Temporal trends in the survival of drug and alcohol abusers according to the primary drug of admission to treatment in Spain.
BACKGROUND
Mortality of alcohol and drug abusers is much higher than the general population. We aimed to characterize the role of the primary substance of abuse on the survival of patients admitted to treatment and to analyze changes in mortality over time.


METHODS
Longitudinal study analyzing demographic, drug use, and biological data of 5023 patients admitted to three hospital-based treatment units in Barcelona, Spain, between 1985 and 2006. Vital status and causes of death were ascertained from clinical charts and the mortality register. Piecewise regression models were used to analyze changes in mortality.


RESULTS
The primary substances of dependence were heroin, cocaine, and alcohol in 3388 (67.5%), 945 (18.8%), and 690 patients (13.7%), respectively. The median follow-up after admission to treatment was 11.6 years (IQR: 6.6-16.1), 6.5 years (IQR: 3.9-10.6), and 4.8 years (IQR: 3.1-7.8) for the heroin-, cocaine-, and alcohol-dependent patients, respectively. For heroin-dependent patients, mortality rate decreased from 7.3×100person-years (p-y) in 1985 to 1.8×100p-y in 2008. For cocaine-dependent patients, mortality rate decreased from 10.7×100p-y in 1985 to <2.5×100p-y after 2004. The annual average decrease was 2% for alcohol-dependent patients, with the lowest mortality rate (3.3×100p-y) in 2008.


CONCLUSIONS
Significant reductions in mortality of alcohol and drug dependent patients are observed in recent years in Spain. Preventive interventions, treatment of substance dependence and antiretroviral therapy may have contributed to improve survival in this population.
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.
Arantza
A
Sanvisens
Institute of Neuropsychiatry & Addictions, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Gabriel
G
Vallecillo
Department of Internal Medicine, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.
Ferran
F
Bolao
Municipal Centre for Substance Abuse Treatment (Centro Delta), IMSP Badalona, Badalona, Spain.
Inmaculada
I
Rivas
Institute of Neuropsychiatry & Addictions, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Francina
F
Fonseca
Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Daniel
D
Fuster
Institute of Neuropsychiatry & Addictions, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Marta
M
Torrens
Department of Preventive Medicine and Public Health, Vall d'Hebrón Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain.
Santiago
S
Pérez-Hoyos
Department of Internal Medicine, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.
Ramon
R
Pujol
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.
Jordi
J
Tor
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain. Electronic address: rmuga.germanstrias@gencat.cat.
Roberto
R
Muga
D000328:Adult; D000437:Alcoholism / Q000401:mortality* / Q000534:rehabilitation; D002423:Cause of Death; D019970:Cocaine-Related Disorders / Q000401:mortality* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D019694:Hepatitis B, Chronic / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000453:epidemiology; D006556:Heroin Dependence / Q000401:mortality* / Q000534:rehabilitation; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013030:Spain / Q000453:epidemiology; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000401:mortality* / Q000534:rehabilitation; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
Epidemiology; Mortality; Substance-related disorders