Changing patterns in causes of death in a cohort of injecting drug users, 1980-2001
Changing patterns in causes of death in a cohort of injecting drug users, 1980-2001
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DOI：
10.1001/archinte.164.11.1214
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发表时间：
2004-06-14
影响因子：
--
通讯作者：
Elton, RA
中科院分区：
文献类型：
--
作者：
Copeland, L;Budd, J;Elton, RA
背景：吸毒者的高死亡率已得到广泛承认。本研究调查，在一个大的家庭实践的10000例患者在苏格兰爱丁堡，是否有一个变化的原因，死亡率随着时间的推移。方法：对1980 ~ 2001年期间已知有注射毒品史的667例患者进行队列研究。方法：对死亡证明和临床记录进行详细分析，并记录与人口学特征、药物使用和死亡原因有关的数据。年平均死亡率为2.3%。死亡率在1990年代早期至中期达到高峰，反映了晚期人类免疫缺陷病毒（艾滋病毒）从1982-1984年早期流行病发展而来，以及抗病毒化疗的效果开始显现。药物死亡和自杀在两种性别中是相同的，但往往发生在年轻的受试者。早年的主要死因是吸毒过量，晚年是艾滋病毒/艾滋病。接近研究期结束时，丙型肝炎成为死因之一。结论：注射吸毒者死亡的风险非常高。非无菌注射引起的传染病是最明显的可预防的死亡原因。在分析与毒品有关的死亡时，仅仅使用死亡证明信息是不准确的，而且大大低估了艾滋病毒流行病的全面影响。这项研究提供了一些迄今为止最令人信服的证据，证明最广泛意义上的危害最小化在降低药物相关死亡率方面有效。
Background: High mortality among drug users has been widely recognized. This study investigates, in a large family practice of 10000 patients in Edinburgh, Scotland, whether there has been a change in causes of mortality over time. Patients known to have ever injected drugs were recruited into a cohort study from 1980 until 2001.Methods: Death certificates and clinical notes were scrutinized and data relating to demographic features, drug use, and causes of death were recorded.Results: Of 667 patients, there were 153 deaths at follow-up (110 men and 43 women). Average annual mortality rate was 2.3%. Death rate peaked in the early to mid-1990s, reflecting the development of advanced human immunodeficiency virus (HIV) from the early epidemic in 1982-1984 and the onset of the effect of antiviral chemotherapy. Drug deaths and suicide were the same in both sexes but tended to occur in younger subjects. Principal cause of death was overdose in the early years and HIV/AIDS in later years. Toward the close of the study period, hepatitis C emerged as a cause of death.Conclusions: Injecting drug users have a very high risk of mortality. Infectious diseases from nonsterile injecting are the most obvious preventable cause of death. Use of death certificate information alone is inaccurate in analyzing drug-related deaths and greatly underestimates the full impact of the HIV epidemic. This study provides some of the most convincing evidence so far that harm minimization, in its broadest sense, is effective in reducing drug-related mortality.