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Association of History of Injection Drug Use with External Cause-Related Mortality Among Persons Linked to HIV Care in an Urban Clinic, 2001–2015

  • Kanal Singh
  • Geetanjali Chander
  • Bryan Lau
  • Jessie K. Edwards
  • Richard D. Moore
  • Catherine R. LeskoEmail author
Original Paper

Abstract

High mortality rates among persons with HIV with a history of injection drug use (PWID) are thought to be driven in part by higher rates of external cause-related mortality. We followed 4796 persons aged 18–70 engaged in continuity HIV care from 2001 to 2015 until death or administrative censoring. We compared cause-specific (csHR) and subdistribution hazards (sdHR) of death due to external causes among PWID and persons who acquired their HIV infection through other routes (non-IDU). We standardized estimates on age, sex, race, and HIV-related health status. The standardized csHR for external cause-related death was 3.57 (95% CI 2.39, 5.33), and the sdHR was 3.14 (95% CI 2.16, 4.55). The majority of external cause-related deaths were overdose-related and standardized sdHR was 4.02 (95% CI 2.40, 6.72). Absolute rate of suicide was low but the csHR for PWID compared to non-IDU was most elevated for suicide (6.50, 95% CI 1.51, 28.03). HIV-infected PWID are at a disproportionately increased risk of death due to external causes, particularly overdose and suicide.

Keywords

Cause-specific mortality Competing risks Injection drug use Injury-related mortality Survival 

Notes

Funding

This work was supported by NIH grants U01 DA036935 and P30 AI094189. The funders have had no influence on the design of this analysis or reporting of results.

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10461_2019_2497_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kanal Singh
    • 1
  • Geetanjali Chander
    • 2
  • Bryan Lau
    • 1
  • Jessie K. Edwards
    • 3
  • Richard D. Moore
    • 1
    • 2
  • Catherine R. Lesko
    • 1
    Email author
  1. 1.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of MedicineJohns Hopkins School of MedicineBaltimoreUSA
  3. 3.Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillUSA

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