Department of Drug Policy, Norwegian Institute of Public Health, Oslo, Norway.
Department of Substance Use, Norwegian Institute of Public Health, Oslo, Norway.
Addiction. 2018 Apr;113(4):729-739. doi: 10.1111/add.14053. Epub 2017 Nov 24.
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).
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.
Seven Norwegian cities.
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.
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.
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.
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.
在一组“难以接触”的多种物质使用者队列中检查死亡率风险及其与物质使用的可能关联。具体而言，我们根据个体物质使用指标估计全因死亡率风险，然后根据通过潜在类别分析 (LCA) 确定的复杂的“现实生活”模式来估计全因死亡率风险。
2013 年 9 月至 11 月期间在街头和低门槛服务机构招募的多种物质使用者中进行前瞻性队列研究，并通过国家死因登记处随访至 2015 年 10 月 31 日。
挪威七个城市。
共 884 名非法使用阿片类药物和/或兴奋剂的使用者。其中，357 名在纳入时正在接受阿片类药物替代治疗 (OST)。在随访期间，有 44 名参与者死亡。
主要结局：全因死亡率风险。未调整和调整后的 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、过量使用经验、OST 状态、注射年限、个体物质使用指标、城市、使用模式）。由于测量不变性，分别为接受和未接受 OST 的人估计 LCA 模型。
粗死亡率为每 100 人年 2.52 人。女性标准化死亡率比为 26.11 [95%置信区间 (CI) = 10.06-54.87]，男性为 10.71 (95% CI = 6.39-16.81)。没有单一的药物使用指标，如“海洛因注射”或“使用的药物数量”，与死亡率风险相关。然而，确实确定了有意义的使用模式；每种 OST 和非 OST 模式各有三个。非 OST 模式“多种物质注射者”[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)与死亡率风险显著相关，即使在调整了其他已知危险因素后也是如此。
在挪威的一项前瞻性队列研究中，“难以接触”的多种物质使用者的死亡率风险比一般人群高 10 倍以上。死亡率风险不是任何单一药物使用指标的函数，而是两种不同的物质、频率和给药途径的组合与死亡率风险相关。
