Division of Infectious Diseases, Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Wellness Wheel Medical Clinic & Indigenous Community Research Network, Regina, Saskatchewan, Canada.
JAMA Netw Open. 2024 Oct 1;7(10):e2437861. doi: 10.1001/jamanetworkopen.2024.37861.
In the US and Canada, women comprise approximately one-third of people who inject drugs (PWID); however, clinical characteristics and outcomes of injection drug use complications in women are poorly described.
To identify clinical characteristics and outcomes of infective endocarditis (IE) among women who inject drugs (WWID).
DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective cohort study of PWID with definite IE (per 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria) admitted from April 5, 2007, to March 15, 2018, at 5 tertiary-care hospitals in London, Ontario, and Regina, Saskatchewan, Canada. Data were analyzed from June 1, 2023, to August 2, 2024. Descriptive analyses were conducted for baseline characteristics at index hospitalization and stratified by sex.
The primary outcome was the difference in 5-year survival between female and male PWID with IE. The secondary outcome was 1-year survival. Multivariable time-dependent Cox proportional hazards regression analyses were conducted for variables of clinical importance to evaluate 5-year mortality.
Of 430 PWID with IE, 220 (51.2%) were women; of 332 non-PWID with IE, 101 (30.4%) were women. WWID with IE were younger than men (median [IQR] age, 31.5 [27.0-38.5] vs 38.5 [31.0-49.0] years), and 11 of 220 (5.0%) were pregnant at index hospitalization, although only 12 of 220 (5.5%) had contraceptive use documented. Women had a larger proportion of right-sided IE than men (158 of 220 women [71.8%] vs 113 of 210 men [53.8%]). WWID living in urban areas had higher mortality than WWID in rural areas (adjusted hazard ratio [aHR], 2.70; 95% CI, 1.15-6.34; P = .02). Overall mortality was lower among PWID referred for substance use disorder counseling in centers with inpatient services compared with centers with only outpatient referrals (aHR, 0.29; 95% CI, 0.17-0.51; P < .001). Overall mortality was lower with right-sided heart disease for both women (aHR, 0.44; 95% CI, 0.27-0.71; P < .001) and men (aHR, 0.22; 95% CI, 0.10-0.50; P < .001) and was higher with congestive heart failure for both women (aHR, 2.32; 95% CI, 1.29-4.18; P = .005) and men (aHR, 1.73; 95% CI, 1.07-2.79; P = .02).
In this cohort of PWID with IE, women were overrepresented. Reasons for women's disproportionately high IE incidence need further study. Inpatient substance use disorder services, contraception counseling, and enhanced social support for WWID living in urban areas need to be prioritized.
在美国和加拿大，女性约占注射毒品者（PWID）的三分之一；然而，女性注射毒品相关并发症的临床特征和结局描述甚少。
确定女性注射毒品者（WWID）中感染性心内膜炎（IE）的临床特征和结局。
设计、地点和参与者：这是一项回顾性队列研究，纳入了 2007 年 4 月 5 日至 2018 年 3 月 15 日期间在加拿大安大略省伦敦和萨斯喀彻温省里贾纳的 5 家三级保健医院因明确的 IE（根据 2023 年杜克-国际心血管感染性疾病学会标准）入院的 PWID。数据分析于 2023 年 6 月 1 日至 2024 年 8 月 2 日进行。对指数住院期间的基线特征进行描述性分析，并按性别进行分层。
主要结局是女性和男性 PWID 中 IE 的 5 年生存率差异。次要结局为 1 年生存率。对有临床重要意义的变量进行多变量时间依赖性 Cox 比例风险回归分析，以评估 5 年死亡率。
在 430 例 IE 的 PWID 中，220 例（51.2%）为女性；332 例非 PWID 的 IE 中，101 例（30.4%）为女性。IE 的 WWID 比男性更年轻（中位数[IQR]年龄，31.5[27.0-38.5]岁 vs 38.5[31.0-49.0]岁），11 例（5.0%）在指数住院时怀孕，尽管只有 12 例（5.5%）有避孕措施的记录。女性右心 IE 的比例高于男性（220 例女性中有 158 例[71.8%] vs 210 例男性中有 113 例[53.8%]）。居住在城市地区的 WWID 比居住在农村地区的 WWID 死亡率更高（调整后的危险比[aHR]，2.70；95%CI，1.15-6.34；P=0.02）。与仅门诊转诊的中心相比，有住院服务的物质使用障碍咨询中心转诊的 PWID 总体死亡率较低（aHR，0.29；95%CI，0.17-0.51；P<0.001）。对于女性（aHR，0.44；95%CI，0.27-0.71；P<0.001）和男性（aHR，0.22；95%CI，0.10-0.50；P<0.001），右心疾病的死亡率较低，对于女性（aHR，2.32；95%CI，1.29-4.18；P=0.005）和男性（aHR，1.73；95%CI，1.07-2.79；P=0.02），充血性心力衰竭的死亡率较高。
在这项 PWID 中 IE 的队列研究中，女性的比例过高。女性 IE 发病率不成比例的原因需要进一步研究。需要优先考虑为 WWID 提供门诊物质使用障碍服务、避孕咨询以及增强城市地区 WWID 的社会支持。
