title: Mortality among people who inject drugs: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically review cohort studies of mortality among people who inject drugs, examine mortality rates and causes of death in this group, and identify participant- and study-level variables associated with a higher risk of death.
  
  
  METHODS
  Tailored search strings were used to search EMBASE, Medline and PsycINFO. The grey literature was identified through online grey literature databases. Experts were consulted to obtain additional studies and data. Random effects meta-analyses were performed to estimate pooled crude mortality rates (CMRs) and standardized mortality ratios (SMRs).
  
  
  RESULTS
  Sixty-seven cohorts of people who inject drugs were identified, 14 of them from low- and middle-income countries. The pooled CMR was 2.35 deaths per 100 person-years (95% confidence interval, CI: 2.12-2.58). SMRs were reported for 32 cohorts; the pooled SMR was 14.68 (95% CI: 13.01-16.35). Comparison of CMRs and the calculation of CMR ratios revealed mortality to be higher in low- and middle-income country cohorts, males and people who injected drugs that were positive for human immunodeficiency virus (HIV). It was also higher during off-treatment periods. Drug overdose and acquired immunodeficiency syndrome (AIDS) were the primary causes of death across cohorts.
  
  
  CONCLUSIONS
  Compared with the general population, people who inject drugs have an elevated risk of death, although mortality rates vary across different settings. Any comprehensive approach to improving health outcomes in this group must include efforts to reduce HIV infection as well as other causes of death, particularly drug overdose.
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia. bmathers@kirby.unsw.edu.au
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Mathers
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.forename: Chiara
authors.initials: C
authors.lastname: Bucello
authors.forename: James
authors.initials: J
authors.lastname: Lemon
authors.forename: Lucas
authors.initials: L
authors.lastname: Wiessing
authors.forename: Mathew
authors.initials: M
authors.lastname: Hickman
mesh_terms: D002423:Cause of Death; D016206:Databases, Bibliographic; D062787:Drug Overdose / Q000401:mortality*; D005260:Female; D006679:HIV Seropositivity / Q000401:mortality* / Q000635:transmission; D006801:Humans; D008297:Male; D017678:Sex Distribution; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000401:mortality*
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