title: Temporal trends in mortality among people who use drugs compared with the general Dutch population differ by hepatitis C virus and HIV infection status.
abstract: OBJECTIVE
  We aimed to identify temporal trends in all-cause and cause-specific mortality rates among people who use drugs (PWUD) compared with the general Dutch population and to determine whether mortality trends differed by hepatitis C virus (HCV)/HIV (co) infection status.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Using data from the Amsterdam Cohort Studies among 1254 PWUD (1985-2012), all-cause and cause-specific standardized mortality ratios (SMRs) were calculated; SMRs were stratified by serological group (HCV/HIV-uninfected, HCV-monoinfected, and HCV/HIV-coinfected) and calendar period. Temporal trends were estimated using Poisson regression.
  
  
  RESULTS
  The overall all-cause SMR was 13.9 (95% confidence interval 12.6-15.3). The SMR significantly declined after 1996, especially due to a decline among women (P < 0.001). The highest SMR was observed among HCV/HIV-coinfected individuals during 1990-1996 (SMR 61.9, 95% confidence interval 50.4-76.0), which significantly declined after this period among women (P = 0.001). In contrast, SMR for HCV-monoinfected, and HCV/HIV-uninfected PWUD did not significantly change over time. The SMR for non-natural deaths significantly declined (P = 0.007), whereas the SMR for HIV-related deaths was the highest during all calendar periods.
  
  
  CONCLUSIONS
  We found evidence for declining all-cause mortality among PWUD compared with the general population rates. Those with HCV/HIV-coinfection showed the highest SMR. The decline in the SMR seems to be attributable to the decline in mortality among women. Mortality rates due to non-natural deaths came closer to those of the general population over time. However, HIV-related deaths remain an important cause of mortality among PWUD when compared with the general Dutch population. This study reinforces the importance of harm-reduction interventions and HCV/HIV treatment to reduce mortality among PWUD.
authors.affiliation: aDepartment of Research, Cluster Infectious Diseases, Public Health Service Amsterdam, Amsterdam bJulius Center, University Medical Center Utrecht, Utrecht cDepartment of Infectious Diseases, Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam dCentre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: Daniëla K
authors.initials: DK
authors.lastname: van Santen
authors.forename: Jannie J
authors.initials: JJ
authors.lastname: van der Helm
authors.forename: Bart P X
authors.initials: BP
authors.lastname: Grady
authors.forename: Anneke S
authors.initials: AS
authors.lastname: de Vos
authors.forename: Mirjam E E
authors.initials: ME
authors.lastname: Kretzschmar
authors.forename: Ineke G
authors.initials: IG
authors.lastname: Stolte
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000150:complications* / Q000401:mortality*; D016019:Survival Analysis; D055815:Young Adult