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Are overdoses treated by ambulance services an opportunity for additional interventions? A prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature278646
Source
Addiction. 2015 Nov;110(11):1767-74
Publication Type
Article
Date
Nov-2015
Author
Linn Gjersing
Anne Line Bretteville-Jensen
Source
Addiction. 2015 Nov;110(11):1767-74
Date
Nov-2015
Language
English
Publication Type
Article
Keywords
Adult
Ambulances
Cohort Studies
Drug Overdose - mortality - therapy
Emergency medical services
Female
Heroin Dependence - mortality - therapy
Humans
Longitudinal Studies
Male
Norway
Opiate Substitution Treatment
Proportional Hazards Models
Prospective Studies
Registries
Substance Abuse, Intravenous - mortality - therapy
Abstract
To assess whether people who inject drugs (PWID) and who are treated for overdose by ambulance services have a greater mortality risk compared with other PWID, and to compare mortality risk within potentially critical time-periods (1?week, 1?month, 3?months, 6?months, 1?year, 5?years) after an overdose attendance with the mortality risk within potentially non-critical time-periods (time before and/or after critical periods).
A prospective cohort study.
Oslo, Norway.
A total of 172 PWID street-recruited in 1997 and followed-up until the end of 2004.
Interview data linked to data from ambulance records, Norwegian Correctional Services, Opioid Substitution Treatment records and National Cause of Death Registry. Separate Cox regression models (one for each critical time-period) were estimated.
Ambulance services treated 54% of the participants for an overdose during follow-up. The mortality rate was 2.8 per 100 person-years for those with an overdose and 3.3 for those without; the adjusted hazard ratio (HR) was 1.3 (95% CI?=?0.6, 2.6, P?=?0.482). Mortality risk was greater in all but the shortest critical time-period following ambulance attendance than in the non-critical periods. The mortality risk remained significantly elevated during critical periods, even when adjusted for total time spent in prison and substitution treatment. The HR ranged from 9.4 (95% CI?=?3.5, 25.4) in the month after an overdose to 13.9 (95% CI?=?6.4, 30.2) in the 5-year period.
Mortality risk among people who inject drugs is significantly greater in time-periods after an overdose attendance than outside these time-periods.
Notes
Comment In: Addiction. 2015 Nov;110(11):1775-626471158
PubMed ID
26118947 View in PubMed
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Differences in mortality rates and causes of death between HIV positive and HIV negative intravenous drug users.

https://arctichealth.org/en/permalink/ahliterature8093
Source
Int J Epidemiol. 1993 Apr;22(2):315-20
Publication Type
Article
Date
Apr-1993
Author
A. Eskild
P. Magnus
S O Samuelsen
C. Sohlberg
P. Kittelsen
Author Affiliation
Department of Epidemiology, National Institute of Public Health, Oslo, Norway.
Source
Int J Epidemiol. 1993 Apr;22(2):315-20
Date
Apr-1993
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cause of Death
Comparative Study
Female
Follow-Up Studies
HIV Seropositivity - mortality
Humans
Male
Middle Aged
Norway - epidemiology
Substance Abuse, Intravenous - mortality
Abstract
In order to study differences in mortality and causes of death between HIV positive and HIV negative intravenous drug users (IVDU), 1009 (180 HIV positive and 829 HIV negative) IVDU in Oslo, Norway, were followed from their first HIV test for a mean period of 36 months (range 1-67 months). Eighty-seven (55 HIV negatives and 32 HIV positives) died during the follow-up period. The risk of death for IVDU was 31 times higher than for the general population. The estimated probability of survival after 3 years of follow-up was 0.92 for the whole cohort, 0.93 for the HIV negative group and 0.87 for the HIV positive group (P 30 years of age and > 5 years of IV drug use prior to study entry were all significantly associated with a fatal outcome. Eleven per cent (n = 20) of the HIV positives and 4% (n = 38) of the HIV negatives died from drug overdose, which accounted for 68% of all deaths; 2.2% of the HIV positives and 0.4% (n = 4) of the total cohort died from AIDS. Drug overdose represented the major threat to life among IVDU in this study. Because of the dynamics of the HIV epidemic, AIDS may have an increasing impact on mortality. However, in order to forecast the number of AIDS cases among IVDU the high non-AIDS mortality must be controlled for.
PubMed ID
8505190 View in PubMed
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Does homosexual activity shorten life?

