Format

Send to

Choose Destination
CMAJ. 2017 Nov 6;189(44):E1352-E1359. doi: 10.1503/cmaj.160778.

The Cedar Project: mortality among young Indigenous people who use drugs in British Columbia.

Author information

1
School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC.
2
School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC spittal@sm.hivnet.ubc.ca.

Abstract

BACKGROUND:

Young Indigenous people, particularly those involved in the child welfare system, those entrenched in substance use and those living with HIV or hepatitis C, are dying prematurely. We report mortality rates among young Indigenous people who use drugs in British Columbia and explore predictors of mortality over time.

METHODS:

We analyzed data collected every 6 months between 2003 and 2014 by the Cedar Project, a prospective cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, BC. We calculated age-standardized mortality ratios using Indigenous and Canadian reference populations. We identified predictors of mortality using time-dependent Cox proportional hazard regression.

RESULTS:

Among 610 participants, 40 died between 2003 and 2014, yielding a mortality rate of 670 per 100 000 person-years. Young Indigenous people who used drugs were 12.9 (95% confidence interval [CI] 9.2-17.5) times more likely to die than all Canadians the same age and were 7.8 (95% CI 5.6-10.6) times more likely to die than Indigenous people with Status in BC. Young women and those using drugs by injection were most affected. The leading causes of death were overdose (n = 15 [38%]), illness (n = 11 [28%]) and suicide (n = 5 [12%]). Predictors of mortality included having hepatitis C at baseline (adjusted hazard ratio [HR] 2.76, 95% CI 1.47-5.16), previous attempted suicide (adjusted HR 1.88, 95% CI 1.01-3.50) and recent overdose (adjusted HR 2.85, 95% CI 1.00-8.09).

INTERPRETATION:

Young Indigenous people using drugs in BC are dying at an alarming rate, particularly young women and those using injection drugs. These deaths likely reflect complex intersections of historical and present-day injustices, substance use and barriers to care.

PMID:
29109208
PMCID:
PMC5675541
DOI:
10.1503/cmaj.160778
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: Eric Yoshida has been an investigator for clinical trials (outside the work reported here) sponsored by Abbvie, Gilead Sciences Inc., Merck Inc., Janssen Inc., Springbank Inc., Intercept Inc. and Genfit Inc.; he has also received honoraria for continuing medical education lectures sponsored by Gilead Sciences Canada Inc., Merck Canada Inc. and Celgene Canada Inc. Patricia Spittal has received grants from Gilead for cultural safety supports and from Merck for an HCV blanket program. No other competing interests were declared.

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center