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Puértolas-Gracia B, Barbaglia MG, Gotsens M, Parés-Badell O, Brugal MT, Torrens M, Treviño L, Rodríguez-Díaz C, Vázquez-Vázquez JM, Pascual A, Coromina-Gimferrer M, Jiménez-Dueñas M, Oliva I, González E, Mestre N, Bartroli M. Lifetime Dual Disorder Screening and Treatment Retention: A Pilot Cohort Study. J Clin Med 2022; 11:jcm11133760. [PMID: 35807045 PMCID: PMC9267195 DOI: 10.3390/jcm11133760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/29/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
The coexistence of a substance use disorder and another mental disorder in the same individual has been called dual disorder or dual diagnosis. This study aimed to examine the prevalence of lifetime dual disorder in individuals with alcohol or cocaine use disorder and their retention in treatment. We conducted a pilot cohort study of individuals (n = 1356) with alcohol or cocaine use disorder admitted to treatment in the public outpatient services of Barcelona (Spain) from January 2015 to August 2017 (followed-up until February 2018). Descriptive statistics, Kaplan−Meier survival curves and a multivariable Cox regression model were estimated. The lifetime prevalence of screening positive for dual disorder was 74%. At 1 year of follow-up, >75% of the cohort remained in treatment. On multivariable analysis, the factors associated with treatment dropout were a positive screening for lifetime dual disorder (HR = 1.26; 95% CI = 1.00−1.60), alcohol use (HR = 1.35; 95% CI = 1.04−1.77), polysubstance use (alcohol or cocaine and cannabis use) (HR = 1.60; 95% CI = 1.03−2.49) and living alone (HR = 1.34; 95% CI = 1.04−1.72). Lifetime dual disorder is a prevalent issue among individuals with alcohol or cocaine use disorders and could influence their dropout from treatment in public outpatient drug dependence care centres, along with alcohol use, polysubstance use and social conditions, such as living alone. We need a large-scale study with prolonged follow-up to confirm these preliminary results.
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Affiliation(s)
- Beatriz Puértolas-Gracia
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - María Gabriela Barbaglia
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Biomedical Research Institute Sant Pau, IIB Sant Pau, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- Red de Investigación en Atención Primaria en Adicciones (RIAPAd), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93202-7702
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Oleguer Parés-Badell
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - María Teresa Brugal
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Marta Torrens
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
- Red de Investigación en Atención Primaria en Adicciones (RIAPAd), 28029 Madrid, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
- Faculty of Medicine, Universitat de Vic i Catalunya Central, Vic, 08500 Barcelona, Spain
| | - Lara Treviño
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Concepción Rodríguez-Díaz
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - José María Vázquez-Vázquez
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Alicia Pascual
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Marcela Coromina-Gimferrer
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Míriam Jiménez-Dueñas
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Israel Oliva
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Erick González
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Nicanor Mestre
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Montse Bartroli
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Biomedical Research Institute Sant Pau, IIB Sant Pau, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- Red de Investigación en Atención Primaria en Adicciones (RIAPAd), 28029 Madrid, Spain
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Konrad G, Leong C, Bolton JM, Prior HJ, Paillé MT, Nepon J, Singal D, Ekuma O, Enns JE, Nickel NC. Use of pharmacotherapy for alcohol use disorder in Manitoba, Canada: A whole-population cohort study. PLoS One 2021; 16:e0257025. [PMID: 34478448 PMCID: PMC8415582 DOI: 10.1371/journal.pone.0257025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 08/22/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Update the evidence on use of pharmacotherapy for alcohol use disorder in a Canadian population. METHODS Using whole-population administrative data from Manitoba, Canada, we identified all residents age 12+ who were first diagnosed with alcohol use disorder between April 1, 1996 and March 31, 2015, and compared characteristics of those who filled a prescription for naltrexone, acamprosate or disulfiram at least once during that period to those who did not fill a prescription for an alcohol use disorder medication. RESULTS Only 1.3% of individuals with alcohol use disorder received pharmacotherapy (62.3% of prescriptions were for naltrexone, 39.4% for acamprosate, 7.5% for disulfiram). Most prescriptions came from family physicians in urban alcohol use disorder (53.6%) and psychiatrists (22.3%). Individuals were more likely to fill a prescription for alcohol use disorder medication if they lived in an urban vs rural environment (OR 2.25; 95% CI 1.83-2.77) or had a mood/anxiety disorder diagnosis vs no diagnosis (OR 2.40, 95% CI 1.98-2.90) in the five years before being diagnosed with alcohol use disorder. CONCLUSION Despite established evidence for the effectiveness of pharmacotherapy for alcohol use disorder, these medications continue to be profoundly underutilized in Canada.
