title: Severe illness and death among injecting drug users in Scotland: a case-control study.
abstract: Between April and September 2000, 60 injecting drug users in Scotland died or were hospitalized with severe illness. Laboratory investigations suggested that Clostridium novyi and other bacteria were important aetiological agents. To determine associated environmental/behavioural factors a case-control study was undertaken with 19 'definite' and 32 'probable' cases in Glasgow, Scotland. For every deceased case (n=19), up to three proxy individuals were interviewed. Three controls were identified for each case. Multivariate logistic regression analyses compared (i) all cases and controls; (ii) definite cases and matched controls; (iii) probable cases and matched controls. In all three analyses injecting into muscle or skin and injecting most of the time with a filter used by someone else were the variables most strongly associated with illness. Comparing only muscle-injecting cases and controls, cases were significantly more likely to have injected larger amounts of heroin per average injection than were controls. The findings make an important epidemiological contribution to the understanding of the public health and clinical implications of the contamination of illicit drugs by histotoxic clostridia.
authors.affiliation: Institute for Applied Social and Health Research, School of Social Sciences, University of Paisley, High Street, Paisley PA1 2BE, Scotland, UK. avril.taylor@paisley.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Taylor
authors.forename: S
authors.initials: S
authors.lastname: Hutchinson
authors.forename: J
authors.initials: J
authors.lastname: Lingappa
authors.forename: S
authors.initials: S
authors.lastname: Wadd
authors.forename: S
authors.initials: S
authors.lastname: Ahmed
authors.forename: L
authors.initials: L
authors.lastname: Gruer
authors.forename: T H
authors.initials: TH
authors.lastname: Taylor
authors.forename: K
authors.initials: K
authors.lastname: Roy
authors.forename: G
authors.initials: G
authors.lastname: Gilchrist
authors.forename: C
authors.initials: C
authors.lastname: McGuigan
authors.forename: G
authors.initials: G
authors.lastname: Penrice
authors.forename: D
authors.initials: D
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003015:Clostridium Infections / Q000401:mortality / Q000635:transmission; D004777:Environment; D016021:Epidemiologic Studies; D005260:Female; D006556:Heroin Dependence / Q000401:mortality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012606:Scotland / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000401:mortality*