Elsevier

Drug and Alcohol Dependence

Volume 96, Issue 3, 1 August 2008, Pages 281-285
Drug and Alcohol Dependence

Short communication
Mortality among injecting drug users in Melbourne: A 16-year follow-up of the Victorian Injecting Cohort Study (VICS)

https://doi.org/10.1016/j.drugalcdep.2008.03.006Get rights and content

Abstract

Multiple factors affect injecting drug-related mortality, many of which will vary over time and between jurisdictions. There are relatively few studies of mortality among injecting drug users (IDU) in Australia. We aimed to provide data comparable to those reported internationally on the rate of mortality among IDU in Australia. We retrospectively examined mortality among participants (N = 220) from the first Australian cohort study of IDU by linking coded personal identifier records with a national death register. The overall mortality rate among those followed-up was 0.83 per 100 PY (95% CI, 0.56–1.21 per 100 PY). This rate is lower than those reported internationally but comparable to the limited Australian data from other cohorts of IDU. Mortality was higher among males, most common among those aged in their early thirties and drug-related mortality occurred typically after substantial injecting careers. Extensive experience of incarceration (≥3 times) was associated with increased risk of mortality. These results suggest that rates of mortality among Australian IDU may be lower than those reported internationally, with low HIV prevalence and Australia's long-held harm reduction framework potentially contributing to this result. Further studies using defined cohorts followed over time are needed to examine long-term outcomes among IDU in Australia.

Introduction

Injecting drug users (IDU) are at considerably greater risk of morbidity and mortality than their non-injecting peers (Warner-Smith et al., 2001). Characteristics such as gender and age (Hickman et al., 2003), psychosocial factors such as unemployment and imprisonment (Brugal et al., 2005), dose and frequency of injection (van Ameijden et al., 1999), medical complications from injecting drugs (Warner-Smith et al., 2001), and healthcare and drug treatment utilisation (Langendam et al., 2001) are important factors determining mortality risk among IDU. Risk may also be affected by structural and environmental characteristics related to drug policy environments (Burris et al., 2004, Kerr et al., 2007).

Few studies of mortality among IDU cohorts have been conducted in Australia, with most research focused on coronial data. While these studies are important, they cannot determine IDU mortality rates as the size of the population at risk is unknown. Given the complexity of the factors described above and variations in the characteristics of IDU and drug using environments internationally, we would expect to see differences in rates of mortality between jurisdictions. Indeed, substantial variations in mortality rates have been reported between countries and over time (EMCDDA, 1999). For this reason it is important to understand IDU mortality in Australia, where harm minimisation is the overarching drug policy (Ritter et al., 2004).

We retrospectively examined mortality within the Victorian Injecting Drug Users Cohort Study (VICS) of Australian IDU recruited in the early 1990s. Our aim was to provide IDU mortality data comparable to those reported internationally and examine characteristics associated with mortality in an Australian context.

Section snippets

VICS

VICS was the first longitudinal study of IDU conducted in Australia. A detailed description of VICS is reported elsewhere (Crofts and Aitken, 1997). Briefly, VICS was a longitudinal study of 626 IDU recruited through the social networks of ‘privileged access’ interviewers (PAIs; former or continuing IDU with extensive experience of the IDU “scene”) and ‘snowballing’ from these networks. VICS PAIs interviewed participants at approximately nine-month intervals between 1990 and 1995, recording

Results

In assessing selection bias, there were few statistically significant differences between the mortality cohort and the remainder of the VICS participants, except that the mortality cohort was more likely to have drug treatment experience and less likely to report government benefits as their primary income source (neither of which were associated with mortality in the mortality cohort). Characteristics of the mortality cohort sample were generally similar to those of other samples of IDU

Discussion

Overall and overdose mortality rates in this cohort were lower than those reported in Europe and the USA, where overall mortality among IDU over comparable years range largely between 1–5 per 100 PY, but were typically in the order of 3 per 100 PY (e.g. EMCDDA, 1999, Langendam et al., 2001, Vlahov et al., 2004). A few previous Australian studies also show relatively low mortality rates. A follow-up of methadone patients (1976–1991) produced an overall mortality rate of 1.12 per 100 PY and an

Conflicts of interest

The authors have no conflicts of interest to declare in relation to this study.

Acknowledgements

The authors would like to acknowledge John Harding, Mark Short and Kun Zhao from the Australian Institute of Health and Welfare for their advice and assistance in facilitating the data linkage component of this study, Jenny Kelsall and Michael Kerger who collected the original VICS data used in this paper and who kindly extracted participant identifying information, and finally Eulalio Ledesma for his advice in the preparation of this manuscript. We would also like to thank Turning Point

References (23)

  • N. Crofts et al.

    Incidence of bloodborne virus infection and risk behaviours in a cohort of injecting drug users in Victoria, 1990–1995

    Med. J. Aust.

    (1997)
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