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Drug-related deaths in a population-level cohort of people living with and without hepatitis C virus in British Columbia, Canada

BACKGROUND: The majority of new HCV infections in Canada occur in people who inject drugs. Thus, while curative direct antiviral agents (DAAs) herald a promising new era in hepatitis C virus (HCV) treatment, improving the lives and wellbeing of people living with HCV (PLHCV) must be considered in th...

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Autores principales: Samji, Hasina, Yu, Amanda, Wong, Stanley, Wilton, James, Binka, Mawuena, Alvarez, Maria, Bartlett, Sofia, Pearce, Margo, Adu, Prince, Jeong, Dahn, Clementi, Emilia, Butt, Zahid, Buxton, Jane, Gilbert, Mark, Krajden, Mel, Janjua, Naveed Z.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier B.V. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569420/
https://www.ncbi.nlm.nih.gov/pubmed/33091735
http://dx.doi.org/10.1016/j.drugpo.2020.102989
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author Samji, Hasina
Yu, Amanda
Wong, Stanley
Wilton, James
Binka, Mawuena
Alvarez, Maria
Bartlett, Sofia
Pearce, Margo
Adu, Prince
Jeong, Dahn
Clementi, Emilia
Butt, Zahid
Buxton, Jane
Gilbert, Mark
Krajden, Mel
Janjua, Naveed Z.
author_facet Samji, Hasina
Yu, Amanda
Wong, Stanley
Wilton, James
Binka, Mawuena
Alvarez, Maria
Bartlett, Sofia
Pearce, Margo
Adu, Prince
Jeong, Dahn
Clementi, Emilia
Butt, Zahid
Buxton, Jane
Gilbert, Mark
Krajden, Mel
Janjua, Naveed Z.
author_sort Samji, Hasina
collection PubMed
description BACKGROUND: The majority of new HCV infections in Canada occur in people who inject drugs. Thus, while curative direct antiviral agents (DAAs) herald a promising new era in hepatitis C virus (HCV) treatment, improving the lives and wellbeing of people living with HCV (PLHCV) must be considered in the context of reducing overdose-related harms and with a syndemic lens. We measure drug-related deaths (DRDs) among HCV-negative people and PLHCV in British Columbia (BC), Canada, and the impact of potent contaminants like fentanyl on deaths. METHODS: We identified DRDs among PLHCV and HCV-negative individuals from 2010 to 2018 in the BC Hepatitis Testers Cohort, a population-based dataset of ~1.7 million British Columbians comprising comprehensive administrative and clinical data. We estimated annual standardized liver- and drug-related mortality rates per 100,000 person-years (PY) and described the contribution of specific drugs, including fentanyl and its analogues, implicated in DRDs over time. RESULTS: DRDs constituted 20.1% of deaths among PLHCV and 4.7% of deaths among HCV-negative individuals; a 4.3-fold (95% confidence interval: 4.0-4.5) difference. Drug-related mortality overtook liver-related mortality for PLHCV in 2015 and HCV-negative individuals in 2016 and rose from 241.7 to 436.5 per 100,000 PY from 2010 to 2018 amongPLHCV and from 20.0 to 57.1 per 100,000 PY for HCV-negative individuals over the same period. The proportion of deaths attributable to drugs among PLHCV and HCV-negative individuals increased from 15.1% to 26.1% and 3.1% to 8.0%, in 2010 and 2018, respectively. The proportion of DRDs attributed solely to synthetic opioids such as fentanyl averaged across both groups increased from 2.1% in 2010 to 69.6% in 2017. CONCLUSION: Steep drug-related mortality increases among PLHCV and HCV-negative individuals over the last decade highlight the urgent need to address overdose-related drivers and harms in these populations using an integrated care approach.
