Mortality among people who inject drugs: a systematic review and meta-analysis
Bradley M Mathers, Louisa Degenhardt, Chiara Bucello, James Lemon, Lucas Wiessing & Mathew Hickman
Volume 91, Number 2, February 2013, 102-123
Table 1. Studies included in this systematic review of studies on mortality among people who inject drugs
| Study | Country | Country income | Sampling frame | n | People who inject drugs (%) | Males (%) | Drug(s) used | Recruitment period | End of follow-up period | PYs of follow-up | CMR | 95% CI | SMR | 95% CI |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Antolini et al. (2006) |
Italy | High | DTS | 4644 | 100 | 79.1 | O, S | 1975–1999 | 1999 | 39 667 | 2.01 | 1.80–2.16 | 13.01 | 12.11–13.91 |
| Azim et al. (2008) |
Bangladesh | Low | DTS | 552 | 100 | 100 | O | 2002–2004 | 2007 | 901.6 | 6.32 | 4.68–7.96 | – | – |
| Azim et al. (2009) |
Bangladesh | Low | DTS | 675 | 100 | 100 | O | 2005–2007 | 2007 | 1191.7 | 3.52 | 2.46–4.59 | – | – |
| Bargagli et al. (2001) |
Italy | High | DTS | 11 432 | 84 | 82.2 | O | 1980–1995 | 1997 | 80 787 | 2.15 | 2.05–2.25 | 17.3 | 16.5–18.2 |
| Bauer et al. (2008) |
Austria | High | DTS | 114 | 99a | 58.8 | O | 1998–1999 | 2004 | 534.8 | 5.42 | 3.45–7.40 | 29.13 | 19.27–44.04 |
| Brancato et al. (1995) |
Italy | High | DTS | 138 | 100 | 76.8 | O | 1985 | 1994 | 1272 | 2.04 | 1.26–2.83 | – | – |
| Cardoso et al. (2006) |
Brazil | Middle | NSP | 478 | 100 | 78.7 | S | 2000–2001 | 2001 | 612 | 2.77 | 1.45–4.09 | – | – |
| Ciccolallo et al. (2000) |
Italy | High | DTS | 4260 | 100 | 78.0 | – | 1975–1995 | 1995 | 28 424 | 2.26 | 2.08–2.43 | 30.7 | 17.3–44.0 |
| Clausen et al. (2008) |
Norway | High | DTS | 3789 | 90–95 | 68.1 | O | 1997–2003 | 2003 | 10 934 | 1.95 | 1.7–2.23 | – | – |
| Cornish et al. (2010) |
United Kingdom | High | HC | 5577 | ≥ 70b | 69 | O | 1990–2005 | 2005 | 17 731.5 | 1.00 | 0.86–1.15 | – | – |
| Copeland et al. (2004) |
United Kingdom | High | DTS | 660 | 100 | 67.4 | – | 1980–2001 | 2001 | 6244 | 2.45 | 2.06–2.84 | 17.45 | 14.59–20.3 |
| Davoli et al. (2007) |
Italy | High | DTS | 10 454 | 72 | 80 | O | 1998–2001 | 2001 | 13 538.2 | 0.74 | 0.59–0.88 | – | – |
| Degenhardt et al. (2009) |
Australia | High | DTS | 42 676 | ≥ 70b | – | O | 1985–2006 | 2006 | 425 998 | 0.89 | 0.86–0.92 | 6.4 | 6.2–6.6 |
| DiGiusto et al. (2004) |
Australia | High | DTS | 1244 | ≥ 70b | 65.0 | O | 1998 | 2002 | 394 | 1.27 | 0.4–2.29 | – | – |
| Eskild et al. (1993) |
Norway | High | T&C | 1009 | 100 | 64.0 | O, S | 1985–1991 | 1991 | 3136.4 | 2.77 | 2.22–3.42 | 31 | 24.6–37.4 |
