Mortality among Problem Drug Users in Rome: An 18-Year Follow-Up Study, 1980-97

To analyze overall & cause-specific mortality among problem drug users (PDUs) attending treatment centers in Rome, Italy, & to evaluate differences in mortality between genders, a cohort of 11,432 PDUs entering treatment between 1980 & 1995 were enrolled & followed up until 31 May 1997. Directly standardized mortality rates & standardized mortality ratios (SMRs) & their 95% confidence intervals (95% CI) were calculated. The study population included mainly males (82%), heroin users (92%), & mean age 26.6 (SD 5.9) at enrollment. At the end of the study period, 1,734 deaths were observed. Overall mortality rates began to increase in 1985/86 & decreased slightly afterward. AIDS mortality peaked in 1991/92 (13.2/1,000) & fell in the following years. A slight decrease in overdose mortality also occurred after 1989/90. Mortality for causes other than AIDS & overdose remained high & relatively steady for the whole study period. Women showed higher mortality rates for AIDS but lower mortality rates for overdose than males. Overall mortality risk among drug addicts was about 15 times higher compared to the general population of the same age among men, & 38 times higher among women. AIDS mortality among drug addicts began to decrease earlier than expected; the decrease was particularly significant in the period 1993/94 for both sexes. Afterward, a continuous but slight decrease was observed among males only. Even though overdose mortality has also decreased slightly in recent years, we still observe high mortality levels for both overdose & all other causes. These findings suggest that interventions directed specifically toward the reduction of baseline mortality are still needed. 3 Tables, 1 Figure, 37 References. Adapted from the source document.