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Affiliation(s)
- Geoffrey Konrad
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Christine Leong
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James M. Bolton
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Heather J. Prior
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Michael T. Paillé
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Josh Nepon
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Deepa Singal
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jennifer E. Enns
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nathan C. Nickel
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Dept. of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Chikritzhs T, Livingston M. Alcohol and the Risk of Injury. Nutrients 2021; 13:2777. [PMID: 34444939 PMCID: PMC8401155 DOI: 10.3390/nu13082777] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 12/14/2022] Open
Abstract
Globally, almost four and a half million people died from injury in 2019. Alcohol's contribution to injury-related premature loss of life, disability and ill-health is pervasive, touching individuals, families and societies throughout the world. We conducted a review of research evidence for alcohol's causal role in injury by focusing on previously published systematic reviews, meta-analyses and where indicated, key studies. The review summarises evidence for pharmacological and physiological effects that support postulated causal pathways, highlights findings and knowledge gaps relevant to specific forms of injury (i.e., violence, suicide and self-harm, road injury, falls, burns, workplace injuries) and lays out options for evidence-based prevention.
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Affiliation(s)
- Tanya Chikritzhs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6008, Australia;
| | - Michael Livingston
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6008, Australia;
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia
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McCutcheon VV, Bucholz KK, Houston-Ludlam AN, Waldron M, Heath AC. Timing of mortality in mothers with recurrent convictions for driving under the influence of alcohol and their children, from childbirth to child age 17. Drug Alcohol Depend 2021; 221:108620. [PMID: 33639571 PMCID: PMC8772583 DOI: 10.1016/j.drugalcdep.2021.108620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We tested variation in the timing of child and maternal mortality associated with severe maternal AUD, as represented by recurrent arrests for driving under the influence of alcohol (rDUI). METHODS rDUI mothers (N = 1614) and Controls with no alcohol-related driving offenses (N = 109,928) who gave birth in Missouri from 2000 to 2004 were identified using vital records. Propensity score matching adjusted for birth record measures including delayed prenatal care, smoking during pregnancy, relationship with reproductive partner [married/unmarried, paternity acknowledged/unacknowledged], partner DUI status from driving records, and for socioeconomic characteristics of maternal residential census tract at birth derived from census data. Survival analysis was used to test months from childbirth to child or maternal death as a function of lifetime rDUI status. RESULTS Maternal rDUIs were associated with a consistently elevated probability of child mortality from birth through child age 17 after propensity score-adjustment (Hazard Ratio [HR] = 1.70, 95 % CI = 1.17-2.47). Maternal mortality was not elevated, relative to Controls, until child age 6-11 (HR = 1.58, 95 % CI = 1.05-2.35) and increased again from child age 12-17 (HR = 4.12, 95 % CI = 3.04-5.86). CONCLUSIONS Severe maternal AUD, as characterized by rDUI, increases the risk for child mortality over that of Controls through age 17. Delays in rDUI maternal mortality until child age 6 may indicate a period when maternal referral for intervention to reduce harm to child and mother is likely to be especially effective.
