The Cedar Project: mortality among young Indigenous people who use drugs in British Columbia
| Autor: | Wayne M. Christian, Eric M Yoshida, Lou Demerais, Earl Henderson, David S. Zamar, Margo E. Pearce, Alden Blair, Kate Jongbloed, Richa Sharma, Martin T. Schechter, Sherri Pooyak, V. O. Thomas, Patricia M. Spittal |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Adolescent Indigenous Cohort Studies 03 medical and health sciences Young Adult 0302 clinical medicine Environmental protection Cause of Death medicine Confidence Intervals Humans 030212 general & internal medicine Prospective Studies Young adult Prospective cohort study Substance Abuse Intravenous 030505 public health British Columbia business.industry Mortality rate Hazard ratio General Medicine Hepatitis C medicine.disease Substance abuse Suicide Indians North American Commentary Regression Analysis Female Drug Overdose 0305 other medical science business Demography Cohort study |
| Zdroj: | CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 189(44) |
| ISSN: | 1488-2329 |
| Popis: | BACKGROUND: Young Indigenous people, particularly those involved in the child welfare system, those entrenched in substance use and those living with HIV or hepatitis C, are dying prematurely. We report mortality rates among young Indigenous people who use drugs in British Columbia and explore predictors of mortality over time. METHODS: We analyzed data collected every 6 months between 2003 and 2014 by the Cedar Project, a prospective cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, BC. We calculated age-standardized mortality ratios using Indigenous and Canadian reference populations. We identified predictors of mortality using time-dependent Cox proportional hazard regression. RESULTS: Among 610 participants, 40 died between 2003 and 2014, yielding a mortality rate of 670 per 100 000 person-years. Young Indigenous people who used drugs were 12.9 (95% confidence interval [CI] 9.2–17.5) times more likely to die than all Canadians the same age and were 7.8 (95% CI 5.6–10.6) times more likely to die than Indigenous people with Status in BC. Young women and those using drugs by injection were most affected. The leading causes of death were overdose (n = 15 [38%]), illness (n = 11 [28%]) and suicide (n = 5 [12%]). Predictors of mortality included having hepatitis C at baseline (adjusted hazard ratio [HR] 2.76, 95% CI 1.47–5.16), previous attempted suicide (adjusted HR 1.88, 95% CI 1.01–3.50) and recent overdose (adjusted HR 2.85, 95% CI 1.00–8.09). INTERPRETATION: Young Indigenous people using drugs in BC are dying at an alarming rate, particularly young women and those using injection drugs. These deaths likely reflect complex intersections of historical and present-day injustices, substance use and barriers to care. |
| Databáze: | OpenAIRE |
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