Gregory D Deans1, Jesse D Raffa2, Calvin Lai3, Benedikt Fischer4, Mel Krajden5, Janaki Amin6, Scott R Walter7, Gregory J Dore6, Jason Grebely6, Mark W Tyndall8. 1. Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC. 2. Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ont. 3. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC. 4. Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. 5. British Columbia Centre for Disease Control, Vancouver, BC. 6. The Kirby Institute for infection and immunity in society, University of New South Wales, Sydney, Australia. 7. Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia. 8. Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ont.
Abstract
BACKGROUND: The Downtown Eastside is a robust and densely populated neighbourhood in Vancouver, Canada, that is characterized by low-income housing and drug use and a high prevalence of HIV infection. We evaluated mortality and excess mortality among the broader community of individuals living in this neighbourhood. METHODS: The Community Health and Safety Evaluation is a community-based study of inner-city residents in the Downtown Eastside who were recruited in 2003 and 2004. Participants' data were linked with data in provincial virology and mortality databases retrospectively and prospectively for the period 1991-2009. Mortality and standardized mortality ratios (SMRs) were calculated for the period 2003-2009 to compare death rates in the study population with rates in the population of Vancouver. RESULTS: Among 2913 participants, 374 deaths occurred, for an all-cause mortality of 223 per 10 000 person-years (95% confidence interval [CI] 201-247 per 10 000 person-years). Compared with the population of Vancouver, significant excess mortality was observed in the study population (SMR 7.1, 95% CI 6.4-7.9). Excess mortality was higher among women (SMR 15.4, 95% CI 12.8-18.5) than among men (SMR 5.8, 95% CI 5.1-6.6). Although crude mortality increased with age, excess mortality was greatest among participants less than 35 years old (SMR 13.2, 95% CI 9.4-18.5) and those 35-39 years old (SMR 13.3, 95% CI 10.3-17.1). Excess risk was also elevated among participants with hepatitis C virus (HCV), HIV and HCV/HIV infection, with SMRs of 5.9 (95% CI 4.9-7.1), 19.2 (95% CI 12.8-28.9) and 23.0 (95% CI 19.3-27.4), respectively. INTERPRETATION: Our study showed high mortality in this inner-city population, particularly when compared with the general population of Vancouver. Excess mortality was highest among women, younger participants and those infected with either HCV or HIV or both.
BACKGROUND: The Downtown Eastside is a robust and densely populated neighbourhood in Vancouver, Canada, that is characterized by low-income housing and drug use and a high prevalence of HIV infection. We evaluated mortality and excess mortality among the broader community of individuals living in this neighbourhood. METHODS: The Community Health and Safety Evaluation is a community-based study of inner-city residents in the Downtown Eastside who were recruited in 2003 and 2004. Participants' data were linked with data in provincial virology and mortality databases retrospectively and prospectively for the period 1991-2009. Mortality and standardized mortality ratios (SMRs) were calculated for the period 2003-2009 to compare death rates in the study population with rates in the population of Vancouver. RESULTS: Among 2913 participants, 374 deaths occurred, for an all-cause mortality of 223 per 10 000 person-years (95% confidence interval [CI] 201-247 per 10 000 person-years). Compared with the population of Vancouver, significant excess mortality was observed in the study population (SMR 7.1, 95% CI 6.4-7.9). Excess mortality was higher among women (SMR 15.4, 95% CI 12.8-18.5) than among men (SMR 5.8, 95% CI 5.1-6.6). Although crude mortality increased with age, excess mortality was greatest among participants less than 35 years old (SMR 13.2, 95% CI 9.4-18.5) and those 35-39 years old (SMR 13.3, 95% CI 10.3-17.1). Excess risk was also elevated among participants with hepatitis C virus (HCV), HIV and HCV/HIV infection, with SMRs of 5.9 (95% CI 4.9-7.1), 19.2 (95% CI 12.8-28.9) and 23.0 (95% CI 19.3-27.4), respectively. INTERPRETATION: Our study showed high mortality in this inner-city population, particularly when compared with the general population of Vancouver. Excess mortality was highest among women, younger participants and those infected with either HCV or HIV or both.
Authors: Thomas Kerr; Will Small; Chris Buchner; Ruth Zhang; Kathy Li; Julio Montaner; Evan Wood Journal: Am J Public Health Date: 2010-06-17 Impact factor: 9.308
Authors: A Boschini; C Smacchia; M Di Fine; A Schiesari; P Ballarini; M Arlotti; C Gabrielli; G Castellani; M Genova; P Pantani; A C Lepri; G Rezza Journal: Clin Infect Dis Date: 1996-07 Impact factor: 9.079
Authors: Kevin J P Craib; Patricia M Spittal; Evan Wood; Nancy Laliberte; Robert S Hogg; Kathy Li; Katherine Heath; Mark W Tyndall; Michael V O'Shaughnessy; Martin T Schechter Journal: CMAJ Date: 2003-01-07 Impact factor: 8.262
Authors: Sunil S Solomon; David D Celentano; Aylur K Srikrishnan; Canjeevaram K Vasudevan; Santhanam Anand; Muniratnam S Kumar; Suniti Solomon; Gregory M Lucas; Shruti H Mehta Journal: AIDS Date: 2009-05-15 Impact factor: 4.177
Authors: William G Honer; Alejandro Cervantes-Larios; Andrea A Jones; Fidel Vila-Rodriguez; Julio S Montaner; Howard Tran; Jimmy Nham; William J Panenka; Donna J Lang; Allen E Thornton; Talia Vertinsky; Alasdair M Barr; Ric M Procyshyn; Geoffrey N Smith; Tari Buchanan; Mel Krajden; Michael Krausz; G William MacEwan; Kristina M Gicas; Olga Leonova; Verena Langheimer; Alexander Rauscher; Krista Schultz Journal: Can J Psychiatry Date: 2017-02-15 Impact factor: 4.356
Authors: Jason Grebely; Gregory J Dore; Sébastien Morin; Jürgen K Rockstroh; Marina B Klein Journal: J Int AIDS Soc Date: 2017-07-28 Impact factor: 5.396
Authors: Nadine Kronfli; Sahir R Bhatnagar; Mark W Hull; Erica E M Moodie; Joseph Cox; Sharon Walmsley; John Gill; Curtis Cooper; Valérie Martel-Laferrière; Neora Pick; Marina B Klein Journal: AIDS Date: 2019-05-01 Impact factor: 4.177
Authors: Viviane D Lima; Ignacio Rozada; Jason Grebely; Mark Hull; Lillian Lourenco; Bohdan Nosyk; Mel Krajden; Eric Yoshida; Evan Wood; Julio S G Montaner Journal: PLoS One Date: 2015-12-03 Impact factor: 3.240
Authors: Verena Knerich; Andrea A Jones; Sam Seyedin; Christopher Siu; Louie Dinh; Sara Mostafavi; Alasdair M Barr; William J Panenka; Allen E Thornton; William G Honer; Alexander R Rutherford Journal: PLoS One Date: 2019-09-23 Impact factor: 3.240