TY - JOUR
T1 - Speed kills
T2 - Associations between methamphetamine use, HIV infection, tobacco use, and accelerated mortality among gay and bisexual men in Los Angeles, CA 20years after methamphetamine dependence treatment
AU - Passaro, R. Colby
AU - Ramsey, Keenan
AU - Segura, Eddy R.
AU - Lake, Jordan E.
AU - Reback, Cathy J.
AU - Clark, Jesse L.
AU - Shoptaw, Steve
N1 - Publisher Copyright:
© 2018 Elsevier B.V.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Background: To better characterize mortality among methamphetamine users, we estimated rates of all-cause mortality by HIV serostatus and smoking history in gay and bisexual men (GBM) treated for methamphetamine dependence, and explored associated clinical and socio-behavioral characteristics. Methods: We searched public records to identify deaths among men screened between 1998–2000 for a trial of outpatient therapy for GBM with methamphetamine dependence. Crude mortality rates (CMRs) were calculated, and standardized mortality ratios (SMRs) estimated, comparing data with historical information from CDC WONDER. Associations of mortality with HIV infection, tobacco use, and other factors were explored using Kaplan-Meier survival analysis and Cox proportional hazards models. Results: Of 191 methamphetamine-dependent GBM (median age 35 years; majority Caucasian), 62.8% had HIV infection, and 31.4% smoked tobacco at baseline. During the 20-year follow-up period, 12.6% died. Relative to controls, methamphetamine-dependent GBM had a three-fold higher 20-year SMR: 3.39, 95% CI: 2.69-4.09. Especially high mortality was observed among participants reporting tobacco use (adjusted HR 3.48, 95% CI: 1.54–7.89), club drug use prior to starting methamphetamine (2.63, 1.15–6.00), or other clinical diagnoses at baseline (3.89, 1.15–13.22). At 20 years, the CMR for HIV infected participants (7.7 per 1000 PY) was 1.5 times that for men without HIV (5.2 per 1000 PY; p = 0.22) and there was a 5-fold difference in CMRs for HIV infected tobacco smokers (16.9 per 1000 PY) compared to non-smokers (3.4 per 1000 PY; p < 0.01). Conclusion: In our sample of methamphetamine-dependent GBM, concomitant HIV infection and tobacco use were associated with dramatic increases in mortality.
AB - Background: To better characterize mortality among methamphetamine users, we estimated rates of all-cause mortality by HIV serostatus and smoking history in gay and bisexual men (GBM) treated for methamphetamine dependence, and explored associated clinical and socio-behavioral characteristics. Methods: We searched public records to identify deaths among men screened between 1998–2000 for a trial of outpatient therapy for GBM with methamphetamine dependence. Crude mortality rates (CMRs) were calculated, and standardized mortality ratios (SMRs) estimated, comparing data with historical information from CDC WONDER. Associations of mortality with HIV infection, tobacco use, and other factors were explored using Kaplan-Meier survival analysis and Cox proportional hazards models. Results: Of 191 methamphetamine-dependent GBM (median age 35 years; majority Caucasian), 62.8% had HIV infection, and 31.4% smoked tobacco at baseline. During the 20-year follow-up period, 12.6% died. Relative to controls, methamphetamine-dependent GBM had a three-fold higher 20-year SMR: 3.39, 95% CI: 2.69-4.09. Especially high mortality was observed among participants reporting tobacco use (adjusted HR 3.48, 95% CI: 1.54–7.89), club drug use prior to starting methamphetamine (2.63, 1.15–6.00), or other clinical diagnoses at baseline (3.89, 1.15–13.22). At 20 years, the CMR for HIV infected participants (7.7 per 1000 PY) was 1.5 times that for men without HIV (5.2 per 1000 PY; p = 0.22) and there was a 5-fold difference in CMRs for HIV infected tobacco smokers (16.9 per 1000 PY) compared to non-smokers (3.4 per 1000 PY; p < 0.01). Conclusion: In our sample of methamphetamine-dependent GBM, concomitant HIV infection and tobacco use were associated with dramatic increases in mortality.
KW - Gay and bisexual men (GBM)
KW - Human immunodeficiency virus (HIV)
KW - Methamphetamine
KW - Mortality
KW - Survival
KW - Tobacco
UR - http://www.scopus.com/inward/record.url?scp=85060631427&partnerID=8YFLogxK
U2 - 10.1016/j.drugalcdep.2018.06.036
DO - 10.1016/j.drugalcdep.2018.06.036
M3 - Artículo
C2 - 30429048
AN - SCOPUS:85060631427
SN - 0376-8716
VL - 195
SP - 164
EP - 169
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
ER -