Titre : | Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies (2011) |
Titre traduit : | (Mortalité chez les usagers réguliers ou dépendants à l'héroïne et aux autres opioïdes : revue systématique de la littérature et méta-analyse d'études de cohorte) |
Auteurs : | L. DEGENHARDT ; C. BUCELLO ; B. MATHERS ; C. BRIEGLEB ; H. ALI ; M. HICKMAN ; J. MCLAREN |
Type de document : | Article : Périodique |
Dans : | Addiction (Vol.106, n°1, January 2011) |
Article en page(s) : | 32-51 |
Langues: | Anglais |
Discipline : | EPI (Epidémiologie / Epidemiology) |
Mots-clés : |
Thésaurus mots-clés USAGE REGULIER ; HEROINE ; OPIOIDES ; MORTALITE ; EPIDEMIOLOGIE ; DEPENDANCE ; USAGER ; COHORTE |
Résumé : | AIMS: To review the literature on mortality among dependent or regular users of opioids across regions, according to specific causes, and related to a number of demographic and clinical variables. METHODS: Multiple search strategies included searches of Medline, EMBASE and PsycINFO, consistent with the methodology recommended by the Meta-analysis of Observational Studies in Epidemiology (MOOSE) group; grey literature searches; and contact of experts for any additional unpublished data from studies meeting inclusion criteria. Random-effects meta-analyses were conducted for crude mortality rates (CMRs) and standardized mortality ratios (SMRs), with stratified analyses where possible. Meta-regressions examined potentially important sources of heterogeneity across studies. RESULTS: Fifty-eight prospective studies reported mortality rates from opioid-dependent samples. Very high heterogeneity across studies was observed; pooled all-cause CMR was 2.09 per 100 person-years (PY; 95% CI; 1.93, 2.26), and the pooled SMR was 14.66 (95% CI: 12.82, 16.50). Males had higher CMRs and lower SMRs than females. Out-of-treatment periods had higher mortality risk than in-treatment periods (pooled RR 2.38 (CI: 1.79, 3.17)). Causes of death varied across studies, but overdose was the most common cause. Multivariable regressions found the following predictors of mortality rates: country of origin; the proportion of sample injecting; the extent to which populations were recruited from an entire country (versus subnational); and year of publication. CONCLUSIONS: Mortality among opioid-dependent users varies across countries and populations. Treatment is clearly protective against mortality even in non-randomized observational studies. Study characteristics predict mortality levels; these should be taken into account in future studies. |
Domaine : | Drogues illicites / Illicit drugs |
Sous-type de document : | Méta-analyse / Meta-analysis ; Revue de la littérature / Literature review |
Refs biblio. : | 85 |
Affiliation : | National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia / Australie |
Lien : | http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03140.x/abstract |
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