title: Mortality trends among heroin users treated between 1975 and 2013 in Northern Italy: Results of a longitudinal study.
abstract: The aim of this study was to examine heroin mortality trends and changes in causes of death, across time and age, in a cohort of the heroin population of treated.
  
  
  
  5899 subjects attending twelve centers for addiction treatment (SERT) in north Italy following problems due to heroin abuse between 1975 and 2013 were recruited.
  
  
  
  This study documented elevated mortality among subjects with primary heroin abuse, with an elevated death risk in all the classes of age, declining until 2009 ad increasing starting from 2010. AIDS was the first cause of death, followed by overdose and liver-related diseases. In the course of time mortality for AIDS and for drug-related deaths has declined, whereas liver mortality and all tumors mortality have risen over time, becoming the most common causes of death by the end of the follow up. As compared with the general population, the excess mortality (SMR) observed for all causes in either sex was 13.2, higher in females (SMR=21.5) as compared with males (SMR=12.1). Higher SMRs were found in 25/34 age-group patients, with a progressive decrease in subjects with age >34years.
  
  
  
  In the course of time, among heroin users, mortality and the causes of death have changed; for SERT clients special attention should be paid to the prevention and treatment of liver-related diseases.
authors.affiliation: Epidemiological Monitoring Center on Addiction, Mental Health DSM-DP, Azienda USL Bologna, Via San Isaia, 94 40100 Bologna, Italy. Electronic address: raimondo.pavarin@ausl.bologna.it.
authors.forename: Raimondo Maria
authors.initials: RM
authors.lastname: Pavarin
authors.affiliation: Azienda USL Bologna, Via Castiglione, 29 Bologna, Italy. Electronic address: angelo.fioritti@ausl.bologna.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Fioritti
authors.affiliation: Epidemiological Monitoring Center on Addiction, Mental Health DSM-DP, Azienda USL Romagna, via Orto del Fuoco, 10 Forlì, Italy. Electronic address: samantha.sanchini@auslromagna.it.
authors.forename: Samantha
authors.initials: S
authors.lastname: Sanchini
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000401:mortality*; D000328:Adult; D000367:Age Factors; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D062787:Drug Overdose / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008107:Liver Diseases / Q000453:epidemiology / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016320:Substance Abuse Treatment Centers; D013997:Time Factors
keywords: AIDS; Cohort study; Drug related deaths; Heroin; Liver mortality; Mortality