- 作者：Sarah Larney ; Deborah R ; all ; Amy Gibson ; Louisa Degenhardt
- 关键词：Heroin ; Opioids ; Mortality ; Hepatitis C ; Liver disease
- 刊名：Drug and Alcohol Dependence
- 出版年：2013
- 出版时间：1 August, 2013
- 年：2013
- 卷：131
- 期：3
- 页码：252-257
- 全文大小：332 K
Background
Mortality rates are elevated among heroin-dependent populations compared to the general population. Liver disease is emerging as an important contributor to mortality as the heroin-dependent population ages. Two major risk factors for liver disease are hepatitis C virus infection and chronic heavy alcohol use. Both of these are highly prevalent among heroin dependent people, but their relative contribution to liver-related mortality is poorly understood.Methods
Data recording all prescriptions of opioid substitution treatment in New South Wales, Australia, 1997-2005, were linked to the National Death Index. Crude and standardised mortality rates and standardised mortality ratios were calculated for liver-related and other major causes of death. Frequency counts were obtained for viral hepatitis and alcohol mentions in underlying liver deaths.
Results
There were 208 underlying liver deaths for a CMR of 72.4 per 100,000 py (95 % CI 62.9, 82.9), and liver deaths occurred at 9.8 times the general population rate (95 % CI 8.5, 11.2). There were increases in liver-related mortality over time. Viral hepatitis was mentioned in three-quarters (n = 156, 76 % ), and alcohol in 43 % (n = 90) of underlying liver deaths.
Conclusions
Liver-related deaths were shown to be increasing in this heroin-dependent population, and the majority of these deaths involved chronic viral hepatitis infection. Increased uptake of treatment for hepatitis C virus infection is crucial to reducing the burden of liver-related mortality in this population. Hepatitis B vaccination, and screening of OST patients for alcohol use disorders and delivery of brief interventions as clinically indicated may also be of benefit.