Gender differences in mortality and risk factors in a 13-year cohort study of street-recruited injecting drug users

Abstract

BackgroundInjecting drug users (IDUs) are at risk of premature mortality. This study examined gender differences in mortality, risk factors, and causes of death among IDUs.MethodsIn a 13-year cohort study including 172 street-recruited IDUs from Oslo, Norway in 1997, interview data was merged with the National Cause of Death Registry. Crude mortality rate (CMR) and indirect standardized mortality ratio (SMR) were estimated with 95% confidence intervals (CI). A log-logistic multivariate survival analysis model was estimated for the full sample. For a smaller data set (1.1.1998-31.12.2004) the influence of substitution treatment and prison were assessed using cox regression survival analysis.ResultsEight females and 37 males died. Acute intoxications were the most common cause of death. Women were more at risk in the short-term, but more protected in the long-term. CMR was 16.0 [95% CI 8.0, 31.9] for women and 26.0 [95% CI 18.0, 35.8]) for men. SMR was 39.4 [95% CI 0.2, 220.8]) for women and 21.3 [95% CI 5.7, 54.1] for men. More women injected heroin (98% vs. 88% [x2 = 3.5, p = 0.063]), used prescription drugs (73% vs. 52% [x2 = 5.6, p = 0.018]) and combined these to inject (45% vs. 26% [x2 = 5.9, p = 0.015]). Mixing prescription drugs in heroin injections, and sex work (only women) were associated with decreased survival time. There were no gender differences in access to substitution treatment, while significantly more men had been in prison (74% vs. 51% [x2 = 7.5, p = 0.006]). The instance of substitution treatment and prison significantly decreased the mortality risk. Prison release increased the risk, but not statistically significantly.ConclusionsThere were gender differences in mortality and risk factors; sex work and prison were gender specific risk factors. These factors should be investigated further to better design future preventive measures.

A 30-year follow-up of substance misusers in Sweden – differences in predictors of mortality between women and men

“…Later studies comparing gender differences have found that in patients treated for opioid dependence, employment decreased the mortality risk in men, but not women (Evans et al 2015). A study of street-recruited injecting drug users reported that sex work increased the mortality risk in women, while an increased mortality risk in men was related to experience of incarceration (Gjersing and Bretteville-Jensen 2014). Also, injuryrelated mortality has been found to be higher among women in patients with alcohol use disorders (Guitart et al 2015).…”

Gender differences in mortality among treated opioid dependent patients

“…For example, an examination of gender differences in opioid/cocaine fatal overdoses in Luxembourg between 1985 and 2011 found that the time between the onset of drug use and death was shorter for women than for men (Origer et al, 2014). A study of injection drug users in Norway reported that the risk of death was heightened among women by sex work and among men by experiences of being incarcerated in prison (Gjersing & Bretteville-Jensen, 2014). Findings are consistent with those generated by other studies that have attributed gender differences in the course of addiction to both socio-cultural (Cloud & Granfield, 2008; Roberts et al, 2010) and biological (Lynch et al, 2002) factors.…”

Patterns of substance use and mortality risk in a cohort of ‘hard‐to‐reach’ polysubstance users

“…Respondents were also asked how old they were at their first injection and what type of substance they injected the first time. The questionnaire is described in more detail elsewhere .…”