Mortality of DUs in Central Asia Mortality of problem gamblers in the Czech Republic

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1 Mortality of DUs in Central Asia Mortality of problem gamblers in the Czech Republic Viktor Mravčík, MD, PhD EMCDDA DRDs/DRIDs annual meeting 2014

2 Mortality ofdusin Central Asia 2

3 Narcological registration strong control function: application for posts in the school system, law enforcement, military, state service in general, driver s licence, firearms licence etc. prophylactic observation x dispensary registration main referral: law enforcement dispensary observation for 3-5 years removal: long-term remission, change of place of residence, imprisonment, death Prevalence of registered drug and alcohol addicts subjected to dispensary registration 3

4 Number of persons with diagnosed drug addiction (toxicomania) subjected to dispensary registration in

5 Proportion of females among registered drug addicts (%) 5

6 Proportion of young adults (15 34) among registered drug addicts (%) 6

7 Number and proportion of registered patients by drugs in

8 Trend in proportion of opiates in registered patients (%) 8

9 Trend in proportion of other opiates than heroin among registered opioid users (%) 9

10 Proportion of IDUs among registered drug users (%) 10

11 Number of registered subjects and crude mortality rate in Uzbekistan by gender and age groups Agegroup Number of registered subjects Crude mortality rate ( ) M F M F M F M F Total

12 2011 Age-group 2012 Number of registered subjects and crude mortality rate in Kazakhstanby gender and age groups Number of registered subjects Crude mortality rate ( ) M F M F Total ,0 0,0 0, ,6 0,0 0, ,5 23,2 14, ,7 31,6 36,3 > ,7 571,4 182,9 Total ,9 24,2 23,0 Number of registered subjects Crude mortality rate ( ) M F M F Total Total Age-group

13 SMR 13

14 SMR by gender and age: Uzbekistan Age M F Total M F Total ( ) ( ) 5.0 ( ) 23.9 ( ) 5.5 ( ) ( ) 12.6 ( ) 3.8 ( ) 6.3 ( ) 46.0 ( ) 7.2 ( ) ( ) 18.0 ( ) 9.8 ( ) 10.4 ( ) 28.1 ( ) 10.8 ( ) ( ( ( ) 77.4) 15.7) 11.7 ( ) 19.5 ( ) 11.9 ( ) ( ) 10.5 ( ) 5.8 ( ) 5.3 ( ) 6.8 ( ) 5.4 ( ) ( ) 3.1 ( ) 2.1 ( ) 4.2 ( ) 10.0 ( ) 5.0 ( ) Total 6.3 ( ) 9.3 ( ) 6.4 ( ) 6.6 ( ) 11.9 ( ) 6.8 ( ) 14

15 SMR by gender and age: Kazakhstan Age group M F Total ( ) ( ) ( ) 25.5 ( ) 5.4 ( ) ( ) 7.3 ( ) 3.4 ( ) > ( ) 11.8 ( ) 2.7 ( ) Total 3.5 ( ) 10.6 ( ) 3.8 ( ) Age group M F Total ( ) 23.0 ( ) 2.3 ( ) ( ) 18.5 ( ) 2.6 ( ) ( ) 13.6 ( ) 4.8 ( ) ( ) 27.9 ( ) 6.0 ( ) ( ) 16.9 ( ) 5.6 ( ) (3.03.6) 7.3 ( ) 3.4 ( ) ( ) 1.6 ( ) 3.4 ( ) Total 2.8 ( ) 4.1 ( ) 2.9 ( ) 15

16 Structure of mortality of drug users in Uzbekistan 16

17 Number of fatal overdoses on illicit drugs 17

18 Mortality of DUs in CA: conclusions crude mortality rate among registered drug users quite high when compared to EU countries however SMR comparably low: high background premature mortality in the general population when compared to EU (15 39: 2012 Kazakh M 315.6, F 109.2, 2010 Uzb M 137.9, F 82.8, 15 EU M 98.4, F 41.9 per 100 thousand) underestimation of mortality: characteristics of the target population and the under-reporting of deaths in the registers high mortality of females: those registered present more sever problems as compared with males a need for specialised programmes 18

