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Premature deaths among Vietnamese injection drug users: predictors and prevention
V.M. Quan1, V.F. Go1, N.P. Ngoc2, T.V. Ha3, D.D. Celentano1, T.T. Mo3, N.L. Minh2
1Johns Hopkins University, Baltimore, United States, 2Center for Preventive Medicine, Thai Nguyen, Viet Nam, 3Johns Hopkins University, Ha Noi, Viet Nam
Background: Premature deaths among Vietnamese injection drug users (IDUs) have been anecdotally reported as common, but no data exist to suggest the magnitude of the problem or to guide prevention efforts. This study investigates the extent and the predictors of mortality among community dwelling IDUs in northern Vietnam.
Methods: From August 2005 to July 2007, we conducted a prospective cohort study of 856 male IDUs in Thai Nguyen province (median age = 32 [range = 18-59], all injected heroin, 23% were HIV-positive). The participants were screened, enrolled, and followed at 3-month intervals for one year. Cox’s proportional hazards models were constructed to estimate cause-specific hazards of death for drug overdose and non-overdose deaths.
Results: During 689 person-years of follow up, 43 injectors died (at median age = 32; 26% were drug overdose deaths). The overall mortality rate was 6% per year, and was significantly higher (p<0.001) among HIV-positive IDUs (14%/year) than among HIV-negatives (4%/year). In multivariate analyses, injecting benzodiazepines in addition to heroin during the 3-month period prior to enrollment increased the hazard of overdose deaths by 4.9 times (95% CI = 1.3-17.9) compared to heroin injection alone. For non-overdose deaths, IDUs who were HIV-positive at enrollment had a 20% increase in the hazard of deaths (HR = 1.2, 95% CI = 1.1-1.4) compared to HIV-negative IDUs, and a history of tuberculosis increased the hazard by 2.2 times (95% CI = 1.4-3.5).
Conclusions: The observed death rate was high. The IDUs should be informed of the risk of fatal overdose associated with injecting benzodiazepines. Increased access to effective tuberculosis treatment and antiretroviral therapy may help reduce premature deaths among the drug users.
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