All-cause and cause-specific mortality among people with regular or problematic cocaine use: a systematic review and meta-analysis

Amy Peacock; Lucy Thi Tran; Sarah Larney; Emily Stockings; Thomas Santo Jr; Hayley Jones; Damian Santomauro; Louisa Degenhardt

doi:10.1111/add.15239

All-cause and cause-specific mortality among people with regular or problematic cocaine use: a systematic review and meta-analysis

Addiction. 2021 Apr;116(4):725-742. doi: 10.1111/add.15239. Epub 2020 Sep 21.

Authors

Amy Peacock^{1

2}, Lucy Thi Tran¹, Sarah Larney^{1

3}, Emily Stockings¹, Thomas Santo Jr¹, Hayley Jones⁴, Damian Santomauro^{5

6}, Louisa Degenhardt¹

Affiliations

¹ National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia.
² School of Psychology, University of Tasmania, Hobart, Australia.
³ Department of Family Medicine and Emergency Medicine, Université de Montréal and Centre de Recherche du CHUM, Canada.
⁴ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
⁵ Queensland Centre for Mental Health Research and School of Public Health, University of Queensland, Brisbane, Australia.
⁶ Institute for Health Metrics and Evaluation, University of Washington, WA, USA.

Abstract

Aims: To estimate pooled all-cause and cause-specific mortality risk for people with regular or problematic cocaine use.

Methods: Systematic review and meta-analysis of prospective or retrospective cohort studies or clinical trials (n ≥30) of people with regular or problematic cocaine use with data on all-cause or cause-specific mortality. Of 2808 papers, 28 were eligible and reported on 21 cohorts, with a total 170 019 individuals. Cohorts identified based on acute care for drug poisoning or other severe health presentation were excluded. Title/abstract screening was conducted by one reviewer; a second reviewer independently checked 10% of excluded studies. Two reviewers conducted full-text screening. Data were extracted by one reviewer and checked by a second. A customized review-specific study reporting quality/risk of bias tool was used. Data on crude mortality rates (CMR) and standardized mortality ratios were extracted for both all-cause and cause-specific mortality. Standardized mortality ratios were imputed where not provided by the author using extracted data and information from the Global Burden of Disease Study 2017. Data were pooled using a random-effects model.

Results: The pooled all-cause crude mortality rate was 1.24 per 100 person-years [95% confidence interval (CI) = 0.86, 1.78; n = 16 cohorts], but with considerable heterogeneity (I² = 98.8%). The pooled all-cause standardized mortality ratio (SMR) was 6.13 (95% CI = 4.15, 9.05; n = 16 cohorts). Suicide (SMR = 6.26, 95% CI = 2.84, 13.80), accidental injury (SMR = 6.36, 95% CI = 4.18, 9.68), homicide (SMR = 9.38, 95% CI 3.45-25.48) and AIDS-related mortality (SMR = 23.12, 95% CI = 11.30, 47.31) were all elevated compared with age and sex peers in the general population.

Conclusions: There are elevated rates of mortality among people with regular or problematic cocaine use for traumatic deaths and deaths attributable to infectious disease.

Keywords: Cardiovascular; cocaine; homicide; infectious disease; injury; mortality; suicide.

Publication types

Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Cause of Death
Cocaine*
Humans
Prospective Studies
Retrospective Studies
Suicide*

Substances

Cocaine

Abstract

Publication types

MeSH terms

Substances

Grants and funding