https://arctichealth.org/en/permalink/ahliterature7621
Source
Psychol Rep. 1998 Dec;83(3 Pt 1):847-66
Publication Type
Article
Date
Dec-1998
Author
P. Cameron
K. Cameron
W L Playfair
Author Affiliation
Family Research Institute, Colorado Springs, CO 80962, USA.
Source
Psychol Rep. 1998 Dec;83(3 Pt 1):847-66
Date
Dec-1998
Language
English
Publication Type
Article
Keywords
Acquired Immunodeficiency Syndrome - mortality
Adult
Aged
Cause of Death
Comparative Study
Cross-Cultural Comparison
District of Columbia - epidemiology
Homosexuality, Male - statistics & numerical data
Humans
Longevity
Male
Middle Aged
Substance Abuse, Intravenous - mortality
Abstract
Previous estimates from obituaries and pre-1994 sex surveys suggested that the median age of death for homosexuals is less than 50 yr. Four contemporary databases were used to test that estimate: (1) obituaries in the homosexual press from 1993 through 1997 reflected treatment success for those with AIDS but suggested a median age of death less than 50 years; (2) two large random sexuality surveys in 1994--one in the USA and the other in Britain--yielded results consistent with a median age of death for homosexuals of less than 50 years; (3) the median age of those ever married in Denmark, Sweden, and Norway was about 50 years, while that of the ever homosexually partnered was about 40 yr; further, the married were about 5 times more apt to be old and 4 times less apt to be widowed young; and (4) intravenous drug abusers and homosexuals taking HIV tests in Colorado had almost identical age distributions. The four lines of evidence were consistent with previous findings suggesting that homosexual activity may be associated with a lifespan shortened by 20 to 30 years.
PubMed ID
9923159 View in PubMed
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Source
Ugeskr Laeger. 1993 Jul 19;155(29):2239-40
Publication Type
Article
Date
Jul-19-1993
Author
P P Ege
Source
Ugeskr Laeger. 1993 Jul 19;155(29):2239-40
Date
Jul-19-1993
Language
Danish
Publication Type
Article
Keywords
Adult
Denmark - epidemiology
Humans
Opioid-Related Disorders - mortality
Substance Abuse Detection
Substance Abuse, Intravenous - mortality
Substance-Related Disorders - mortality
Notes
Comment In: Ugeskr Laeger. 1994 Feb 21;156(8):1154-58116098
PubMed ID
8328089 View in PubMed
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[Fatal poisonings among drug addicts in Denmark in 2002]

https://arctichealth.org/en/permalink/ahliterature9209
Source
Ugeskr Laeger. 2005 May 2;167(18):1954-7
Publication Type
Article
Date
May-2-2005

Mortality among HIV-infected intravenous drug addicts in Stockholm in relation to methadone treatment.

