@article{ref1,
title="Mortality among persons who inject drugs: a prospective cohort followed over three decades in Baltimore, Maryland, USA",
journal="Addiction",
year="2021",
author="Sun, Jing and Mehta, Shruti H. and Astemborski, Jacquie and Piggott, Damani A. and Genberg, Becky L. and Woodson-Adu, Tanita and Benson, Eve-Marie and Thomas, David L. and Celentano, David D. and Vlahov, David and Kirk, Gregory D.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND AND AIMS: Over the past decades, people who inject drugs (PWID) have been impacted by the development of combination antiretroviral therapy (cART) to combat HIV/AIDS, the prescription opioid crisis, and increased use of lethal synthetic opioids. We measured how these dynamics have impacted mortality among PWID in an urban U.S. city. <br><br>DESIGN: Prospective cohort study using data from the AIDS Linked to the Intravenous Experience (ALIVE) SETTING: Baltimore, Maryland, USA from 1988-2018. PARTICIPANTS: 5,506 adult PWIDs (median age at baseline 37 years). MEASUREMENTS: Mortality was identified by linkage to National Death Index-Plus (NDI-Plus) and categorized into HIV/infectious disease (HIV/ID) deaths, overdose and violence-related (drug-related) deaths, and chronic-disease deaths. Person-time at risk accrued from baseline, and ended at the earliest of death or study period. All-cause and cause-specific mortality were calculated annually. Fine and Gray method was used to estimate the sub-distribution hazards of cause-specific deaths accounting for competing risks. <br><br>FINDINGS: Among 5,506 participants with 84,011 person-years of follow-up, 43.9% were deceased by 2018. Among all deaths, 30.5% were HIV/ID-deaths, 24.4% drug-related deaths, and 33.3% chronic-disease deaths. Age-standardized all-cause mortality increased from 23 to 45 per 1000-person-years from 1988-1996, declined from 1996 through 2012, then trended upward through 2018. HIV/ID-deaths peaked in 1996 coincident with the availability of cART, then continuously declined. Chronic-disease deaths increased continuously as the cohort aged. Drug-related deaths declined until 2011, but increased over 4-fold by 2018. HIV/HCV infection and active injecting were independently associated with HIV/ID and drug-related deaths. Female and Black participants had higher risk of dying from HIV/ID deaths and a lower risk of dying from drug-related deaths than male and non-Black participants. <br><br>CONCLUSIONS: Deaths in Baltimore, Maryland, USA attributable to HIV/ID appear to have declined following the widespread use of combination antiretroviral therapy. Increases in the rates of drug-related deaths in Baltimore were observed prior to and continue in conjunction with national mortality rates associated with the opiate crisis.<p /> <p>Language: en</p>",
language="en",
issn="0965-2140",
doi="10.1111/add.15659",
url="http://dx.doi.org/10.1111/add.15659"
}