High mortality among young crack cocaine users in Brazil – a 5-year follow-up study.
M Ribeiro, J Dunn, R Laranjeira, R Sesso
Aims: Follow-up studies show that smokers, alcoholics and heroin addicts have high mortality rates, but there is little information on crack users. We have investigated the mortality rate among this population, including its risk factors and causes of death. Design: A five-year follow-up study. Participants and Setting: A cohort of 131 crack dependent patients, admitted to a public detoxification unit in Sao Paulo between 1992 and 1994. Measurements: Data collected from a structured personal interview and from a review of patients' hospital records, confirming the deaths from records held at the Municipal Offices. Findings: Of the 124 (94.6%) patients located 23 (18.5%) had died (a mortality ratio of 7.6). Homicide was the commonest cause of death (n=13). Observed mortality rate, adjusted for age and sex, was 24.92 per 1000, whilst the expected all-cause mortality rate in São Paulo, also adjusted for age and sex, was 3.28 per 1000, giving an excess mortality rate of 21.64 per 1000. Survival analysis showed that the probability of being alive 5 years post-treatment was 0.80 (95% CI = 0.77 to 0.84). Cox's proportional hazards regression showed 3 factors predicted mortality: history of intravenous drug use (hazard ratio 3.28, 95% CI 1.42 – 7.59), unemployment at index admission (hazard ratio 3.48, 95% CI 1.03 – 11.80) and premature discharge from index admission (hazard ratio 2.21, CI 0.94 – 5.18).
Conclusions: Community-based and tailored interventions should be considered to improve those patients' social support and permanence in treatment.