https://arctichealth.org/en/permalink/ahliterature7889
Source
Addiction. 1995 May;90(5):711-6
Publication Type
Article
Date
May-1995
Author
A. Fugelstad
J. Rajs
M. Böttiger
M. Gerhardsson de Verdier
Author Affiliation
Psychiatric Dependency Clinic, St Göran's Hospital, Stockholm, Sweden.
Source
Addiction. 1995 May;90(5):711-6
Date
May-1995
Language
English
Publication Type
Article
Keywords
Adult
Cause of Death
Comparative Study
Cross-Cultural Comparison
Female
HIV Infections - mortality
Humans
Male
Methadone - therapeutic use
Middle Aged
Overdose - mortality
Patient Discharge - statistics & numerical data
Risk factors
Substance Abuse, Intravenous - mortality - rehabilitation
Sweden - epidemiology
Violence - statistics & numerical data
Abstract
The aim of the study was to estimate the mortality rate and evaluate the causes of death in all diagnosed HIV-positive IDUs in the Stockholm area, 1986-90, and to compare the risk of death of those who received methadone treatment with that of those never admitted to or discharged from the programme. Data were collected from the Swedish National Bacteriological Laboratory, the Methadone Maintenance Programme (MMTP) and the Department of Forensic Medicine, as well as from hospitals in the Stockholm region. In Sweden 90% of all IDUs are HIV-tested. Most deceased IDUs are examined forensically. This examination always includes HIV-testing. During the observation period, 472 HIV-infected IDUs were reported from the Stockholm area. Of these addicts 135 participated in the methadone maintenance programme for a shorter or longer time during the study period. Most of them had received the HIV-diagnosis more than 1 year before first entering the programme. Sixty-nine subjects died during the observation period. A majority, 52 persons, died from violence or poisoning. Seventeen died from somatic complications of drug abuse. Nine of them were diagnosed as suffering from AIDS. Eight of the deceased had participated in the MMTP. The relative risk of death from external violence and poisoning was 0.25 (95% confidence interval 0.1-1.0) when participants in the MMTP were compared with HIV-infected IDUs never attending the programme. When all causes of death are compared the relative risk was 0.8. Those patients discharged from the programme have a higher mortality rate than those who never participated.(ABSTRACT TRUNCATED AT 250 WORDS)
PubMed ID
7795507 View in PubMed
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Mortality among patients with cleared hepatitis C virus infection compared to the general population: a Danish nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature132692
Source
PLoS One. 2011;6(7):e22476
Publication Type
Article
Date
2011
Author
Lars Haukali Omland
Peer Brehm Christensen
Henrik Krarup
Peter Jepsen
Nina Weis
Henrik Toft Sørensen
Niels Obel
Author Affiliation
Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. omland@dadlnet.dk
Source
PLoS One. 2011;6(7):e22476
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Alcoholism - mortality
Cause of Death
Cohort Studies
Comorbidity
Denmark - epidemiology
Female
Hepacivirus - physiology
Hepatitis C - mortality - virology
Humans
Incidence
Kaplan-Meier Estimate
Male
Middle Aged
Substance Abuse, Intravenous - mortality
Abstract
The increased mortality in HCV-infected individuals partly stems from viral damage to the liver and partly from risk-taking behaviours. We examined mortality in patients who cleared their HCV-infection, comparing it to that of the general population. We also addressed the question whether prognosis differed according to age, substance abuse (alcohol abuse and injection drug use) and comorbidity.
Patients with cleared HCV-infection were categorized into one of 8 groups according to age (20-39 years or 40-69 years) and patient characteristics (no substance abuse/no comorbidity; substance abuse/no comorbidity; no substance abuse/comorbidity; and substance abuse/comorbidity). For each patient, 4 age- and gender-matched individuals without substance abuse or comorbidity were selected from the general population, comprising a total of 8 comparison cohorts. We analyzed 10-year survival and used stratified Cox Regression analysis to compute mortality rate ratios (MRRs), comparing mortality between the 8 patient groups and the comparison cohorts, adjusting for personal income. Among patients without substance abuse or comorbidity, those aged 40-69 years had the same mortality as the comparison cohort (10-year survival: 95% (95% confidence interval [CI]: 93%-97%), MRR: 1.3 (95% CI: 0.8-2.3)), whereas those aged 20-39 years had higher mortality than the comparison cohort (10-year survival: 93% versus 99%, MRR: 5.7 (95% CI: 2.3-14.0). For both age categories, substance abuse and comorbidity decreased survival and increased MRRs. Patients aged 40-69 years with substance abuse and comorbidity suffered from substantial mortality (MRR: 12.5 (95% CI: 5.1-30.6)).
Mortality in patients aged 40-69 years with cleared HCV-infection is comparable to individuals without HCV, provided they have no substance abuse or comorbidity. Any substance abuse and/or comorbidity not captured in the registries used for our study could explain the increased mortality in patients aged 20-39 years without documented substance abuse or comorbidity.
Notes
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PubMed ID
21789259 View in PubMed
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Mortality and causes and manner of death among drug addicts in Stockholm during the period 1981-1992.

https://arctichealth.org/en/permalink/ahliterature7713
Source
Acta Psychiatr Scand. 1997 Sep;96(3):169-75
Publication Type
Article
Date
Sep-1997
Author
A. Fugelstad
A. Annell
J. Rajs
G. Agren
Author Affiliation
Psychiatric Clinic for Alcohol and Drug Dependence, Karolinska Institute, St Görans Hospital, Stockholm, Sweden.
Source
Acta Psychiatr Scand. 1997 Sep;96(3):169-75
Date
Sep-1997
Language
English
Publication Type
Article
Keywords
Adult
Amphetamines
Cause of Death
Cohort Studies
Cross-Sectional Studies
Female
HIV Infections - mortality - rehabilitation
Heroin Dependence - mortality - rehabilitation
Humans
Incidence
Male
Methadone - therapeutic use
Psychotropic Drugs
Street Drugs
Substance Abuse, Intravenous - mortality - rehabilitation
Substance-Related Disorders - mortality - rehabilitation
Sweden - epidemiology
Urban Population - statistics & numerical data
Abstract
A cohort of 1640 hospitalized drug addicts was studied over an 8-year period, and consisted of 678 heroin users, 578 amphetamine users and 384 users of other drugs. In total, 234 addicts were HIV-positive, most of them heroin users. During the observation period, 214 deaths occurred in the cohort. The total mortality was 2.2% annually. Death linked to injection of heroin was the main cause of death not only among heroin users but also among subjects classified as users of amphetamines or other drugs. During the observation period, a total of 222 addicts (115 of whom were HIV-positive) entered the methadone programme. No deaths occurred among the HIV-negative subjects who were participating in the methadone programme. A total of 15 HIV-positive subjects died while taking part in the programme--13 of these subjects from natural causes (mostly HIV/AIDS).
PubMed ID
9296546 View in PubMed
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[Mortality and causes of death among intravenous drug addicts in Oslo]

