title: Mortality among injection drug users in northern Thailand: a prospective cohort study.
abstract: OBJECTIVE
  : To measure mortality rates and assess predictors of all-cause mortality in a cohort of Thai injection drug users (IDUs) who were enrolled and followed up from 2004 through 2006.
  
  
  METHODS
  : In this prospective cohort study, we enrolled 314 community-dwelling IDUs (95% being men; 42% of ethnic minority; median age, 29 years [range, 18-69 years]) and followed up them at 6-month intervals. Mortality rates were calculated based on person-years of follow-up. Marginal Cox proportional hazards models for clustered data were constructed to determine the factors associated with all-cause mortality.
  
  
  RESULTS
  : During 445.7 person-years of follow-up, 17 of 314 (5.4%) IDUs died. The all-cause mortality rate was 3.8 per 100 person-years (95% confidence interval [CI] = 2.2-6.1). The standardized mortality ratio was 5.8 (95% CI = 3.5-9.1). The mortality rate among HIV-positive IDUs was 13.4 per 100 person-years (95% CI = 5.4-27.6). In a marginal Cox proportional-hazards model for clustered data, the excess mortality was associated with HIV-positivity (hazard ratio [HR] = 7.0, 95% CI = 2.8-17.6), benzodiazepine use (HR = 3.1, 95% CI = 1.1-9.4), and excessive alcohol consumption at enrollment (HR = 3.5, 95% CI = 1.3-9.1).
  
  
  CONCLUSIONS
  : The all-cause mortality among the drug injectors is high. The increased mortality was associated with HIV infection, benzodiazepine use, and excessive alcohol consumption.
authors.affiliation: From the Bloomberg School of Public Health (VMQ, CL, DDC), Johns Hopkins University, Baltimore, MD; Chiang Mai University (AA, TV, KW), Chiang Mai, Thailand; and Statistical Center for HIV/AIDS Research & Prevention (DD, T-YL), Seattle, WA.
authors.forename: Vu Minh
authors.initials: VM
authors.lastname: Quan
authors.forename: Apinun
authors.initials: A
authors.lastname: Aramrattana
authors.forename: Tasanai
authors.initials: T
authors.lastname: Vongchak
authors.forename: Carl
authors.initials: C
authors.lastname: Latkin
authors.forename: Deborah
authors.initials: D
authors.lastname: Donnell
authors.forename: Ting-Yuan
authors.initials: TY
authors.lastname: Liu
authors.forename: Kanokporn
authors.initials: K
authors.lastname: Wiboonnatakul
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano