title: Drug-related mortality and its impact on adult mortality in eight European countries.
abstract: 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 1,000 person-years in Barcelona; the rates were approximately 7 per 1,000 person-years in Denmark, London, Rome, and Vienna, and <3.5 per 1,000 person-years for the others cohorts. The mortality rate for AIDS was <2 per 1,000 person-years in all the cohorts except Lisbon, Rome, and Barcelona, for which it was approximately 6 per 1,000 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Epidemiology, ASL Rome E, 00198 Rome, Italy. bargagli@asplazio.it
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Bargagli
authors.forename: Matthew
authors.initials: M
authors.lastname: Hickman
authors.forename: Marina
authors.initials: M
authors.lastname: Davoli
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Perucci
authors.forename: Patrizia
authors.initials: P
authors.lastname: Schifano
authors.forename: Marcel
authors.initials: M
authors.lastname: Buster
authors.forename: Teresa
authors.initials: T
authors.lastname: Brugal
authors.forename: Julian
authors.initials: J
authors.lastname: Vicente
mesh_terms: D000293:Adolescent; D000328:Adult; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009293:Opioid-Related Disorders / Q000401:mortality*; D012042:Registries