https://arctichealth.org/en/permalink/ahliterature8086
Source
Tidsskr Nor Laegeforen. 1993 Apr 30;113(11):1331-3
Publication Type
Article
Date
Apr-30-1993
Author
A. Eskild
P. Magnus
S O Samuelsen
C. Sohlberg
P. Kittelsen
Author Affiliation
Seksjon for epidemiologi, Statens Institutt for Folkehelse, Oslo.
Source
Tidsskr Nor Laegeforen. 1993 Apr 30;113(11):1331-3
Date
Apr-30-1993
Language
Norwegian
Publication Type
Article
Keywords
Acquired Immunodeficiency Syndrome - mortality - transmission
Adolescent
Adult
Cause of Death
English Abstract
Female
Follow-Up Studies
HIV Seropositivity - mortality
Humans
Male
Norway - epidemiology
Overdose
Substance Abuse, Intravenous - mortality
Abstract
In order to study mortality and causes of death among intravenous drug users in Oslo, 1,009 (829 HIV negative and 180 HIV positive) intravenous drug users were followed from their first HIV test for a mean period of 36 months (range 1-67 months). 87 (55 HIV negatives and 32 HIV positives) died during the follow-up period. Compared with the general population with the same age and sex distribution, the relative risk of death for the intravenous drug users was 31. 4% of the HIV negatives (38/829) and 11% of the HIV positives (20/180) died from drug overdose during the follow-up period. 2% of the HIV positives and 0.4% of the total cohort (4/1,009) died from AIDS. Drug overdose represented the major threat to life among intravenous drug users in this study. Due to the dynamic of the HIV epidemic, AIDS may gain an increasing impact on mortality. However, in order to forecast the number of AIDS cases among intravenous drug users, it is necessary to control for the high non-AIDS related mortality.
PubMed ID
8337619 View in PubMed
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Mortality and causes of death among people who inject amphetamine: A long-term follow-up cohort study from a needle exchange program in Sweden.

https://arctichealth.org/en/permalink/ahliterature295132
Source
Drug Alcohol Depend. 2018 07 01; 188:274-280
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
07-01-2018
Author
Ada Åhman
Anna Jerkeman
Marianne Alanko Blomé
Per Björkman
Anders Håkansson
Author Affiliation
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden, Malmö Addiction Center, Södra Förstadsgatan 35, plan 4, 205 02 Malmö, Sweden. Electronic address: ada.ahman@med.lu.se.
Source
Drug Alcohol Depend. 2018 07 01; 188:274-280
Date
07-01-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Aged
Aged, 80 and over
Amphetamine - adverse effects
Case-Control Studies
Cause of Death
Cohort Studies
Female
Humans
Male
Middle Aged
Needle-Exchange Programs - statistics & numerical data
Retrospective Studies
Substance Abuse, Intravenous - mortality
Sweden - epidemiology
Young Adult
Abstract
Abuse of amphetamines is a worldwide problem with around 34 million users, and amphetamine is commonly used by people who inject drugs (PWID). Despite this, there is relatively little research on mortality and cause of death among people who use amphetamines primarily. The present study aimed to examine mortality and causes of death among people who inject amphetamine, and compare these results to the general population.
This retrospective cohort study was based on data from The Malmö Needle Exchange Program in Sweden (MNEP) and on data from The Swedish National Cause of Death Register. Participants in the MNEP, between 1987 and 2011, with registered national identity number and amphetamine as their primary drug of injection use, were included in the study. Standardized mortality ratios (SMR) was calculated for overall mortality and categories of causes of death.
2019 individuals were included (mean follow-up-time 13.7 years [range 0.02-24.2 years], a total of 27,698 person-years). Of the 448 deceased, 428 had a registered cause of death. The most common causes of death were external causes (n?=?162, 38%), followed by diseases of the circulatory system (n?=?67, 16%). SMR were significantly elevated (8.3, 95% CI [7.5-9.1]) for the entire study population, and for every category of causes of death respectively.
People injecting amphetamine as a primary drug were found to have significantly elevated mortality compared with the general population, with high rates of both external and somatic causes of death.
PubMed ID
29803034 View in PubMed
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14 records – page 1 of 2.