Ribeiro Marcelo, Dunn John, Laranjeira Ronaldo, Sesso Ricardo
UNIAD, Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Addiction. 2004 Sep;99(9):1133-5. doi: 10.1111/j.1360-0443.2004.00804.x.
Follow-up studies show that smokers, alcoholics and heroin addicts have high mortality rates, but there is little information on crack users. We have investigated the mortality rate among this population, including its risk factors and causes of death.
A 5-year follow-up study.
A cohort of 131 crack-dependent patients, admitted to a public detoxification unit in São Paulo between 1992 and 1994.
Data collected from a structured personal interview and from a review of patients' hospital records, confirming the deaths from records held at the Municipal Offices.
Of the 124 (94.6%) patients located, 23 (18.5%) had died (a mortality ratio of 7.6). Homicide was the most common cause of death (n = 13). Observed mortality rate, adjusted for age and sex, was 24.92 per 1000, while the expected all-cause mortality rate in São Paulo, also adjusted for age and sex, was 3.28 per 1000, giving an excess mortality rate of 21.64 per 1000. Survival analysis showed that the probability of being alive 5 years post-treatment was 0.80 (95% CI = 0.77-0.84). Cox's proportional hazards regression showed three factors predicted mortality: history of intravenous drug use (hazard ratio 3.28, 95% CI 1.42-7.59), unemployment at index admission (hazard ratio 3.48, 95% CI 1.03-11.80) and premature discharge from index admission (hazard ratio 2.21, CI 0.94-5.18).
Community-based and tailored interventions should be considered to improve those patients' social support and permanence in treatment.
随访研究表明，吸烟者、酗酒者和海洛因成瘾者死亡率较高，但关于快克可卡因使用者的信息较少。我们调查了这一人群的死亡率，包括其风险因素和死亡原因。
一项为期5年的随访研究。
1992年至1994年间，131名依赖快克可卡因的患者队列被收治于圣保罗的一家公共戒毒所。
通过结构化的个人访谈以及查阅患者的医院记录收集数据，并根据市政办公室保存的记录确认死亡情况。
在找到的124名（94.6%）患者中，23名（18.5%）已经死亡（死亡率为7.6）。凶杀是最常见的死亡原因（n = 13）。经年龄和性别调整后的观察死亡率为每1000人中有24.92人死亡，而圣保罗经年龄和性别调整后的全因预期死亡率为每1000人中有3.28人死亡，超额死亡率为每1000人中有21.64人死亡。生存分析表明，治疗后5年存活的概率为0.80（95%可信区间 = 0.77 - 0.84）。考克斯比例风险回归分析显示，有三个因素可预测死亡率：静脉注射吸毒史（风险比3.28，95%可信区间1.42 - 7.59）、首次入院时失业（风险比3.48，95%可信区间1.03 - 11.80）以及首次入院后过早出院（风险比2.21，可信区间0.94 - 5.18）。
应考虑采取基于社区的针对性干预措施，以改善这些患者的社会支持并提高其治疗依从性。
