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 2. Comparison of risk of dying from all causes and from drug overdose among people injecting opioids and those injecting stimulants
| Study | Users of opioids |
Users of stimulants |
All-cause CMR ratio |
Overdose CMR ratio |
Opioid use definition | Stimulant use definition | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PY | All-cause deaths (No.) | All-cause CMRa | Deaths from OD (No.) | OD CMRa | PY | All-cause deaths (No.) | All-cause CMRa | Deaths from OD (No.) | OD CMRa | Ratiob | 95% CI | Ratiob | 95% CI | ||||||
| Fugelstad et al. (1997) |
3022.7 | 133 | 4.40 | 72 | 1.67 | 3938 | 39 | 0.99 | 15 | 0.38 | 4.44 | 3.12–6.33 | 4.39 | 3.46–5.53 | Hospital records – at least once had a diagnosis of heroin dependence –opioid user | Hospital records – if had no heroin dependence diagnosis and at least once had a diagnosis of ATS dependence | |||
| Lejckova et al. (2007) |
13 323.9 | 114 | 0.86 | 36 | 0.27 | 9748.4 | 48 | 0.49 | 8 | 0.08 | 1.74 | 1.24–2.44 | 3.29 | 2.35–4.61 | ICD-10 code F11 opioid dependence | ICD-10 code F15 – stimulant dependence | |||
| O’Driscoll et al. (2001) |
2984.9 | 40 | 1.34 | 19 | 0.64 | 544.6 | 14 | 2.57 | 7 | 1.29 | 0.52 | 0.29–0.95 | 0.50 | 0.20–1.24 | Primary drug – heroin | Primary drug – cocaine or speed | |||
| van Haastrecht et al. (1996) |
268 | 9 | 3.36 | – | – | 326 | 15 | 4.60 | – | – | 0.73 | 0.33–1.64 | – | – | Main drug injected – heroin | Main drug injected – cocaine or ATS | |||
| Vlahov et al. (2005) |
2047 | 85 | 4.15 | 16 | 0.78 | 3727 | 175 | 4.70 | 20 | 0.54 | 0.88 | 0.69–1.14 | 1.44 | 1.12–1.86 | Heroin | Any cocaine or crack | |||
| Pooled estimate | – | – | – | – | – | – | – | – | – | – | 1.25c | 0.60–2.61 | 1.85d | 0.75–4.56 | – | – | |||
CI, confidence interval; CMR, crude mortality rate; ICD-10, International Classification of Diseases; OD, overdose; PY, person–years; S, stimulant.
a Deaths per 100 PY of follow-up.
b Represents the CMR ratio for people injecting opioids (numerator) versus people injecting stimulants (denominator).
c Meta-analysis of all-cause CMR ratio: Test of estimate = 1; P = 0.553; heterogeneity (χ2) = 67.99; P < 0.0005; I2 = 94.1%.
d Meta-analysis of overdose CMR ratio: Test of estimate = 1: P = 0.18; heterogeneity (χ2) = 20.10; P < 0.0005; I2 = 85.1%.
Note: Values reported in papers appear in plain text; italicized values were derived from other available data.