Miller Cari L, Kerr Thomas, Strathdee Steffanie A, Li Kathy, Wood Evan
British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, Vancouver, Canada.
Harm Reduct J. 2007 Jan 4;4:1. doi: 10.1186/1477-7517-4-1.
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 (< or = 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.
年轻的注射吸毒者（IDU）由于与注射吸毒相关的健康风险，包括过量用药和感染，可能面临更高的过早死亡风险。然而，针对这一人群的死亡原因、死亡率及相关因素的研究较少。我们开展这项研究以调查30岁之前年轻注射吸毒者的过早死亡模式。
自1996年以来，572名年龄小于或等于29岁的注射吸毒者被纳入温哥华注射吸毒者研究（VIDUS）。参与者每半年完成一份由访谈员进行的问卷调查，并接受艾滋病毒和丙型肝炎（HCV）血清学检测。通过与省级验尸官办公室的联系，不断更新死亡数据。使用人时方法计算粗死亡率和年龄别死亡率、标准化死亡率比值及预期寿命指标。使用Cox回归分析确定死亡的预测因素。
在随访期间，22名参与者在30岁之前死亡，总粗死亡率为每100,000人年1368例。总体而言，年轻注射吸毒者死亡的可能性是常人的16.4倍（95%置信区间[CI]；9.1 - 27.1）；与加拿大同年龄非注射吸毒人群相比，年轻女性注射吸毒者死亡的可能性是54.1倍（95%CI；29.6 - 90.8），年轻男性注射吸毒者死亡的可能性是12.9倍（95%CI；5.5，25.3）。观察到的女性主要死亡原因是：凶杀（N = 9）；男性主要死亡原因是：自杀（N = 3）和过量用药（N = 3）。在Cox回归分析中，与死亡率相关的因素是艾滋病毒感染（风险比[HR]：4.55；CI：1.92 - 10.80）和性工作（HR：2.76；CI：1.16 - 6.56）。
温哥华年轻的注射吸毒男性和女性过早死亡率分别比加拿大普通人群高13倍和54倍。女性中的大多数死亡归因于凶杀，这表明干预措施不仅应通过减少伤害服务进行，还应通过法律和政策层面的结构性干预来实施。