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spelling pubmed-75694202020-10-19 Drug-related deaths in a population-level cohort of people living with and without hepatitis C virus in British Columbia, Canada Samji, Hasina Yu, Amanda Wong, Stanley Wilton, James Binka, Mawuena Alvarez, Maria Bartlett, Sofia Pearce, Margo Adu, Prince Jeong, Dahn Clementi, Emilia Butt, Zahid Buxton, Jane Gilbert, Mark Krajden, Mel Janjua, Naveed Z. Int J Drug Policy Research Paper BACKGROUND: The majority of new HCV infections in Canada occur in people who inject drugs. Thus, while curative direct antiviral agents (DAAs) herald a promising new era in hepatitis C virus (HCV) treatment, improving the lives and wellbeing of people living with HCV (PLHCV) must be considered in the context of reducing overdose-related harms and with a syndemic lens. We measure drug-related deaths (DRDs) among HCV-negative people and PLHCV in British Columbia (BC), Canada, and the impact of potent contaminants like fentanyl on deaths. METHODS: We identified DRDs among PLHCV and HCV-negative individuals from 2010 to 2018 in the BC Hepatitis Testers Cohort, a population-based dataset of ~1.7 million British Columbians comprising comprehensive administrative and clinical data. We estimated annual standardized liver- and drug-related mortality rates per 100,000 person-years (PY) and described the contribution of specific drugs, including fentanyl and its analogues, implicated in DRDs over time. RESULTS: DRDs constituted 20.1% of deaths among PLHCV and 4.7% of deaths among HCV-negative individuals; a 4.3-fold (95% confidence interval: 4.0-4.5) difference. Drug-related mortality overtook liver-related mortality for PLHCV in 2015 and HCV-negative individuals in 2016 and rose from 241.7 to 436.5 per 100,000 PY from 2010 to 2018 amongPLHCV and from 20.0 to 57.1 per 100,000 PY for HCV-negative individuals over the same period. The proportion of deaths attributable to drugs among PLHCV and HCV-negative individuals increased from 15.1% to 26.1% and 3.1% to 8.0%, in 2010 and 2018, respectively. The proportion of DRDs attributed solely to synthetic opioids such as fentanyl averaged across both groups increased from 2.1% in 2010 to 69.6% in 2017. CONCLUSION: Steep drug-related mortality increases among PLHCV and HCV-negative individuals over the last decade highlight the urgent need to address overdose-related drivers and harms in these populations using an integrated care approach. Elsevier B.V. 2020-12 2020-10-19 /pmc/articles/PMC7569420/ /pubmed/33091735 http://dx.doi.org/10.1016/j.drugpo.2020.102989 Text en © 2020 Elsevier B.V. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Research Paper
Samji, Hasina
Yu, Amanda
Wong, Stanley
Wilton, James
Binka, Mawuena
Alvarez, Maria
Bartlett, Sofia
Pearce, Margo
Adu, Prince
Jeong, Dahn
Clementi, Emilia
Butt, Zahid
Buxton, Jane
Gilbert, Mark
Krajden, Mel
Janjua, Naveed Z.
Drug-related deaths in a population-level cohort of people living with and without hepatitis C virus in British Columbia, Canada
title Drug-related deaths in a population-level cohort of people living with and without hepatitis C virus in British Columbia, Canada
title_full Drug-related deaths in a population-level cohort of people living with and without hepatitis C virus in British Columbia, Canada
title_fullStr Drug-related deaths in a population-level cohort of people living with and without hepatitis C virus in British Columbia, Canada
title_full_unstemmed Drug-related deaths in a population-level cohort of people living with and without hepatitis C virus in British Columbia, Canada
title_short Drug-related deaths in a population-level cohort of people living with and without hepatitis C virus in British Columbia, Canada
title_sort drug-related deaths in a population-level cohort of people living with and without hepatitis c virus in british columbia, canada
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569420/
https://www.ncbi.nlm.nih.gov/pubmed/33091735
http://dx.doi.org/10.1016/j.drugpo.2020.102989
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