Trends in mortality among problem drug users

Figure 16

Overall mortality among problem drug users in several EU cities or countries

item Rome | item Barcelona | item Vienna | item Amsterdam | item Denmark | item Lisbon | item Hamburg | item Dublin

NB:

Standardised mortality rates, men and women. Mortality from all causes in cohorts of opiate users recruited in treatment centres.

There are some differences in typology of recruitment settings (treatment centres) and treatment modalities across sites, although treatment setting and modalities tend to represent the common types of treatment available in each site and therefore the cohorts will tend to be representative of the treatment using population per site.

The EMCDDA multi-site study included also a Swedish cohort (see characteristics of participants in Statistical Table 26 and Bargagli et al., 2002). Presentation of further results from this cohort has been postponed to allow for Swedish review of the cohort and additional data analysis.

For more detailed information see Statistical Table 26: Mortality cohorts participating in EMCDDA multisite project – characteristics of participants and results.

Sources: EMCDDA projects CT.99.EP.07 and CT.00.EP.13, ‘Mortality of drug users in the EU’, coordinated by Department of Epidemiology, Rome E Health Authority.

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The multisite study coordinated by the EMCDDA (34) shows differences in overall mortality rates and distribution of causes of death between participating sites. The study also reveals relevant changes over time in overall and cause-specific mortality (35).

Barcelona presented the highest mortality rates and Vienna and Dublin the lowest. In several locations, mortality rates have decreased since the early or mid-1990s. In Barcelona, rates were particularly high between 1992 and 1996 but have decreased sharply in recent years, mainly because of a decrease in deaths due to AIDS. In Lisbon, mortality rates were increasing until recently (Figure 16).

Direct comparisons across sites should be made with caution, as there are differences in the typology of treatment centres where cohorts are recruited, although they would tend to represent the common types of treatment available. However, age- and gender-standardised mortality rates among drug users can provide a useful measure of the impact of problem drug use on mortality in different countries.

Analysis of the standardised mortality ratios (SMRs) (36) from cohorts enrolled within the multisite study showed that in Barcelona the risk of death among male and female problem drug users was, respectively, 24 and 64 times higher than in individuals of the same age and gender in the general Spanish population. In Lisbon, Hamburg and Rome the risk of death among female problem drug users was 30- to 40-fold higher than in the general population. The high SMRs among female problem drug users can be explained, to some extent, by the low baseline mortality among young women in the general population.


(34) EMCDDA projects CT.99.EP and CT.00.EP.13, Mortality of drug users in the EU, coordinated by the Department of Epidemiology, Rome E Health Authority.

(35) See Statistical Table 26: Mortality cohorts participating in EMCDDA multisite project – characteristics of participants and results.

(36)  SMR estimates the mortality excess (number of times) of problem drug users compared with people of the same age and gender in the general population.