Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
Addict Behav. 2013 Oct;38(10):2619-23. doi: 10.1016/j.addbeh.2013.03.003. Epub 2013 Mar 21.
The present study investigates one-year incidence of mortality from suicide and other causes among heroin users in Taiwan.
A prospective national register-based cohort study.
All heroin users who attended the methadone maintenance treatment (MMT) programs in all treatment centers in Taiwan.
The sample comprised 10,842 heroin users attending MMT. Between Jan 2006 and Dec 2007, cases were identified through the multiple-center register system and followed until Dec 2008 for date and cause of death on the Taiwan national mortality database.
Standardized mortality ratios within one year of starting MMT were calculated as a ratio of actual versus expected numbers of deaths in the general population in Taiwan. Cox regression models were fitted to estimate the effects of gender, age, education and marital status as well as heroin related behaviors.
In total, 256 cases died, 67 through suicide. The mortality rate (per 100 person-years) in the first year of all-cause and suicide was 1.71 and 0.45 respectively, representing 7.5- and 18.4-fold age- and gender-standardized mortality ratio (SMR) compared to the general population. Besides, the mortality rate in the first year of overdoses, murder, HIV, somatic was 0.19, 0.02, 0.07, and 0.75 respectively, representing 68.4-, 27.7-, 76.8-, and 4.3-fold SMR increases to the general population. Older age and unemployment were independent risk factors for mortality. Females had higher standardized mortality ratio than males for suicide and all-cause mortality.
Results showed higher risk of suicide and other-cause mortality among heroin users in MMT than general population. Suicide is an important contributor to overall excess mortality among heroin users in MMT, and especially among women. Suicide prevention and physical health monitoring are important components of MMT programs.
本研究旨在调查台湾地区海洛因使用者一年内自杀和其他原因导致的死亡率。
一项前瞻性全国登记队列研究。
所有参加台湾地区所有治疗中心美沙酮维持治疗（MMT）项目的海洛因使用者。
该样本包括 10842 名参加 MMT 的海洛因使用者。2006 年 1 月至 2007 年 12 月期间，通过多中心登记系统确定病例，并在台湾国家死亡数据库中随访至 2008 年 12 月，以确定死亡日期和原因。
在开始 MMT 的一年内，标准化死亡率作为台湾地区一般人群实际死亡人数与预期死亡人数的比率来计算。Cox 回归模型用于估计性别、年龄、教育和婚姻状况以及与海洛因相关行为的影响。
共有 256 例死亡，67 例死于自杀。第一年全因和自杀的死亡率（每 100 人年）分别为 1.71 和 0.45，与一般人群相比，年龄和性别标准化死亡率分别为 7.5 倍和 18.4 倍。此外，第一年因过量用药、谋杀、艾滋病毒、躯体疾病导致的死亡率分别为 0.19、0.02、0.07 和 0.75，与一般人群相比，标准化死亡率分别增加 68.4 倍、27.7 倍、76.8 倍和 4.3 倍。年龄较大和失业是死亡的独立危险因素。女性自杀和全因死亡率的标准化死亡率高于男性。
研究结果表明，参加 MMT 的海洛因使用者的自杀和其他原因导致的死亡率高于一般人群。自杀是 MMT 项目中海洛因使用者总超额死亡率的一个重要原因，尤其是女性。自杀预防和身体健康监测是 MMT 项目的重要组成部分。
