The Cedar Project: mortality among young Indigenous people who use drugs in British Columbia

Abstract

BACKGROUND: Young Indigenous people, particularly those involved in the child welfare system, those entrenched in sub stance use and those living with HIV or hepatitis C, are dying prematurely. We report mortality rates among young Indigenous people who use drugs in Brit ish Columbia and explore predictors of mortality over time. METHODS:We analyzed data collected every 6 months between 2003 and 2014 by the Cedar Project, a prospective cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, BC. We calculated agestandardized mortality ratios using Indigenous and Canadian reference popu lations. We identified predictors of mortality using timedependent Cox pro portional hazard regression. RESULTS:Among 610 participants, 40 died between 2003 and 2014, yielding a mortality rate of 670 per 100 000 personyears. Young Indigenous people who used drugs were 12.9 (95% confi dence interval [CI] 9.2-17.5) times more likely to die than all Canadians the same age and were 7.8 (95% CI 5.6-10.6) times more likely to die than Indigenous people with Status in BC. Young women and those using drugs by injection were most affected. The lead ing causes of death were overdose (n = 15 [38%]), illness (n = 11 [28%]) and sui cide (n = 5 [12%]). Predictors of mortal ity included having hepatitis C at base line (adjusted hazard ratio [HR] 2.76, 95% CI 1.47-5.16), previous attempted suicide (adjusted HR 1.88, 95% CI 1.01-3.50) and recent overdose (adjusted HR 2.85, 95% CI 1.00-8.09). INTERPRETATION:Young Indigenous people using drugs in BC are dying at an alarming rate, particularly young women and those using injection drugs. These deaths likely reflect complex intersec tions of historical and presentday injus tices, substance use and barriers to care.

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