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Differences in mortality in a cohort of cocaine use disorder patients with concurrent alcohol or opiates disorder
Author(s) -
Colell Esther,
DomingoSalvany Antònia,
Espelt Albert,
ParésBadell Oleguer,
Brugal M. Teresa
Publication year - 2018
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.14165
Subject(s) - medicine , confidence interval , hazard ratio , cohort , alcohol use disorder , standardized mortality ratio , cohort study , opioid use disorder , poison control , population , mortality rate , proportional hazards model , demography , alcohol , opioid , emergency medicine , environmental health , biochemistry , chemistry , receptor , sociology
Aims To study mortality in a cohort of cocaine use disorder patients, and compare results in those with concurrent alcohol or opiates disorder. Design, Setting and Participants A cohort of 10 539 cocaine use disorder individuals entering drug treatment in public out‐patient centres in the city of Barcelona was followed from 1997 to 2011. Participants were divided at baseline into three groups: those with only cocaine use disorder (CUD), those with cocaine and alcohol use disorder but not opioid (CAUD) and those with cocaine and opioid use disorder (COUD). Mortality was assessed through the Spanish National Mortality Register. Measurements Crude mortality rates (CMR), standardized mortality ratios (SMR) and rate ratios (RR) were calculated for each group. A multivariable Cox regression model was fitted to obtain adjusted mortality hazard ratios (aHR) of CAUD and COUD with respect to CUD. Specific mortality causes were also examined. Findings The total of 716 deaths registered resulted in a CMR = 6.0/1000 person‐years (PY); 95% confidence interval (CI) = 5.1–7.0 for CUD, CMR = 5.8/1000 PY (95% CI = 4.9–6.7) for CAUD and CMR = 20.7/1000 PY (95% CI = 18.8–22.8) for COUD, with no significant differences among sexes. Compared with the general population, mortality was four times higher (SMR = 4.1, 95% CI = 3.5–4.8) among CUD, more than three times among CAUD (SMR = 3.4, 95% CI = 2.9–3.9) and more than 10 times among COUD (SMR = 11.6, 95% CI = 10.5–12.8), being always higher in women. External injuries, led by overdose, accumulated the biggest percentage of deaths among the three groups, but infectious diseases showed the highest excess mortality. Some differences regarding causes of death were observed between the three groups. Conclusions Mortality risk and excess mortality are significantly greater among those with cocaine and opiates use disorder than among people with only cocaine use disorder or cocaine and alcohol use disorder.