title: Impact of binge alcohol on mortality among people who inject drugs.
abstract: BACKGROUND
  While the impacts of illicit drug use on mortality have been well described, the impact of poly-substance that includes alcohol has received less attention. We examined the impact of binge alcohol use on mortality among a cohort of people who inject drugs (PWID) in a Canadian setting.
  
  
  METHODS
  Using data derived from a prospective cohort study of PWID in Vancouver, Canada recruited between May 1996 and November 2013. We ascertained dates and causes of death through a confidential linkage with the provincial registry and examined the impact of binge alcohol use. The primary outcome of interest was all-cause mortality. We used Cox proportional hazard regression to determine factors associated with mortality, including socio-demographic characteristics, drug use patterns and other risk behaviours.
  
  
  RESULTS
  During the study period, 2550 individuals were followed (844 of whom were HIV positive at baseline) for a median of 75.4 months (interquartile range 37.9 113.2). Of these, 795 (31%) participants reported binge alcohol use at some time during the study period. In multivariable analyses, binge alcohol use remained independently associated with all-cause-mortality (adjusted hazard ratio=1.41; 95% confidence interval: 1.06-1.88) after adjustment for other drug use patterns.
  
  
  CONCLUSIONS
  Binge alcohol use was associated with time to all-cause mortality among PWID in this setting. Since alcohol use is often overlooked as a risk factor for mortality among this population, these findings highlight the continued need to incorporate addiction treatment and public health interventions and policies that address binge alcohol use to reduce alcohol related-harms.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital 603-1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6.
authors.forename: Cheyenne
authors.initials: C
authors.lastname: Johnson
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital 603-1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6.
authors.forename: Huiru
authors.initials: H
authors.lastname: Dong
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital 603-1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6 ; Department of Family Practice, University of British Columbia.
authors.forename: Keith
authors.initials: K
authors.lastname: Ahamad
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital 603-1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6 ; Department of Medicine, University of British Columbia.
authors.forename: Kanna
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital 603-1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6 ; Department of Medicine, University of British Columbia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Milloy
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital 603-1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6 ; Department of Medicine, University of British Columbia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital 603-1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6 ; Department of Medicine, University of British Columbia.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
keywords: Vancouver; alcohol; binge alcohol; illicit drug use; mortality; people who inject drugs (PWID)