title: Suicide and other-cause mortality among heroin users in Taiwan: a prospective study.
abstract: OBJECTIVE
  The present study investigates one-year incidence of mortality from suicide and other causes among heroin users in Taiwan.
  
  
  METHODS
  A prospective national register-based cohort study.
  
  
  METHODS
  All heroin users who attended the methadone maintenance treatment (MMT) programs in all treatment centers in Taiwan.
  
  
  METHODS
  The sample comprised 10,842 heroin users attending MMT. Between Jan 2006 and Dec 2007, cases were identified through the multiple-center register system and followed until Dec 2008 for date and cause of death on the Taiwan national mortality database.
  
  
  METHODS
  Standardized mortality ratios within one year of starting MMT were calculated as a ratio of actual versus expected numbers of deaths in the general population in Taiwan. Cox regression models were fitted to estimate the effects of gender, age, education and marital status as well as heroin related behaviors.
  
  
  RESULTS
  In total, 256 cases died, 67 through suicide. The mortality rate (per 100 person-years) in the first year of all-cause and suicide was 1.71 and 0.45 respectively, representing 7.5- and 18.4-fold age- and gender-standardized mortality ratio (SMR) compared to the general population. Besides, the mortality rate in the first year of overdoses, murder, HIV, somatic was 0.19, 0.02, 0.07, and 0.75 respectively, representing 68.4-, 27.7-, 76.8-, and 4.3-fold SMR increases to the general population. Older age and unemployment were independent risk factors for mortality. Females had higher standardized mortality ratio than males for suicide and all-cause mortality.
  
  
  CONCLUSIONS
  Results showed higher risk of suicide and other-cause mortality among heroin users in MMT than general population. Suicide is an important contributor to overall excess mortality among heroin users in MMT, and especially among women. Suicide prevention and physical health monitoring are important components of MMT programs.
authors.affiliation: Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Charles T C
authors.initials: CT
authors.lastname: Lee
authors.forename: Vincent C H
authors.initials: VC
authors.lastname: Chen
authors.forename: Happy K L
authors.initials: HK
authors.lastname: Tan
authors.forename: Sun-Yuan
authors.initials: SY
authors.lastname: Chou
authors.forename: Kuen-Hong
authors.initials: KH
authors.lastname: Wu
authors.forename: Chia-Hsiang
authors.initials: CH
authors.lastname: Chan
authors.forename: Michael
authors.initials: M
authors.lastname: Gossop
mesh_terms: D000328:Adult; D017677:Age Distribution; D002423:Cause of Death; D005260:Female; D006556:Heroin Dependence / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data*; D017678:Sex Distribution; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D013405:Suicide / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology
keywords: Heroin; Mortality; Suicide