Mortality cohort study among problem drug users in Poland

Transcription

1 Mortality cohort study among problem drug users in Poland Janusz Sierosławski Institute of Psychiatry and Neurology Warsaw Annual expert meeting on Drug-related deaths (DRD) and Drug-related infectious diseases (DRID) Lisbon, October 2014

2 Introduction previous studies Two cohort studies all patients diagnosed with ICD 9 code 304 in residential treatment in Poland (4 year follow up) in 1974 in 1984 Cohort study covering patients of one detox unit over the period of years in Cohort study all patients diagnosed with ICD code F11-F16, F18, F19 in residential treatment in Poland in (observation period ) CMR 2

3 The goals of the study to estimate mortality rate among problem drug users to identify risk factors of deaths related to problem drug use to formulate recommendations for mortality prevention addressed to problem drug using population 3

4 Definition of problem drug use Regular, frequent drug use and experiencing serious drug related problems All drugs included Problems as one of definition criteria Justification: Data available individual data from residential treatment only, lack of information on types of drugs used (the ICD diagnose only) Dominating patterns of drug use polydrug use Research traditions Demand from policy makers and professionals 4

5 Method Data collection procedure Preparing data base of treated drug users eliminating double counting in 12 years period Checking vital status using national electronic population register Analyses: Crude mortality rate, standardized mortality ratio, potential years of life lost, Kaplan-Meier survival analysis and Cox regression Population Drug users treated in in residential drug addiction treatment in whole country Follow up period:

6 Research materials Size of initial group Vital status identified (77.2%) Vital status unidentified (22.8%) Number of person-years Number of deaths (7.7%) Crude mortality rate (CMR).2 per 00 person/years Standardized mortality ratio (SMR) 3.3 (95% CI: ) 6

7 Hazard function for particular cohorts (Kaplan-Meier survival analysis) 7

8 Hazard function for males and females (Kaplan-Meier survival analysis) 8

9 Crude mortality rate (CMR) Males Females Total

10 Standardized mortality ratio (SMR) by age and gender Male Female and more

11 Mortality of problem drug users Standardized Mortality Ratio (SMR) Opioid addicts (F) Drug addicts - total

12 Potential years of life lost (PYLL) 45 Average PYLL Males Females

13 Mortality and drug related deaths Index data for 2000 = Mortality (CMR) - cohort study Drug related deaths - statistics

14 Conclusions Decreasing trend in all mortality indicators (CMR, SMR, PYLL) SMR particularly high among young females Mortality higher among opioid addicts than among other addicts but stronger decreasing trend Mortality among drug addicts went down more than drug related deaths 14

15 Restrictions and limitations Relatively high share of cases with unidentified vital status ID code (initials, date of birth, gender) not always stable and unique Data quality in treatment data base and population register not perfect Limited scope of information available in treatment data base national register of deaths Data protection issues causes of deaths unavailable yet 15