Mortality among people who inject drugs: a systematic review and meta-analysis

• Published in: Bulletin of the World Health Organization Vol. 91; no. 2; pp. 102 - 123
• Main Authors: MATHERS, Bradley M, DEGENHARDT, Louisa, BUCELLO, Chiara, LEMON, James, WIESSING, Lucas, HICKMAN, Mathew
• Format: Journal Article
• Language: English; Portuguese
• Published: Genève Organisation mondiale de la santé 01.02.2013; World Health Organization; The World Health Organization
• Subjects: Acquired immune deficiency syndrome; AIDS; Amphetamines; Biological and medical sciences; Cause of Death; Causes of death; Cocaine; Cohort analysis; Databases, Bibliographic; Death; Diseases; Drug abuse; Drug overdose; Drug Overdose - mortality; Drug use; Drugs; Epidemiology; Female; General aspects; Grey literature; Health; Health Policy & Services; HIV; HIV Seropositivity - mortality; HIV Seropositivity - transmission; Human immunodeficiency virus; Humans; Immune system; Infections; Low income groups; Male; Males; Medical sciences; Miscellaneous; Mortality; Narcotics; On-line systems; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk; Searching; Sex Distribution; Strings; Studies; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - mortality; Systematic review; Systematic Reviews; Theme Issue; Drug; Mortality; Tropical medicine; Systematic review; Epidemiology; Public health; Metaanalysis; WHO
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.12.108282

To systematically review cohort studies of mortality among people who inject drugs, examine mortality rates and causes of death in this group, and identify participant- and study-level variables associated with a higher risk of death. Tailored search strings were used to search EMBASE, Medline and PsycINFO. The grey literature was identified through online grey literature databases. Experts were consulted to obtain additional studies and data. Random effects meta-analyses were performed to estimate pooled crude mortality rates (CMRs) and standardized mortality ratios (SMRs). Sixty-seven cohorts of people who inject drugs were identified, 14 of them from low- and middle-income countries. The pooled CMR was 2.35 deaths per 100 person-years (95% confidence interval, CI: 2.12-2.58). SMRs were reported for 32 cohorts; the pooled SMR was 14.68 (95% CI: 13.01-16.35). Comparison of CMRs and the calculation of CMR ratios revealed mortality to be higher in low- and middle-income country cohorts, males and people who injected drugs that were positive for human immunodeficiency virus (HIV). It was also higher during off-treatment periods. Drug overdose and acquired immunodeficiency syndrome (AIDS) were the primary causes of death across cohorts. Compared with the general population, people who inject drugs have an elevated risk of death, although mortality rates vary across different settings. Any comprehensive approach to improving health outcomes in this group must include efforts to reduce HIV infection as well as other causes of death, particularly drug overdose.