Epidemiology and Infection

Table of Contents - 2005 - Volume 133, Issue 02  


Severe illness and death among injecting drug users in Scotland: a case-control study

A. TAYLOR a1c1, S. HUTCHINSON a2a3, J. LINGAPPA a4, S. WADD a2, S. AHMED a5, L. GRUER a6, T. H. TAYLOR Jr. a7, K. ROY a2, G. GILCHRIST a5, C. McGUIGAN a5, G. PENRICE a5 and D. GOLDBERG a2
a1 University of Paisley, Paisley, Scotland, UK
a2 Health Protection Scotland, Scotland, UK
a3 University of Glasgow, Glasgow, Scotland, UK
a4 University of Washington, USA
a5 Greater Glasgow NHS Board, Scotland, UK
a6 NHS Health Scotland, Scotland, UK
a7 Centers for Disease Control and Prevention, Atlanta, GA, UK

Article author query
taylor a   [PubMed][Google Scholar] 
hutchinson s   [PubMed][Google Scholar] 
lingappa j   [PubMed][Google Scholar] 
wadd s   [PubMed][Google Scholar] 
ahmed s   [PubMed][Google Scholar] 
gruer l   [PubMed][Google Scholar] 
taylor th   [PubMed][Google Scholar] 
roy k   [PubMed][Google Scholar] 
gilchrist g   [PubMed][Google Scholar] 
mcguigan c   [PubMed][Google Scholar] 
penrice g   [PubMed][Google Scholar] 
goldberg d   [PubMed][Google Scholar] 

Abstract

Between April and September 2000, 60 injecting drug users in Scotland died or were hospitalized with severe illness. Laboratory investigations suggested that Clostridium novyi and other bacteria were important aetiological agents. To determine associated environmental/behavioural factors a case-control study was undertaken with 19 ‘definite’ and 32 ‘probable’ cases in Glasgow, Scotland. For every deceased case (n=19), up to three proxy individuals were interviewed. Three controls were identified for each case. Multivariate logistic regression analyses compared (i) all cases and controls; (ii) definite cases and matched controls; (iii) probable cases and matched controls. In all three analyses injecting into muscle or skin and injecting most of the time with a filter used by someone else were the variables most strongly associated with illness. Comparing only muscle-injecting cases and controls, cases were significantly more likely to have injected larger amounts of heroin per average injection than were controls. The findings make an important epidemiological contribution to the understanding of the public health and clinical implications of the contamination of illicit drugs by histotoxic clostridia.

(Accepted November 18 2004)


Correspondence:
c1 Professor Avril Taylor, Director, Institute for Applied Social and Health Research, School of Social Sciences, University of Paisley, High Street, Paisley PA1 2BE, Scotland, UK. (Email: avril.taylor@paisley.ac.uk)

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