Patterns of substance use and mortality risk in a cohort of 'hard-to-reach' polysubstance users
Patterns of substance use and mortality risk in a cohort of 'hard-to-reach' polysubstance users
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DOI：
10.1111/add.14053
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发表时间：
2018-04-01
期刊：
影响因子：
6
通讯作者：
Bretteville-Jensen, Anne Line
中科院分区：
文献类型：
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作者：
Gjersing, Linn;Bretteville-Jensen, Anne Line
目的 检查一组“难以接触”的多物质使用者的死亡风险及其与物质使用的假定关联。具体来说，我们根据个体物质使用指标，然后根据潜在类别分析（LCA）确定的复杂的“现实生活”模式来估计全因死亡风险。设计对 2013 年 9 月至 11 月期间街头和低门槛服务招募的多物质使用者进行前瞻性队列研究，并通过国家死因登记处进行跟踪，直至 2015 年 10 月 31 日。设定了七个挪威城市。参与者 共有 884 名非法阿片类药物和/或兴奋剂使用者。其中，357 人在纳入时正在接受阿片类药物替代治疗 (OST)。四十四名参与者在随访期间死亡。测量 主要结果：全因死亡风险。未经调整和调整的 Cox 比例风险 (PH) 回归模型（协变量：男性、年龄、无家可归/庇护所使用、用药过量经历、OST 状态、注射年数、个人物质使用指标、城市、使用模式）。由于测量不变性，LCA 模型分别估计了 OST 中和非 OST 中的模型。结果 粗死亡率为每 100 人年 2.52 人。女性标准化死亡率为 26.11 [95% 置信区间 (CI) = 10.06-54.87]，男性标准化死亡率为 10.71 (95% CI = 6.39-16.81)。没有任何单一的药物使用指标，例如“注射海洛因”或“使用的药物数量”与死亡风险相关。然而，有意义的使用模式已被确定；各三个 OST 和非 OST 模式。非 OST 模式“多物质注射者”[风险比 (HR) = 3.45，95% CI = 0.98-12.14] 和“低频率注射者”（HR = 3.17，CI = 1.05-9.56）与死亡风险显着相关，即使针对其他已知风险因素进行调整后也是如此。结论 在挪威的一项前瞻性队列研究中，“难以接触”的多物质使用者的死亡风险比一般人群高出 10 倍以上。死亡风险不是任何单一药物使用指标的函数，而是物质、给药频率和途径的两种不同组合与死亡风险相关。
Aims To examine the mortality risk in a cohort of 'hard-to-reach' polysubstance users and its putative associations with substance use. Specifically, we estimated all-cause mortality risk as a function of individual substance use indicators, and then as a function of their complex, 'real-life' patterns as identified through latent class analysis (LCA). Design Prospective cohort study among street-and low-threshold service-recruited polysubstance users included between September and November 2013 and followed through the National Cause of Death Registry until 31 October 2015. Setting Seven Norwegian cities. Participants A total of 884 users of illegal opioids and/or stimulants. Of these, 357 were in opioid substitution treatment (OST) at the time of inclusion. Forty-four participants died during follow-up. Measurements Primary outcome: all-cause mortality risk. Unadjusted and adjusted Cox proportional hazard (PH) regression models (covariates: male, age, homelessness/shelter use, overdose experience, OST status, years of injecting, individual substance use indicators, city, use patterns). LCA models estimated separately for those in and those not in OST due to measurement invariance. Findings The crude mortality rate was 2.52 per 100 person-years. Standardized mortality ratio was 26.11 [95% confidence interval (CI) = 10.06-54.87] for women and 10.71 (95% CI = 6.39-16.81) for men. No single drug use indicator, such as 'heroin injection' or 'number of drugs used', was associated with the mortality risk. However, meaningful use patterns were identified; three OST and non-OST patterns each. The non-OST patterns 'polysubstance injectors' [hazard ratio (HR) = 3.45, 95% CI = 0.98-12.14] and 'low frequent injectors' (HR = 3.17, CI = 1.05-9.56) were associated significantly with the mortality risk even when adjusted for other known risk factors. Conclusions In a Norwegian prospective cohort study, 'hard-to-reach' polysubstance users had a more than 10 times higher mortality risk than the general population. Mortality risk was not a function of any single drug use indicator, but two distinct combinations of substances, frequencies and routes of administration were associated with the mortality risk.