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Affiliation(s)
- Vivia V. McCutcheon
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Kathleen K. Bucholz
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Alexandra N. Houston-Ludlam
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8134, St. Louis, MO 63110,Medical Scientist Training Program, Washington University School of Medicine in St. Louis, Missouri,Human and Statistical Genetics, Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, Missouri
| | - Mary Waldron
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8134, St. Louis, MO 63110,Department of Counseling and Educational Psychology, School of Education, Bloomington, Indiana University, Indiana
| | - Andrew C. Heath
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8134, St. Louis, MO 63110
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Abdul-Rahman AK, Card TR, Grainge MJ, Fleming KM. All-cause and cause-specific mortality rates of patients treated for alcohol use disorders: A meta-analysis. Subst Abus 2018; 39:509-517. [PMID: 29958085 DOI: 10.1080/08897077.2018.1475318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although alcohol use disorders (AUDs) are known to increase the relative risk of all-cause and some cause-specific mortality, the absolute mortality rates of the AUD population are unknown. Such knowledge would benefit planners of the provision of services for this population, including in prioritizing the identification and/or treatment of diseases likely to cause their death. METHODS We conducted a systematic review of studies in English, reporting the cause-specific mortality rates among people treated for AUDs. Number of deaths by cause and total person-years of follow-up were extracted. All-cause and cause-specific mortality rates per 1000 person-years were meta-analyzed assuming random effects. RESULTS Thirty-one studies were included. Participants were mainly middle-aged males. The quality of studies was generally good. A total of 6768 all-cause deaths in 276,990.7 person-years of follow-up (36,375 patients) were recorded, and the pooled all-cause mortality rate was 27.67/1000 person-years (py) (95% confidence interval [CI]: 23.9, 32.04). The most common cause of death in the AUD population was cardiovascular disease (CVD) (6.9/1000 py; 95% CI: 5.61, 8.49), followed by gastrointestinal deaths (5.63/1000 py; 95% CI: 4.1, 7.74), unnatural deaths (4.95/1000 py; 95% CI: 4.01, 6.09)), neoplasms, respiratory diseases, and substance use disorders. CONCLUSIONS Patients with AUDs have increased rates of all-cause and cause-specific mortality compared with the general population. Like the general population, they are most likely to die of CVD. In contrast to the general population, gastrointestinal and unnatural deaths are the next most common causes of death. We believe these facts should be considered when planning health care services for patients with AUDs.
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Affiliation(s)
- Abdul-Kareem Abdul-Rahman
- a Division of Epidemiology and Public Health, School of Medicine , University of Nottingham, Clinical Sciences Building, Hucknall Road , Nottingham , United Kingdom.,b UK Centre for Tobacco and Alcohol Studies , Clinical Sciences Building, Hucknall Road , Nottingham , United Kingdom
| | - Timothy R Card
- a Division of Epidemiology and Public Health, School of Medicine , University of Nottingham, Clinical Sciences Building, Hucknall Road , Nottingham , United Kingdom.,c Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and the University of Nottingham, Queens Medical Centre , Nottingham , United Kingdom
| | - Matthew J Grainge
- a Division of Epidemiology and Public Health, School of Medicine , University of Nottingham, Clinical Sciences Building, Hucknall Road , Nottingham , United Kingdom
| | - Kate M Fleming
- d Department of Public Health and Policy , University of Liverpool , Liverpool , United Kingdom
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Villalbí JR, Espelt A, Suelves JM, Bosque-Prous M, Bartroli M, Brugal MT. A population based perspective of twenty years of specialized ambulatory treatment for alcohol use disorders in publicly financed clinics. Barcelona 1996-2015. J Subst Abuse Treat 2018; 92:11-16. [PMID: 30032939 DOI: 10.1016/j.jsat.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/11/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To provide information on persons treated for alcohol use disorders (AUD) over 20 years in a large city in a Southern European country and its trends, adding knowledge on the frequency of treatment from a population perspective. METHODS This is a study of the number of annual admissions to ambulatory addiction treatment centers funded by the public sector in Barcelona (Catalonia, Spain) for the years 1996-2015. Descriptive analyses of AUD admissions were conducted, comparing changes in the number of patients entering treatment by different independent variables across periods. For city residents, sex and age-specific population annual treatment initiation rates were estimated. RESULTS The number of ambulatory admissions to AUD treatment increased over the study period. There were about 2100 treatment admissions per year in 2011-2015, of which one fourth were women. About half of these patients had never been treated before for any substance use disorder. Annual rates of treatment initiation among city residents were 208 and 68 per 100,000 people aged 15 and older for men and women respectively, almost the double among 45-54 years old citizens. Rates of total AUD treatment admission increased moderately, but declined among younger adult men. CONCLUSIONS These figures provide a basic population-based estimation for formal AUD treatment use in a Southern European urban setting with services available free of charge. The development of ambulatory publicly funded addiction centers may have improved access to treatment for people with AUD. age-related changes in treatment admissions may either be related to trends in the population pattern of drinking or to changes in the city demographics.
