Premature Death as the Ultimate Failure: Predictors of Death in the US Drug User Treatment Population

Abstract

Premature death is the ultimate failure in public health. Failure to complete substance user treatment increases the likelihood of death. Using the five-year follow-up (1990/91–1995/96) of a representative sample of 3,047 clients discharged from drug user treatment, this article documents that deaths after treatment were 4.7 times higher for substance user treatment clients than for the U.S. population matched by age, sex, and race; death rates ranged from 3.5 times as likely for Black males to nine times as likely for White females. Logistic regression models show that completion of treatment is associated with a three-fifths decreased likelihood of death.

Keywords :

• premature death
• public health
• drug user treatment
• death
• treatment completion

Notes

2 We developed estimates of the expected number of deaths in the sample involved multiplying the five-year age-sex-race-specific death rates of the United States by the size of the initial SROS sample in each age-sex-race category at the beginning of the sample period, using these steps: (1) The 1990 age-sex-race-specific death rates per 100,000 were multiplied by five to reflect the observed interval of five posttreatment years; (2) This proportion was multiplied by the sample size in each group, and the result was the expected number of deaths in each age-sex-race group. The resulting numbers of deaths for each age group and category were then summed to produce the number of each demographic subgroup that would be expected to die during the five-year period. This process was carried out separately for Blacks and Whites, and for males and females; the four totals sum to the total number of the sample clients who would be expected to die during the period. The SROS sample included very few individuals younger than 15 years or older than 60 years, and the number of Hispanics in the sample was also relatively small. These small sample sizes for each of the subgroups would not support analyses of these subgroups. As a result, this analysis refers only to non-Hispanic Whites and Blacks 15–60 years of age at the time of discharge from the 1989–1990 index treatment episode, and it excludes Hispanics from both the expected and observed death totals. This methodological decision excludes from the analysis 53 individuals who died. Finally, although we compare the SROS population with the U.S. population, this study has not controlled for risk variables that are exogenous to this study (e.g., smoking rates, proportion residing in high-crime areas, health insurance status rates), but not exogenous to life outcomes.