Differences in mortality in a cohort of cocaine use disorder patients with concurrent alcohol or opiates disorder

Esther Colell; Antònia Domingo-Salvany; Albert Espelt; Oleguer Parés-Badell; M Teresa Brugal

doi:10.1111/add.14165

Differences in mortality in a cohort of cocaine use disorder patients with concurrent alcohol or opiates disorder

Esther Colell, Antònia Domingo-Salvany^*, Albert Espelt, Oleguer Parés-Badell, M Teresa Brugal

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

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Abstract

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.

Original language	English
Pages (from-to)	1045-1055
Number of pages	11
Journal	Addiction
Volume	113
Issue number	6
DOIs	https://doi.org/10.1111/add.14165
Publication status	Published - Jun 2018

Keywords

Adult
Alcoholism/epidemiology
Case-Control Studies
Cause of Death
Cocaine-Related Disorders/epidemiology
Cohort Studies
Comorbidity
Drug Overdose/mortality
Female
Humans
Infections/mortality
Longitudinal Studies
Male
Mortality
Multivariate Analysis
Opioid-Related Disorders/epidemiology
Proportional Hazards Models
Spain
Wounds and Injuries/mortality

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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@article{d1e6110684074c9abd582d20301c0c11,

title = "Differences in mortality in a cohort of cocaine use disorder patients with concurrent alcohol or opiates disorder",

abstract = "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.",

keywords = "Adult, Alcoholism/epidemiology, Case-Control Studies, Cause of Death, Cocaine-Related Disorders/epidemiology, Cohort Studies, Comorbidity, Drug Overdose/mortality, Female, Humans, Infections/mortality, Longitudinal Studies, Male, Mortality, Multivariate Analysis, Opioid-Related Disorders/epidemiology, Proportional Hazards Models, Spain, Wounds and Injuries/mortality",

author = "Esther Colell and Ant{\`o}nia Domingo-Salvany and Albert Espelt and Oleguer Par{\'e}s-Badell and Brugal, {M Teresa}",

note = "{\textcopyright} 2018 Society for the Study of Addiction.",

year = "2018",

month = jun,

doi = "10.1111/add.14165",

language = "English",

volume = "113",

pages = "1045--1055",

number = "6",

}

TY - JOUR

T1 - Differences in mortality in a cohort of cocaine use disorder patients with concurrent alcohol or opiates disorder

AU - Colell, Esther

AU - Domingo-Salvany, Antònia

AU - Espelt, Albert

AU - Parés-Badell, Oleguer

AU - Brugal, M Teresa

PY - 2018/6

Y1 - 2018/6

N2 - 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.

AB - 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.

KW - Adult

KW - Alcoholism/epidemiology

KW - Case-Control Studies

KW - Cause of Death

KW - Cocaine-Related Disorders/epidemiology

KW - Cohort Studies

KW - Comorbidity

KW - Drug Overdose/mortality

KW - Female

KW - Humans

KW - Infections/mortality

KW - Longitudinal Studies

KW - Male

KW - Mortality

KW - Multivariate Analysis

KW - Opioid-Related Disorders/epidemiology

KW - Proportional Hazards Models

KW - Spain

KW - Wounds and Injuries/mortality

U2 - 10.1111/add.14165

DO - 10.1111/add.14165

M3 - Article

C2 - 29357115

SN - 0965-2140

VL - 113

SP - 1045

EP - 1055

JO - Addiction

JF - Addiction

IS - 6

ER -

Differences in mortality in a cohort of cocaine use disorder patients with concurrent alcohol or opiates disorder

Abstract

Keywords

UN SDGs

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