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Affiliation(s)
- Joan R Villalbí
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, 08023 Barcelona, Spain; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, C/ Melchor Fernández Almagro 3-5, 28029 Madrid, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, C/ Doctor Aiguader 80, 08003 Barcelona, Spain; Grupo de Trabajo sobre Alcohol (GTOH), Sociedad Española de Epidemiología, C/ Marina 27, 08005 Barcelona, Spain
| | - Albert Espelt
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, 08023 Barcelona, Spain; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, C/ Melchor Fernández Almagro 3-5, 28029 Madrid, Spain; Grupo de Trabajo sobre Alcohol (GTOH), Sociedad Española de Epidemiología, C/ Marina 27, 08005 Barcelona, Spain; Facultat de Ciències de la Salut de Manresa, Universitat de Vic Universitat Central de Catalunya (UVicUCC), Av. Universitària, 46, 08242 Manresa, Spain.
| | - Josep M Suelves
- Grupo de Trabajo sobre Alcohol (GTOH), Sociedad Española de Epidemiología, C/ Marina 27, 08005 Barcelona, Spain; Agència de Salut Pública de Catalunya, C/ Roc Boronat 81-95, 08005 Barcelona, Spain; Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018 Barcelona, Spain
| | - Marina Bosque-Prous
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, 08023 Barcelona, Spain; Grupo de Trabajo sobre Alcohol (GTOH), Sociedad Española de Epidemiología, C/ Marina 27, 08005 Barcelona, Spain; Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018 Barcelona, Spain
| | - Montse Bartroli
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, 08023 Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, C/ Doctor Aiguader 80, 08003 Barcelona, Spain
| | - M Teresa Brugal
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, 08023 Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, C/ Doctor Aiguader 80, 08003 Barcelona, Spain; Grupo de Trabajo sobre Alcohol (GTOH), Sociedad Española de Epidemiología, C/ Marina 27, 08005 Barcelona, Spain
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Colell E, Domingo-Salvany A, Espelt A, Parés-Badell O, Brugal MT. Differences in mortality in a cohort of cocaine use disorder patients with concurrent alcohol or opiates disorder. Addiction 2018; 113:1045-1055. [PMID: 29357115 DOI: 10.1111/add.14165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/21/2017] [Accepted: 01/12/2018] [Indexed: 12/24/2022]
Abstract
AIMS To study mortality in a cohort of cocaine use disorder patients, and compare results in those with concurrent alcohol or opiates disorder. DESIGN, SETTING AND PARTICIPANTS A cohort of 10 539 cocaine use disorder individuals entering drug treatment in public out-patient centres in the city of Barcelona was followed from 1997 to 2011. Participants were divided at baseline into three groups: those with only cocaine use disorder (CUD), those with cocaine and alcohol use disorder but not opioid (CAUD) and those with cocaine and opioid use disorder (COUD). Mortality was assessed through the Spanish National Mortality Register. MEASUREMENTS Crude mortality rates (CMR), standardized mortality ratios (SMR) and rate ratios (RR) were calculated for each group. A multivariable Cox regression model was fitted to obtain adjusted mortality hazard ratios (aHR) of CAUD and COUD with respect to CUD. Specific mortality causes were also examined. FINDINGS The total of 716 deaths registered resulted in a CMR = 6.0/1000 person-years (PY); 95% confidence interval (CI) = 5.1-7.0 for CUD, CMR = 5.8/1000 PY (95% CI = 4.9-6.7) for CAUD and CMR = 20.7/1000 PY (95% CI = 18.8-22.8) for COUD, with no significant differences among sexes. Compared with the general population, mortality was four times higher (SMR = 4.1, 95% CI = 3.5-4.8) among CUD, more than three times among CAUD (SMR = 3.4, 95% CI = 2.9-3.9) and more than 10 times among COUD (SMR = 11.6, 95% CI = 10.5-12.8), being always higher in women. External injuries, led by overdose, accumulated the biggest percentage of deaths among the three groups, but infectious diseases showed the highest excess mortality. Some differences regarding causes of death were observed between the three groups. CONCLUSIONS Mortality risk and excess mortality are significantly greater among those with cocaine and opiates use disorder than among people with only cocaine use disorder or cocaine and alcohol use disorder.