| Esteban et al. (2003) |
Spain | High | DTS | 1487 | 85 | – | O | 1990–1997 | 1997 | 4352 | 3.68 | 3.11–4.25 | – | – |
| EMCDDA (2011) |
Bulgaria | Middle | DTS | 652 | > 80 | 81.6 | O | 1999 | 2008 | 6011 | 1.18 | 0.91–1.46 | – | – |
| EMCDDA (2011) |
Croatia | Middle | DTS | 3059 | > 73 | 78.0 | O | 2000–2006 | 2007 | 15 968 | 1.09 | 0.93–1.25 | 10.3 | 8.9–12 |
| EMCDDA (2011) |
Latvia | Middle | DTS | 3644 | > 98 | 80.0 | O | 2000–2009 | 2009 | 21 294 | 1.60 | 1.43–1.77 | 9.0 | 8.0–10.0 |
| EMCDDA (2011) |
Romania | Middle | DTS | 2707 | > 94 | 30.8 | O | 2001–2006 | 2010 | 20 188 | 0.57 | 0.47–0.68 | 6.5 | 5.4–7.7 |
| EMCDDA (2011) |
Sweden | High | DTS | 678 | > 72 | – | O | 1981–1988 | 2007 | 10 307 | 3.33 | 2.98–3.68 | 27.6 | 24.9–30.7 |
| Evans (2012) |
USA | High | OR | 644 | 100 | 68.3 | O, S | 1997–2007 | 2007 | 4167 | 0.91 | 0.62–1.20 | ||
| Ferri et al. (2007) |
Italy | High | DTS | 10 376 | 72 | 85.6 | O | 1998–2001 | 2001 | 15 369 | – | – | 7.77 | 6.7–8.95 |
| Fingerhood et al. (2006) |
USA | High | DTS | 175 | 100 | O, S | 1994–1998 | 5 yearsc | 742.5 | 7.14 | 5.22–9.06 | – | – | |
| Frischer et al. (1997) |
United Kingdom | High | DTS | 459 | 100 | 99.4 | O | 1982–1993 | 1994 | 2547 | 2.08 | 1.52–2.64 | 22 | 16.5–28.8 |
| Fugelstad et al. (1995) |
Sweden | High | DTS, other | 472 | 100 | – | O, S | 1986–1990 | 1990 | 1793 | 3.85 | 2.94–4.76 | – | – |
| Fugelstad et al. (1997) |
Sweden | High | DTS | 1640 | ≥ 70a | 69.2 | O, S | 1981–1988 | 1992 | 10 772 | 1.99 | 1.72–2.25 | – | – |
| Fugelstad et al. (1998) |
Sweden | High | DTS | 101 | 100 | 55.4 | O | 1986–1988 | 1993 | 515.3 | 7.76 | 5.54–10.58 | – | – |
| Galli & Musicco (1994) |
Italy | High | DTS | 2432 | 100 | 78.3 | O | 1980–1998 | 1991 | 16 415 | 2.52 | 2.28–2.77 | 20.5 | 20.02–24.34 |
| Goedert et al. (1995) |
Italy | High | DTS | 4962 | 99d | – | O | 1980–1990 | 1990 | 21 130 | 1.57 | 1.41–1.75 | – | – |
| Goedert et al. (2001) |
USA | High | DTS | 6570 | 100 | 66.0 | – | 1987–1991 | 1998 | 28 900.2 | 4.67 | 4.42–4.92 | – | – |
| Golz et al. (2001) |
Germany | High | DTS | 178 | 100 | 58.0 | – | 1996–2000 | 2000 | 805 | 4.22 | 2.80–5.64 | – | – |
| Haarr & Nessa (2007) |
Norway | High | DTS | 146 | 100 | 70.0 | O | 1997–2006 | 2006 | 574 | 1.92 | 0.95–3.44 | – | – |
| Hickman et al. (2003) |
United Kingdom | High | DTS | 881 | 76 | 74.5 | O | 1997–1999 | 2001 | 2075 | 1.59 | 1.13–2.23 | – | – |
| Jafari et al. (2010) |
Islamic Republic of Iran | Middle | DTS | 66 | 100 | – | O | – | – | 196 | 4.08 | 1.25–6.91 | – | – |
