Factors associated with premature mortality among young injection drug users in Vancouver.
Factors associated with premature mortality among young injection drug users in Vancouver.
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DOI：
10.1186/1477-7517-4-1
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发表时间：
2007-01-04
影响因子：
4.4
通讯作者：
Wood E
中科院分区：
文献类型：
--
作者：
Miller CL;Kerr T;Strathdee SA;Li K;Wood E
年轻的注射吸毒者过早死亡的风险可能会增加，这是由于与注射吸毒有关的健康风险，包括过量和感染。然而，关于这一人群的死亡原因、死亡率和相关性的研究很少。我们进行了这项研究，以调查年轻注射吸毒者中30岁以前过早死亡的模式。自1996年以来，温哥华注射吸毒者研究（VIDUS）共招募了572名年轻（≤29岁）注射吸毒者。每半年，参与者完成了一个访谈管理的问卷，并进行了艾滋病毒和丙型肝炎（HCV）的血清学检测。通过与省验尸官办公室的联系，不断更新死亡率数据。粗死亡率和年龄别死亡率、标准化死亡率比和预期寿命指标采用人-时间法计算。采用考克斯回归分析确定死亡率的预测因子。在随访期间，22名参与者在30岁之前死亡，总体粗死亡率为1，368/100，000人年。总体而言，与加拿大同龄非注射吸毒人群相比，年轻注射吸毒者死亡的可能性高16.4倍（95%置信区间[CI]; 9.1-27.1）;年轻女性注射吸毒者死亡的可能性高54.1倍（95% CI; 29.6-90.8），年轻男性注射吸毒者死亡的可能性高12.9倍（95% CI; 5.5，25.3）。女性中观察到的主要死亡原因为：他杀（N = 9）;男性中为：自杀（N = 3）和药物过量（N = 3）。在考克斯回归分析中，与死亡率相关的因素是HIV感染（风险比[HR]：4.55; CI：1.92-10.80）和性工作（HR：2.76; CI：1.16-6.56）。在温哥华，使用注射毒品的年轻男性和女性的过早死亡率分别是加拿大普通人群的13倍和54倍。大多数妇女的死亡归因于他杀，这表明干预措施不仅应通过减少伤害服务进行，还应通过法律的和政策层面的结构性干预进行。
Young injection drug users (IDUs) may be at increased risk of premature mortality due to the health risks associated with injection drug use including overdoses and infections. However, there has been little research conducted on mortality causes, rates and associations among this population. We undertook this study to investigate patterns of premature mortality, prior to age 30 years, among young IDUs. Since 1996, 572 young (≤29 years) IDUs have been enrolled in the Vancouver Injection Drug Users Study (VIDUS). Semi-annually, participants have completed an interviewer-administered questionnaire and have undergone serologic testing for HIV and hepatitis C (HCV). Mortality data have been continually updated through linkages with the Provincial Coroner's Office. Crude and age-specific mortality rates, standardized mortality ratios, and life expectancy measures were calculated using person-time methods. Predictors of mortality were identified using Cox regression analyses. Twenty-two participants died prior to age 30 years during the follow-up period for an overall crude mortality rate of 1,368 per 100,000 person-years. Overall, young IDUs were 16.4 times (95% confidence interval [CI]; 9.1–27.1) more likely to die; young women IDUs were 54.1 times (95%CI; 29.6–90.8) and young men IDUs were 12.9 times (95%CI; 5.5, 25.3) more likely to die when compared to the Canadian non-IDU population of the same age. The leading observed cause of death among females was: homicide (N = 9); and among males: suicide (N = 3) and overdose (N = 3). In Cox regression analyses, factors associated with mortality were, HIV infection (Hazard Ratio [HR]: 4.55; CI: 1.92–10.80) and sex work (HR: 2.76; CI: 1.16–6.56). Premature mortality was 13 and 54 times higher among young men and women who use injection drugs in Vancouver than among the general population in Canada. The majority of deaths among the women were attributable to homicide, suggesting that interventions should occur not only through harm reduction services but also through structural interventions at the legal and policy level.