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Affiliation(s)
- Esther Colell
- Drug Abuse Epidemiology Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Antònia Domingo-Salvany
- Drug Abuse Epidemiology Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Albert Espelt
- Public Health Agency of Barcelona, Spain.,Institute of Biomedical Research Sant Pau, Barcelona, Spain.,Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Bellaterra, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Biomedical Research Centre Network for Epidemiology and Public Health (Spain), Madrid, Spain.,Facultat de Ciències de la Salut de Manresa, Universitat de Vic. Universitat Central de Catalunya (UVicUCC), Av Universitària, Manresa, Spain
| | - Oleguer Parés-Badell
- Public Health Agency of Barcelona, Spain.,Institute of Biomedical Research Sant Pau, Barcelona, Spain
| | - M Teresa Brugal
- Public Health Agency of Barcelona, Spain.,Institute of Biomedical Research Sant Pau, Barcelona, Spain
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Midlöv P, Calling S, Memon AA, Sundquist J, Sundquist K, Johansson SE. Women's health in the Lund area (WHILA)--Alcohol consumption and all-cause mortality among women--a 17 year follow-up study. BMC Public Health 2016; 16:22. [PMID: 26753789 PMCID: PMC4709864 DOI: 10.1186/s12889-016-2700-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background Alcohol consumption contributes to many negative health consequences and is a risk factor for death. Some previous studies however suggest a J-shaped relationship between the level of alcohol consumption and all-cause mortality. These findings have in part been suggested to be due to confounders. The aim of our study was to analyze the relationship between self-reported alcohol intake and all-cause mortality in women, adjusted for sociodemographic, lifestyle factors and diseases such as diabetes and previous ischemic heart disease. Methods All women aged 50–59 years (born between 1935 and 1945) that lived in any of the five municipalities in southern Sweden were invited to participate in a health survey. From December 1995 to February 2000 a total of 6916 women (out of 10,766, the total population of women in 1995) underwent a physical examination and answered a questionnaire. We followed the women from the day of screening until death, or if no event occurred until May 31st 2015. Mortality was ascertained through the national cause-of-death register. Results In this study a total of 6353 women were included. Alcohol consumption showed a J-formed relationship with mortality, when adjusted for education, marital status, smoking, BMI, physical fitness, diabetes and ischemic heart disease before screening. Non consumption of alcohol was associated with increased mortality as well as higher levels of consumption, from 12 grams per day and upwards. Conclusions There was a clear J-shaped relation between the amount of alcohol consumption and all-cause mortality even after controlling for sociodemography, lifestyle factors and diseases such as diabetes and previous ischemic heart disease. The observed protective effect of light drinking (1–12 grams/day) could thus not be attributed to any of these known confounders.
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Affiliation(s)
- Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.
| | - Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
| | - Ashfaque A Memon
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
| | - Sven-Erik Johansson
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
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