to a recent review paper with a wider geographic scope than the previous one, the crude mortality rate (CMR) of opiate users is estimated to be 2.09 deaths per 100 person-years (PY) (95% CI; 1 . …

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