Abstract
BackgroundMortality in high-risk groups such as people who use illicit drugs is often expressed in relative terms such as standardised ratios. These measures are highest for diseases that are rare in the general population, such as hepatitis C, and may understate the importance of common long-term conditions. Population6683 people in community-based treatment for heroin dependence between 2006 and 2017 in London, England, linked to national hospital and mortality databases with 55,683 years of follow-up. MethodAge- and sex-specific mortality and hospital admission rates in the general population of London were used to calculate the number of expected events. We compared standardised ratios (relative risk) to excess deaths and admissions (absolute risk) across ICD-10 chapters and subcategories. ResultsDrug-related diseases had the highest relative risks, with a standardised mortality ratio (SMR) of 48 (95% CI 42–54) and standardised admission ratio (SAR) of 293 (95% CI 282–304). By contrast, other diseases had an SMR of 4.4 (95% CI 4.0–4.9) and an SAR of 3.15 (95% CI 3.11–3.19). However, the majority of the 621 excess deaths (95% CI 569–676) were not drug-related (361; 58%). The largest groups were liver disease (75 excess deaths) and COPD (45). Similarly, 80% (11,790) of the 14,668 excess admissions (95% CI 14,382–14,957) were not drug-related. The largest groups were skin infections (1073 excess admissions), alcohol (1060), COPD (812) and head injury (612). ConclusionsAlthough relative risks of drug-related diseases are very high, most excess morbidity and mortality in this cohort was caused by common long-term conditions.
Highlights
People who use illicit opioids such as heroin have high rates of mortality and morbidity, with an age-standardised mortality risk of between four and 15 times the general population (Degenhardt et al, 2011)
There are fewer studies of morbidity in this population, with most focusing on blood f borne viral infections and mental health problems (Aldridge et al, 2018). o drug overdose is often found to be the largest single cause of death among ro people who are dependent on illicit drugs, it usually accounts for less than half of deaths overall p (Degenhardt et al, 2011a; Gao et al, 2019; Pierce et al, 2015)
We reported drug use according to standard National Drug Treatment and Monitoring System (NDTMS, Public Health England and Department of Health, 2017) forms collected by the service provider
Summary
People who use illicit opioids such as heroin have high rates of mortality and morbidity, with an age-standardised mortality risk of between four and 15 times the general population (Degenhardt et al, 2011). Available data suggests - cardiovascular disease, respiratory disease, and liver disease cause many deaths among re people who use drugs, and account for an increasing proportion as age increases (Degenhardt et al, 2014; Merrall et al, 2013; Pierce et al, 2015). Treatment and harm Jo reduction initiatives to improve health among people who use drugs have focused on these areas
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