Predictors of mortality among injecting and non‐injecting HIV‐negative drug users in northern Thailand

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Abstract
Aims  To estimate mortality rates among HIV‐negative injecting drug users (IDUs) and non‐injecting drug users (non‐IDUs), and to assess predictors for mortality among the IDUs.Design  Prospective cohort study in northern Thailand with 2‐year follow‐up.Setting  IDUs and non‐IDUs who were admitted for detoxification treatment for opiate or amphetamine dependence in a regional drug treatment center were screened. After discharge, HIV‐negative individuals were followed‐up in the community.Participants  A total of 821 HIV‐negative drug users [346 IDUs (42%) and 475 non‐IDUs, median age = 32; 51% were ethnic minorities].Measurements  All‐cause mortality.Findings  There were 33 deaths over 1360 person‐years of follow‐up. The all‐cause mortality rate was 39 per 1000 person‐years among IDUs [standardized mortality ratio (SMR) = 13.9], and was 14 per 1000 person‐years among non‐IDUs (SMR = 4.4). Among male IDUs, the hazards for all‐cause deaths were ethnic minority status [adjusted hazard ratio (HR) = 2.9, 95% CI = 1.2–7.2], incident HIV infection (HR = 2.8, 95% CI = 1.1–7.7) and longer duration of drug injection (HR = 1.07, 95% CI = 1.01–1.14).Conclusions  The mortality among IDUs is high. Being from an ethnic minority, recent HIV acquisition, and a greater number of years of drug injection are predictors of mortality among the IDUs in this region.