| Jarrin et al. (2007) |
Spain | High | PR | 6575 | 100 | 77.2 | – | 1987–1996 | 2004 | 73 901 | 2.02 | 1.92–2.12 | – | – |
| Lejckova et al. (2007) |
Czech Republic | High | DTS | 12 207 | 80 | 67.5 | O, S | 1997–2002 | 2002 | 38 131.2 | 0.84 | 0.75–0.93 | 8.15 | 7.28–9.09 |
| Liu et al. (2011) |
China | Middle | DTS | 860 | 95.2 | 96.1 | O | 2005–2011 | 2011 | 2192.9 | 6.85 | 5.79–7.98 | ||
| Lumbreras et al. (2006) |
Spain | High | DTS, other | 3247 | 100 | 77.4 | – | 1990–1996 | 2002 | 26 826 | 2.18 | 2.00–2.36 | – | – |
| Manfredi et al. (2006) |
Italy | High | DTS | 1214 | 100 | 75.5 | O | 1977–1996 | 2002 | 13 280.3 | 2.04 | 1.8–2.3 | – | – |
| McAnulty et al. (1995) |
USA | High | OR, HC | 1769 | 100 | 73.3 | – | 1989–1991 | 1992 | 3149 | 1.05 | 0.69–1.41 | 8.3 | 5.71–11.66 |
| Mezzelani et al. (1998) |
Italy | High | DTS | 6248 | 100 | – | – | 1991 | 1991 | 6158.5 | 2.91 | 2.48–3.33 | 14.28 | 12.28–16.56 |
| Miller et al. (2007) |
Canada | High | SIF | 572 | 100 | 53.1 | O, S | 1966–2004 | 2004 | 1608 | 1.37 | 0.80–1.94 | 16.4 | 9.1–27.1 |
| Moroni et al. (1991) |
Italy | High | DTS | 2279 | 100 | – | O | 1981–1988 | 1989 | 13 069 | 2.43 | 2.16–2.69 | – | – |
| Moskalewicz et al. (1996) |
Poland | Middle | DTS | 656 | 100 | 74.2 | O | 1983–1992 | 1992 | 3594 | 2.28 | 1.81–2.83 | 12.06 | 9.6–15.0 |
| Muga et al. (2007) |
Spain | High | DTS | 1181 | 100 | 79.5 | O | 1987–2004 | 2004 | 10 116 | 3.74 | 3.38–4.14 | – | – |
| Nyhlén (2011) |
Sweden | High | DTS | 561 | 79 | 68 | O, S | 1970–1978 | 2006 | 15 203.1 | 1.30 | 1.12–1.48 | 5.94 | 5.5–6.8 |
| O’Driscoll et al. (2001) |
USA | High | DTS, other | 2849 | 100 | 63.9 | O, S | 1994–1997 | 1997 | 4591 | 1.59 | 1.22–1.96 | – | – |
| Oppenheimer et al. (1994) |
United Kingdom | High | DTS | 128 | 100 | 72.7 | O | 1969 | 1991 | 2349.7 | 1.83 | 1.28–2.38 | 11.9 | 8.64–16.09 |
| Quan et al. (2007) |
Thailand | Middle | DTS | 346 | 100 | 93.1 | O, S | 1999 | 2002 | 571.4 | 3.85 | 2.42–5.83 | 13.9 | 8.71–21.04 |
| Quan et al. (2010) |
Viet Nam | Middle | DTS | 894 | 100 | 100 | O | 2005 | 2007 | 710.1 | 6.30 | 4.60–8.50 | 13.4 | 11.4–15.3 |
| Rahimi-Movaghar et al. (2009) |
Islamic Republic of Iran | Middle | DTS | 79 | 100 | – | O | 2007 | 2007 | 20.7 | 4.83 | 0–14.30 | – | – |
| Reece (2010) |
Australia | High | DTS | 2773 | 100 | 72.8 | O | 2000–2007 | 2007 | 9362.4 | 0.50 | 0.36–0.65 | – | – |
| Sánchez-Carbonell et al. (2000) |
Spain | High | DTS | 135 | 88 | 71.0 | O | 1985 | 1995 | 1205.9 | 3.4 | 2.36–4.44 | 28.58 | 14.65–42.65 |
| Seaman et al. (1998) |
