title: Mortality risk factors and excess mortality in a cohort of cocaine users admitted to drug treatment in Spain.
abstract: We assessed mortality risk factors and excess mortality compared to the general population in two Spanish sub-cohorts of 8,825 cocaine and heroin users (CHUs) and 11,905 only cocaine users (OCUs) aged 15-49 admitted to drug treatment. Heroin use (among all cocaine users), no-regular employment and drug injection (among CHUs and OCUs), daily cocaine use and previous drug treatment (among CUs), and death before 2005 and >10 years of heroin use (among CHUs) were clearly associated with higher mortality in Cox regression. Excess mortality was assessed by the directly standardized mortality rate ratio, which was higher in CHUs (14.3; 95% CI: 12.6-16.2) than CUs (5.1; 95% CI: 4.3-6.0) and in women than men, especially among OCUs (8.6; 95% CI: 7.5-10.0 vs. 3.5; 95% CI: 3.3-3.8); it decreased with age among CHUs, but did not decrease overall during 1997-2008. OCUs excess mortality was considerable and showed no signs of decline, suggesting the need for improved treatment and prevention interventions.
authors.affiliation: National Epidemiology Center, Carlos III Health Institute, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: de la Fuente
authors.forename: Gemma
authors.initials: G
authors.lastname: Molist
authors.forename: Albert
authors.initials: A
authors.lastname: Espelt
authors.forename: Gregorio
authors.initials: G
authors.lastname: Barrio
authors.forename: Anna
authors.initials: A
authors.lastname: Guitart
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Bravo
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Brugal
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019970:Cocaine-Related Disorders / Q000401:mortality* / Q000534:rehabilitation; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006556:Heroin Dependence / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D016320:Substance Abuse Treatment Centers; D055815:Young Adult
keywords: Cocaine; Cohort; Drug treatment; Excess mortality; Mortality; Risk factors