The European Journal of Public Health Advance Access originally published online on September 12, 2005
The European Journal of Public Health 2006 16(2):198-202; doi:10.1093/eurpub/cki168
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Mental Health |
Drug-related mortality and its impact on adult mortality in eight European countries
Anna Maria Bargagli1, Matthew Hickman2, Marina Davoli1, Carlo A. Perucci1, Patrizia Schifano1, Marcel Buster3, Teresa Brugal4, Julian Vicente5 for the COSMO European Group6
1 Department of Epidemiology, ASL Rome E, Rome, Italy
2 Centre for Research on Drugs and Health Behaviour, Social Science and Medicine, Imperial College School of Medicine, London, UK
3 Department of Epidemiology, Documentation and Health Promotion, Municipal Health Service, Amsterdam, The Netherlands
4 Public Health Agency, Epidemiologic Service, IMS, Barcelona, Spain
5 Department of Epidemiology, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
6 COSMO (COhort Studies on Mortality of Opiate addicts): Joseph Barry (Ireland), Valeria Belleudi (Italy), Sheila Bird (UK), Daniela De Angelis (UK), Filipa Ferraz de Oliveira (Portugal), Paul Griffith (EMCDDA), Lene Haastrup (Denmark), Eva Hammerby (Denmark), Gordon Hay (Scotland), Axel Heinemann (Germany), Sharon Hutchinson (Scotland), Dominique Lopez (France), Louise Mullen (Ireland), Daniele Risser (Austria), Alessandra Sperati (Italy), Colin Taylor (EMCDDA)
Correspondence: Anna Maria Bargagli, Department of Epidemiology, ASL Rome E, Via di Santa Costanza 53, 00198 Roma, Italy, tel: +39 06 83060402, fax: +39 06 83060463, e-mail: bargagli{at}asplazio.it
Objective: To estimate the mortality rates from drug-related deaths and other causes among problem drug users and population attributable risk of death due to opiate use in eight study sites in Europe. Methods: Opiate users were recruited from drug treatment centres during the period 1990–1998 and deaths followed up through national or local mortality registries. Gender-specific overall mortality rate, proportion of deaths by cause (drug-related, HIV, other), standardized mortality ratios (SMRs), and the attributable risk fraction (ARF) were estimated. Results: Crude mortality rates varied from 1 per 100 person-years in the Dublin and London cohorts to 3.8 per 100 person-years in Barcelona. The highest drug-related mortality rate was 10 per 1000 person-years in Barcelona; the rates were 
7 per 1000 person-years in Denmark, London, Rome, and Vienna, and <3.5 per 1000 person-years for the others cohorts. The mortality rate for AIDS was <2 per 1000 person-years in all the cohorts except Lisbon, Rome, and Barcelona, for which it was 6 per 1000 person-years. The highest SMR among males was 21.1 in Barcelona, and among females the highest SMRs were 53.7 and 37.7 in Barcelona and Rome, respectively. In Denmark the ARF was 5%, whereas it was >10% in all other study sites and 24% in Barcelona. Conclusion: Cohort mortality studies, especially in combination with estimates of prevalence, provide useful insights into the impact of opiate use on mortality across European countries and emphasize how preventing overall and drug-related deaths among opiate users can significantly improve the health of the population.
Keywords: drug-related mortality, longitudinal studies, opiate addiction