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CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
Nov 06, 2017;189 (44): E1352-E1359.

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

Kate Jongbloed, Margo E Pearce, Sherri Pooyak, David Zamar, Vicky Thomas, Lou Demerais, Wayne M Christian, Earl Henderson, Richa Sharma, Alden H Blair, Eric M Yoshida, Martin T Schechter, Patricia M Spittal, Cedar Project Partnership
Author Information
  1. Kate Jongbloed: 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. Margo E Pearce: 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.
  3. Sherri Pooyak: 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.
  4. David Zamar: 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.
  5. Vicky Thomas: 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.
  6. Lou Demerais: 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.
  7. Wayne M Christian: 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.
  8. Earl Henderson: 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.
  9. Richa Sharma: 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.
  10. Alden H Blair: 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.
  11. Eric M Yoshida: 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.
  12. Martin T Schechter: 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.
  13. Patricia M Spittal: 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.
PMID: 29109208 DOI: 10.1503/cmaj.160778

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 ( = 15 [38%]), illness ( = 11 [28%]) and suicide ( = 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.

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MeSH Term

Adolescent
British Columbia
Cause of Death
Cohort Studies
Confidence Intervals
Drug Overdose
Female
Hepatitis C
Humans
Indians, North American
Male
Prospective Studies
Regression Analysis
Substance Abuse, Intravenous
Suicide
Young Adult
Journal Article
Article has an altmetric score of 58

Word Cloud

Created with Highcharts 10.0.0Indigenouspeoplemortalitydrugsuseusing95%YoungyoungCI1BC5likely=adjustedparticularlysubstancehepatitisCdyingamongBritishColumbiapredictors620032014Cedarhazardrate9timesdiewomeninjectionoverdosesuicide2HRBACKGROUND:involvedchildwelfaresystementrenchedlivingHIVprematurelyreportratesexploretimeMETHODS:analyzeddatacollectedeverymonthsProjectprospectivecohortstudyinvolvingillicitVancouverPrinceGeorgecalculatedage-standardizedratiosCanadianreferencepopulationsidentifiedtime-dependentCoxproportionalregressionRESULTS:Among610participants40diedyielding670per100000person-yearsused12confidenceinterval[CI]2-17Canadiansage786-10Statusaffectedleadingcausesdeath15[38%]illness11[28%][12%]Predictorsincludedbaselineratio[HR]7647-516previousattempted8801-350recent8500-809INTERPRETATION:alarmingdeathsreflectcomplexintersectionshistoricalpresent-dayinjusticesbarrierscareProject:

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