People who inject drugs have an elevated risk of death, although mortality rates vary across different settings. Public health initiatives must include efforts to reduce HIV infection as well as other causes of death, particularly drug overdose.
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Objectives: To systematically review cohort studies of mortality among injecting drug users (IDUs), examining rates and causes of mortality, and identifying participant and study-level variables associated with mortality levels.
Methods: Tailored search strings were used to search EMBASE, Medline and PsycINFO; grey literature documents were identified using online grey literature databases; experts were consulted to obtain additional studies and/or data. Random-effects meta-analyses were performed to estimate pooled crude mortality rates (CMR) and standardised mortality ratios (SMR).
Results: Fifty-four cohorts were identified, nine from low or middle-income countries (LMICs) and a pooled CMR of 2.53 deaths/100PY (95%CI 2.25, 2.80). SMRs were reported for twenty-four cohorts with a pooled SMR of 15.76 (95%CI 13.70, 17.83). Mortality was higher in LMICs, males, HIV-positive IDUs and during out-of-treatment periods. Overdose and AIDS were the primary causes of mortality across cohorts.
Conclusions: Compared to the general population, IDUs have a considerably elevated risk of mortality, though mortality varies in different settings. A comprehensive approach to improving health outcomes for this group must also include efforts to reduce HIV and other causes of mortality, particularly drug-overdose. The treatment of opioid dependence, therefore, remains of critical importance among this population.