Excess Mortality Among Injection Drug Users With AIDS, New York City (1999–2004)

Abstract

We calculated proportions and trends in contributing causes of death among persons with AIDS (PWA) and a history of injection drug use (IDU) in New York City and compared the proportions with those among PWA with a transmission risk of high-risk heterosexual sex (HRH) and men who have sex with men (MSM). We included all 10,575 injection drug user, HRH, and MSM residents aged 13+ years with AIDS reported by September 30, , who died from 1999 through 2004. Accidental drug overdose was the most frequent contributing cause of death among IDUs (20.5%). Overdose prevention initiatives may greatly and immediately reduce deaths among PWA.

Keywords :

• mortality
• cause of death
• overdose
• injection drug users
• AIDS
• preventable death

THE AUTHORS

Melissa R. Pfeiffer, MPH, has been a research scientist at the New York City Department of Health and Mental Hygiene (NYC DOHMH) since 2001. After 6 years with the HIV Epidemiology and Field Services Program, she is now Research Director of an early childhood development project in the Bureau of Epidemiology Services.

David B. Hanna, MS, was a research scientist at the HIV Epidemiology and Field Services Program of the NYC DOHMH, where he worked in HIV surveillance. He holds a Master's of Science degree from the Harvard School of Public Health and is currently pursuing a PhD in epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

Elizabeth M. Begier, MD, is a medical epidemiologist and public health physician. She oversees the HIV surveillance, research, and partner notification programs at the NYC DOHMH. She has authored over 25 articles, including publication on disease surveillance, outbreak investigations, HIV testing, and partner notification.

Kent A. Sepkowitz, MD, received his BA in English then his MD from the University of Oklahoma in 1980 and completed his residency and chief residency in internal medicine at Roosevelt Hospital in New York City. After a fellowship in infectious diseases at Memorial Sloan-Kettering Cancer Center (MSKCC), he joined the faculty, where he has remained. He is currently a member, Memorial Hospital and a Professor of Medicine, Weill Medical College of Cornell University. He is Vice Chairman of Medicine and Director of Infection Control at MSKCC. He serves as a Senior Advisor to the DOHMH, Bureau of HIV/AIDS Prevention and Control. He is the author of over 200 articles, chapters, and reviews on issues relating to HIV and other immunocompromised hosts.

Regina Zimmerman, PhD, MPH, is Director of the Office of Vital Statistics of the NYC DOHMH. Her professional background includes positions in the pharmaceutical industry (training, marketing, and clinical research), training as a cancer epidemiologist (National Cancer Institute Predoctoral training fellow at Columbia University Divisions of Epidemiology, Biostatistics, and Environmental Health Sciences in Cancer Epidemiology; Program Director at Metropolitan NY Registry of Breast and Ovarian Cancer Families, NCI grant operated by Columbia University, and Mailman School of Public Health, Department of Epidemiology), and management as an Assistant Commissioner at the DOHMH for the Bureau of Public Health Training. In her current position, she is responsible for the analyses and reporting of NYC's vital data, the quality of NYC's vital data, expansion of data access and use for public health interventions, surveillance and research and vital data disclosure and confidentiality policies. Dr. Zimmerman has initiated and participates in interventions and research that address vital data quality improvement.

Judith E. Sackoff, PhD, is the Director of Research and Evaluation for the Bureau of Maternal, Infant and Reproductive Health at the NYC DOHMH. Her research focuses on measurement issues in the use of birth and infant death vital records and the impact of maternal chronic health conditions such as obesity on birth outcomes. She worked for more than 10 years in the HIV Epidemiology Program at the NYC DOHMH, most recently as the Director of HIV Surveillance. She received her PhD (Epidemiology) in 1992 from Columbia University.