Drastic elevations in mortality among female injection drug users in a Canadian setting

Abstract

The health and social conditions of women living in Vancouver's Downtown Eastside has recently been the focus of substantial international attention. Since few studies have examined rates and correlates of death among addicted women in Canada, we have characterized patterns of mortality among female injection drug users (IDUs) in Vancouver. The Vancouver Injection Drug Users Study (VIDUS) is a prospective open cohort study of IDUs. The analyses presented here, were restricted to women enrolled between May 1996 and May 2002 and who were aged 14 years or older. We estimated cumulative mortality rates using Kaplan-Meier methods and Cox regression was used to calculate univariate and adjusted relative hazards. Between May 1996 and May 2002, 520 female IDUs have been recruited from the Vancouver area among whom 68 died during the study period. Elevated rates of mortality were observed among those who reported, baseline sex-trade involvement, those with HIV-infection at baseline, and those who lived in unstable housing at baseline (all log-rank: p<0.05). In adjusted analyses, HIV infection (RH = 3.09 [95% CI: 1.86–5.11]; p<0.001), unstable housing (RH = 1.74 [95% CI: 1.10–2.86]; p=0.029) and sex-trade involvement (RH = 1.82 [95% CI: 0.95–3.45]; p=0.071) were associated with the time to death. When the number of observed deaths was compared to the number of expected deaths based on the general female population of British Columbia using indirect standardization, the rate of death among female IDUs was elevated by a factor of 47.3 (95% CI: 36.1–58.5). In Vancouver, female IDUs have rates of mortality almost 50 times that of the province's female population. Our findings are consistent with a growing number of reports from other settings internationally, and demonstrate the need for an appropriate evidence-based strategy to address the health and social needs of addicted women.

Acknowledgments

The authors wish to acknowledge the contribution of all participants of the VIDUS study. This study would not have been possible without the financial support of Status of Women Canada, and the mentorship of Dr Michael O'Shaughnessy who spent much of his career bringing attention to the health crisis in the Downtown Eastside. Robert Hogg and Evan Wood are supported by the Michael Smith Foundation for Health Research and the Canadian Institutes of Health Research.

We also thank Bonnie Devlin, Elizabeth Ferris, Nada Gataric, Kelly Hsu, Myrna Reginaldo, Chandra Lips, and Peter Vann, John Charette, Kathy Churchill, Robin Brooks, Steve Kain, and Nancy Laliberte for their research and administrative assistance.