Abstract
BackgroundYoung injection drug users (IDUs) may be at increased risk of premature mortality due to the health risks associated with injection drug use including overdoses and infections. However, there has been little research conducted on mortality causes, rates and associations among this population. We undertook this study to investigate patterns of premature mortality, prior to age 30 years, among young IDUs.MethodsSince 1996, 572 young (â¤29 years) IDUs have been enrolled in the Vancouver Injection Drug Users Study (VIDUS). Semi-annually, participants have completed an interviewer-administered questionnaire and have undergone serologic testing for HIV and hepatitis C (HCV). Mortality data have been continually updated through linkages with the Provincial Coroner's Office. Crude and age-specific mortality rates, standardized mortality ratios, and life expectancy measures were calculated using person-time methods. Predictors of mortality were identified using Cox regression analyses.FindingsTwenty-two participants died prior to age 30 years during the follow-up period for an overall crude mortality rate of 1,368 per 100,000 person-years. Overall, young IDUs were 16.4 times (95% confidence interval [CI]; 9.1â27.1) more likely to die; young women IDUs were 54.1 times (95%CI; 29.6â90.8) and young men IDUs were 12.9 times (95%CI; 5.5, 25.3) more likely to die when compared to the Canadian non-IDU population of the same age. The leading observed cause of death among females was: homicide (N = 9); and among males: suicide (N = 3) and overdose (N = 3). In Cox regression analyses, factors associated with mortality were, HIV infection (Hazard Ratio [HR]: 4.55; CI: 1.92â10.80) and sex work (HR: 2.76; CI: 1.16â6.56).InterpretationPremature mortality was 13 and 54 times higher among young men and women who use injection drugs in Vancouver than among the general population in Canada. The majority of deaths among the women were attributable to homicide, suggesting that interventions should occur not only through harm reduction services but also through structural interventions at the legal and policy level.
Highlights
Young injection drug users (IDUs) may be at increased risk of premature mortality due to the health risks associated with injection drug use including overdoses and infections
Among IDUs in Edinburgh, Scotland deaths due to overdose and suicide were higher among younger IDUs than among older IDUs, with higher proportions of young males than females dying by suicide [7]
The Downtown Eastside is Vancouver's poorest neighborhood where an estimated 4,700 IDUs and 1,000 street youth reside in an area of approximately ten city blocks, and where inexpensive housing in the form of hotels and single room occupancies (SROs) are abundant
Summary
Young injection drug users (IDUs) may be at increased risk of premature mortality due to the health risks associated with injection drug use including overdoses and infections. We undertook this study to investigate patterns of premature mortality, prior to age 30 years, among young IDUs. Premature mortality among injection drug users (IDUs) is higher than in the general population with rates of mortality estimated to range between 0.8â3.26/100 personyears [1,2]. In a study of new onset injection drug users, mortality rates varied by calendar year, were elevated in comparison to the general population and were estimated to be 3.3 per 100-preson years [2]. In the study of street youth in Montreal, Quebec, overdose deaths and suicide represented the leading causes of premature mortality [4]
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