Center for Surgical Medical and Acute Care Research at the Birmingham VA Medical Center, Birmingham, AL, USA.
J Gen Intern Med. 2012 Jul;27(7):808-16. doi: 10.1007/s11606-011-1975-3. Epub 2012 Jan 25.
For adults in general population community settings, data regarding long-term course and outcomes of illicit drug use are sparse, limiting the formulation of evidence-based recommendations for drug use screening of adults in primary care.
To describe trajectories of three illicit drugs (cocaine, opioids, amphetamines) among adults in community settings, and to assess their relation to all-cause mortality.
Longitudinal cohort, 1987/88-2005/06.
Community-based recruitment from four cities (Birmingham, Chicago, Oakland, Minneapolis).
Healthy adults, balanced for race (black and white) and gender were assessed for drug use from 1987/88-2005/06, and for mortality through 12/31/2008 (n = 4301)
Use of cocaine, amphetamines, and opioids (last 30 days) was queried in the following years: 1987/88, 1990/91, 1992/93, 1995/96, 2000/01, 2005/06. Survey-based assessment of demographics and psychosocial characteristics. Mortality over 18 years.
Trajectory analysis identified four groups: Nonusers (n = 3691, 85.8%), Early Occasional Users (n = 340, 7.9%), Persistent Occasional Users (n = 160, 3.7%), and Early Frequent/Later Occasional Users (n = 110, 2.6%). Trajectories conformed to expected patterns regarding demographics, other substance use, family background and education. Adjusting for demographics, baseline health status, health behaviors (alcohol, tobacco), and psychosocial characteristics, Early Frequent/Later Occasional Users had greater all-cause mortality (Hazard Ratio, HR = 4.94, 95% CI = 1.58-15.51, p = 0.006).
Study is restricted to three common drugs, and trajectory analyses represent statistical approximations rather than identifiable "types". Causal inferences are tentative.
Four trajectories describe illicit drug use from young adulthood to middle age. Two trajectories, representing over one third of adult users, continued use into middle age. These persons were more likely to continue harmful risk behaviors such as smoking, and more likely to die.
对于普通人群社区环境中的成年人，关于非法药物使用的长期过程和结果的数据很少，这限制了为初级保健中的成年人制定药物使用筛查的循证建议。
描述成年人在社区环境中三种非法药物（可卡因、阿片类药物、苯丙胺）的轨迹，并评估它们与全因死亡率的关系。
纵向队列，1987/88-2005/06。
从四个城市（伯明翰、芝加哥、奥克兰、明尼阿波利斯）进行社区招募。
健康成年人，按种族（黑人和白人）和性别均衡，从 1987/88 年至 2005/06 年评估药物使用情况，并通过 12/31/2008 年评估死亡率（n=4301）
在以下年份询问可卡因、苯丙胺和阿片类药物（过去 30 天）的使用情况：1987/88 年、1990/91 年、1992/93 年、1995/96 年、2000/01 年、2005/06 年。基于调查的人口统计学和心理社会特征评估。18 年以上的死亡率。
轨迹分析确定了四个群体：非使用者（n=3691，85.8%）、早期偶用者（n=340，7.9%）、持续偶用者（n=160，3.7%）和早期频繁/后期偶用者（n=110，2.6%）。轨迹符合关于人口统计学、其他物质使用、家庭背景和教育的预期模式。调整人口统计学、基线健康状况、健康行为（酒精、烟草）和心理社会特征后，早期频繁/后期偶用者的全因死亡率更高（风险比，HR=4.94，95%置信区间=1.58-15.51，p=0.006）。
该研究仅限于三种常见药物，轨迹分析代表统计近似值，而不是可识别的“类型”。因果推论是暂定的。
四种轨迹描述了从青年到中年的非法药物使用情况。两种轨迹，代表了三分之一以上的成年使用者，将使用持续到中年。这些人更有可能继续吸烟等有害风险行为，并且更有可能死亡。
