Citation

Lewer D, Tweed EJ, Aldridge RW, Morley KI. Drug Alcohol Depend. 2019; 204: 107525.

Affiliation

National Addictions Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Camberwell, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK; RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, UK.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.drugalcdep.2019.06.027

PMID

31581023

Abstract

BACKGROUND: Mortality 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. POPULATION: 6683 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.

METHOD: Age- 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.

RESULTS: Drug-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).

CONCLUSIONS: Although relative risks of drug-related diseases are very high, most excess morbidity and mortality in this cohort was caused by common long-term conditions.

Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.

Language: en

Keywords

Crack cocaine; Epidemiology; Heroin; Public health; Substance-related disorders