19 Mortality of DUs in CA: references DAMOS / CADAP 5. (2013). The Regional Report on the Drug Situation in Central Asia [ Региональный обзор о наркоситуации в Центральной Азии] (T. Zabransky & V. Mravcik Eds. 1st ed.). Prague: ResAd. Mravcik, V., Zabransky, T., Talu, A., Jasaitis, E., Gafarova, N., Musabekova, Z.,... Ganiev, F. (2014). Mortality of registered drug users in Central Asia. Int J Drug Policy Apr6. doi: /j.drugpo Zabransky, T., Mravcik, V., Talu, A., & Jasaitis, E. (2014). Post- Soviet Central Asia: A summary of the drug situation. Int J Drug Policy May 21. doi: /j.drugpo

20 Mortality of problem gamblersin CZ database-linkage retrospective cohort study cohort: hospitalised with a primary or secondary dg. F63.0 in deaths: Deaths Statistics (general mortality register of CR) indirect standardization Standardized Mortality Ratio (SMR) mortality structure weighting by sex and age 20

21 Sample characteristics Year Number of persons Males Females PY total PY males PY females Deaths total Deaths males Deaths females Total

22 Sample characteristics Year CMR total CMR males CMR females ,98 0,00 145, ,04 12,31 0, ,78 8,02 0, ,99 5,15 0, ,15 13,09 15, ,28 8,60 0, ,39 8,31 10, ,42 6,68 0, ,82 5,43 14, ,57 8,39 12, ,22 7,57 0, ,37 9,72 23, ,68 9,77 8, ,38 8,64 3, ,98 9,14 6, ,67 7,11 16, ,81 8,90 7, ,99 8,83 11,29 Total 8,50 8,44 9,63 22

23 Sample characteristics patient age Sex N % M F Total

24 Mortality of pathological gamblers: SMR males SMR males 95% CI high SMR males 95% CI low SMR males central estimate

25 Mortality of pathological gamblers: SMR females SMR females 95% CI high SMR females 95% CI low SMR females central estimate

26 Mortality of hospitalised pathological gamblers: SMR total SMR total 95% CI high SMR total 95% CI low SMR total central estimate

27 Mortality of hospitalized pathological gamblers: mortality structure Causes of deaths General population (%) Gamblers before weighting (%) Gamblers after weighting (%) Neoplasms Diseases of the circulatory system Diseases of the respiratory system Diseases of the digestive system Injury, poisoning and certain other consequences of external causes Other causes Total External causes of deaths General population Gamblers before weighting (%) Gamblers after weighting (%) Traffic accidents Falls Accidental drowning and submersion Intentional self-harm Assault Complications of medical and surgical care Other external causes of morbidity and mortality No external cause Total

28 Mortality of hospitalized pathological gamblers: weighted mortality structure (%) % % Neoplasms Diseases of the circulatory system Diseases of the respiratory system Diseases of the digestive system Injury, poisoning and certain other consequences of external causes Other causes general population pathological gamblers 95% CI high pathological gamblers 95% CI low pathological gamblers central estimate

29 Mortality of hospitalised pathological gamblers: weighted mortality structure external causes (%) % % Traffic accidents Falls Exposure to inanimate mechanica l forces Accidental drowning and submersio n Exposure to animate mechanica l forces Contact with venomous animals and plants Exposure to electric current, radiation and Intentional extreme self-harm ambient air temperatur e and pressure Assault Complicati ons of medical and surgical care general population pathological gamblers 95% CI high pathological gamblers 95% CI low pathological gamblers central estimate Other external causes of morbidity and mortality

30 Mortality of hospitalised pathological gamblers in CZ: references Mravčík, V., Černý, J., Leštinová, Z., Chomynová, P., Grohmannová, K., Licehammerová, Š., Ziegler, A., Kocarevová, V. Hazardní hraní v České republice a jeho dopady [Gambling i the Czech Republic and its consequences]. Mravčík, V. (Ed.). Praha: Úřad vlády České republiky. 30

31 Thanks rvkpp.vlada.cz