United Kingdom | High | DTS | 316 | 100 | 100 | O | 1983–1994 | 1994 | 1416.9 | 2.33 | 1.6–3.27 | – | – |
| Solomon et al. (2009) |
India | Middle | DTS, other | 1158 | 100 | 100 | O | 2005–2006 | 2008 | 1998 | 4.25 | 3.35–5.16 | 11.1 | 8.85–13.7 |
| Sørensen et al. (2005) |
Denmark | High | DTS | 101 | 100 | 67.3 | O | 1980–1984 | 1999 | 1232.3 | 3.49 | 2.44–4.53 | 15.75 | 11.4–21.2 |
| Stenbacka et al. (2007) |
Sweden | High | Multiple | 817 | 83 | 79.2 | O, S | 1967 | 2003 | 22 468.2 | 2.12 | 1.93–2.31 | 4.38 | 3.99–4.78 |
| Stoov et al. (2008) |
Australia | High | OR, SB | 220 | 100 | 56.4 | O, S | 1990–1995 | 2006 | 3151 | 0.83 | 0.56–1.21 | – | – |
| Tait et al. (2008) |
Australia | High | DTS | 894 | ≥ 70b | 59.6 | O | 2001–2001 | 2005 | 4166.9 | 0.54 | 0.28–0.72 | – | – |
| van Haastrecht et al. (1996) |
Netherlands | High | DTS, other | 509 | 100 | 61.9 | O, S | 1985–1992 | 1993 | 2229 | 3.23 | 2.56–4.07 | 24.8 | 19.41–31.23 |
| Vlahov et al. (2005) |
USA | High | OR, SB | 3593 | 100 | 77.3 | O, S | 1988 | 2005 | 25 736 | 4.50 | 4.24–4.76 | – | – |
| Vlahov et al. (2008) |
USA | High | OR, SB | 2089 | 100 | 62.3 | O, S | 1997–1999 | 2002 | 8629.3 | 0.71 | 0.54–0.88 | – | – |
| Zabranksy et al. (2011) |
Czech Republic | High | OR | 151 | 100 | 43 | O, S | 1996–1998 | 2008 | 1659.7 | 0.48 | 0.15–0.81 | 14.4 | 9.31–19.49 |
| Zaccarelli et al. (1994) |
Italy | High | DTS | 2029 | 100 | 75.5 | – | 1985–1991 | 1991 | 7872.2 | 2.30 | 1.96–2.63 | 31.92 | 27.44–36.93 |
| Zhang et al. (2005) |
China | Middle | DTS | 376 | 100 | 82.8 | O | 2002 | 2003 | 382.4 | 7.73 | 4.87–10.6 | 47.62 | 31.63–68.71 |
CI, confidence interval, CMR, crude mortality rate; DTS, drug treatment service; HC, health clinic; NSP, needle and syringe programme; O, opioids; OR, outreach; PR, HIV prevention service; PY, person–years; S, stimulants; SB, snowballing; SIF, supervised injecting facility; SMR, standardized mortality ratio; T&C, HIV testing and counselling; USA, United States of America.
a Not explicitly stated, but implied in the paper.
b The proportion of subjects who injected drugs was not reported but was assumed to be at least 70% because of the predominance of injecting as a route of administration among opioid-dependent people in this country.
c Subjects were followed for 5 years after the date of enrolment.
d Data on history of drug use was available for 62% of the subjects, and of these, 99% had a history of injecting drugs.
Note: Some CMRs and PYs of follow-up were calculated (formulae available from the corresponding author).