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Death after diagnosis of noncommunicable disease comorbid conditions, stratified by injection drug use

Lesko, Catherine R.a; Lau, Bryana,b; Chander, Geetanjalia,b; Moore, Richard D.a,b

doi: 10.1097/QAD.0000000000002054
Epidemiology and Social

Objective: Describe all-cause mortality associated with history of injection drug use (IDU) after a validated diagnosis of four noncommunicable disease (NCD) diagnoses: end-stage liver disease (ESLD); end-stage renal disease (ESRD); cancer; or myocardial infarction (MI) or stroke.

Design: We followed four cohorts of persons in continuity HIV care in the Johns Hopkins HIV Clinic with a validated diagnosis of ESLD (n = 67), ESRD (n = 187), cancer (n = 424), and MI or stroke (n = 213) from 1996 through approximately 2014.

Methods: Crude and adjusted Cox proportional hazards models to estimate hazard ratios for death after a validated diagnosis of one of four NCD diagnoses associated with history of IDU as an HIV acquisition risk factor.

Results: History of IDU was not associated with death after ESRD (adjusted hazard ratio 0.98, 95% confidence interval (CI) 0.57–1.68). Associations between history of IDU and death after ESLD and MI or stroke were weak, imprecise and not statistically significant (hazard ratio 1.17, 95% CI 0.63–2.19; hazard ratio 1.21, 95% CI 0.80–1.83). History of IDU was not associated with death after cancer in the first 6 months, but subsequently, the adjusted hazard ratio was 2.03 (95% CI 1.26–3.27).

Conclusion: Persons with a history of injection drug use and non-IDU had strikingly similar risk and hazard of mortality after several major NCD diagnoses. Mortality after cancer diagnosis in this cohort was higher for persons with a history of IDU than those without; this may be because of being diagnosed with a different mix of specific sites and stages of cancers.

aDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health

bDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.

Correspondence to Catherine R. Lesko, MPH, PhD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe St, Baltimore, MD 21205, USA. Tel: +1 410 614 6517; fax: +1 410 955 0863; e-mail:

Received 15 May, 2018

Accepted 21 September, 2018

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