College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38163, USA; South American Program in HIV Prevention Research, UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
UCLA Center for Behavioral and Addiction Medicine, 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA, 90024, USA; National Institute on Drug Abuse, Office of Science Policy and Communications, Public Information and Liaison Branch, 6001 Executive Blvd., Room 5213, MSC 9561, Bethesda, MD, 20892, USA.
Drug Alcohol Depend. 2019 Feb 1;195:164-169. doi: 10.1016/j.drugalcdep.2018.06.036. Epub 2018 Nov 11.
To better characterize mortality among methamphetamine users, we estimated rates of all-cause mortality by HIV serostatus and smoking history in gay and bisexual men (GBM) treated for methamphetamine dependence, and explored associated clinical and socio-behavioral characteristics.
We searched public records to identify deaths among men screened between 1998-2000 for a trial of outpatient therapy for GBM with methamphetamine dependence. Crude mortality rates (CMRs) were calculated, and standardized mortality ratios (SMRs) estimated, comparing data with historical information from CDC WONDER. Associations of mortality with HIV infection, tobacco use, and other factors were explored using Kaplan-Meier survival analysis and Cox proportional hazards models.
Of 191 methamphetamine-dependent GBM (median age 35 years; majority Caucasian), 62.8% had HIV infection, and 31.4% smoked tobacco at baseline. During the 20-year follow-up period, 12.6% died. Relative to controls, methamphetamine-dependent GBM had a three-fold higher 20-year SMR: 3.39, 95% CI: 2.69-4.09. Especially high mortality was observed among participants reporting tobacco use (adjusted HR 3.48, 95% CI: 1.54-7.89), club drug use prior to starting methamphetamine (2.63, 1.15-6.00), or other clinical diagnoses at baseline (3.89, 1.15-13.22). At 20 years, the CMR for HIV infected participants (7.7 per 1000 PY) was 1.5 times that for men without HIV (5.2 per 1000 PY; p = 0.22) and there was a 5-fold difference in CMRs for HIV infected tobacco smokers (16.9 per 1000 PY) compared to non-smokers (3.4 per 1000 PY; p < 0.01).
In our sample of methamphetamine-dependent GBM, concomitant HIV infection and tobacco use were associated with dramatic increases in mortality.
为了更好地描述冰毒使用者的死亡率，我们估计了在接受治疗的男同性恋和双性恋者（GBM）中，按 HIV 血清状况和吸烟史划分的所有原因死亡率，并探讨了相关的临床和社会行为特征。
我们搜索了公共记录，以确定在 1998 年至 2000 年期间接受门诊治疗男性的筛查结果，这些男性患有 GBM 伴冰毒依赖。计算了粗死亡率（CMR），并使用来自 CDC WONDER 的历史信息进行了标准化死亡率比（SMR）的估计，以比较数据。使用 Kaplan-Meier 生存分析和 Cox 比例风险模型探索死亡率与 HIV 感染、烟草使用和其他因素的关联。
在 191 名患有冰毒依赖的 GBM 中（中位年龄 35 岁；大多数为白种人），62.8%的人 HIV 感染，31.4%的人在基线时吸烟。在 20 年的随访期间，12.6%的人死亡。与对照组相比，患有冰毒依赖的 GBM 有三倍的 20 年 SMR：3.39，95%CI：2.69-4.09。在报告使用烟草（调整后的 HR 3.48，95%CI：1.54-7.89）、在开始使用冰毒之前使用俱乐部药物（2.63，1.15-6.00）或其他临床诊断（3.89，1.15-13.22）的参与者中，死亡率特别高。20 年后，HIV 感染者（每 1000 人年 7.7 例）的 CMR 是未感染 HIV 者（每 1000 人年 5.2 例；p=0.22）的 1.5 倍，HIV 感染者中吸烟（每 1000 人年 16.9 例）与非吸烟者（每 1000 人年 3.4 例；p<0.01）相比，CMR 差异有 5 倍。
在我们的冰毒依赖的 GBM 样本中，同时感染 HIV 和吸烟与死亡率的显著增加有关。
