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Citation
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Stockings E, Tran LT, Santo T, Peacock A, Larney S, Santomauro D, Farrell M, Degenhardt L. Addiction 2019; ePub(ePub): ePub. |
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Affiliation
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National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, 2052, Australia. |
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Abstract
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BACKGROUND AND AIMS: Amphetamines are the second most commonly used class of illicit drugs. We aimed to produce pooled estimates of mortality risks among people with regular or dependent use of amphetamines, with a focus upon all-cause mortality as well as specific causes of death.
DESIGN: Systematic review and meta-analysis of cohorts of people with problematic use or dependence on amphetamines with data on all-cause or cause-specific mortality. SETTING AND PARTICIPANTS: Of 4,240 papers, 30 were eligible, reporting on 25 cohorts that measured all-cause mortality, drug poisoning, suicide, accidental injuries, homicide and cardiovascular mortality. Cohorts (n=35-74,139) were in North America, several Nordic countries, and Asia-Pacific. MEASUREMENT: Titles/abstracts were independently screened by one reviewer and excluded ones reviewed by a second. Full-text screening was by two reviewers with discrepancies resolved via a third reviewer. We extracted data on crude mortality rates (CMR) per 100-person-years (PY), standardised mortality ratios (SMRs). We imputed SMRs where possible if not reported by study authors. We also calculated mortality relative risks. Data were pooled using random-effects models; potential reasons for heterogeneity were explored using subgroup analyses and meta-regressions.
FINDINGS: Twenty-three cohorts contributed data for the pooled all-cause CMR: 1.11 per 100PY (95%CI 0.90-1.37). Pooled cause-specific mortality rates were: drug poisoning, 0.14 per 100PY (95%CI: 0.06-0.34); cardiovascular disease, 0.13 per 100PY (95%CI: 0.06-0.55); suicide, 0.20 per 100PY (95%CI: 0.07-0.55); accidental injury, 0.20 per 100PY (95%CI: 0.08-0.47) and homicide, 0.03 per 100PY (95%CI: 0.02-0.06). There was substantial heterogeneity for all pooled CMR estimates except homicide. The pooled all-cause SMR was 6.83 (95%CI: 5.27-8.84). Pooled cause-specific SMRS were: poisoning, 24.70 (95%CI: 16.67, 36.58); homicide, 11.90 (95%CI: 7.82-18.12); suicide, 12.20 (95%CI: 4.89-30.47); cardiovascular disease, 5.12 (95%CI: 3.74-7.00) and accidental injury, 5.12 (95%CI: 2.88-9.08).
CONCLUSIONS: People with regular or dependent amphetamine use are at elevated risk of a range of causes of mortality compared with people without regular or dependent amphetamine use.
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Language: en |