{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T18:05:42Z","timestamp":1791223542815,"version":"4.1.0"},"reference-count":84,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,9,22]],"date-time":"2021-09-22T00:00:00Z","timestamp":1632268800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>During the past decades, people who inject drugs (PWID) have been impacted by the development of combination antiretroviral therapy (cART) to combat HIV\/AIDS, the prescription opioid crisis and increased use of lethal synthetic opioids. We measured how these dynamics have impacted mortality among PWID in an urban US city.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study using data from the AIDS Linked to the Intravenous Experience (ALIVE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Baltimore, MD, USA from 1988 to 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 5506 adult PWIDs (median age at baseline 37\u2009years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Mortality was identified by linkage to National Death Index\u2010Plus (NDI\u2010Plus) and categorized into HIV\/infectious disease (HIV\/ID) deaths, overdose and violence\u2010related (drug\u2010related) deaths and chronic disease deaths. Person\u2010time at risk accrued from baseline and ended at the earliest of death or study period. All\u2010cause and cause\u2010specific mortality were calculated annually. The Fine &amp; Gray method was used to estimate the subdistribution hazards of cause\u2010specific deaths accounting for competing risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Among 5506 participants with 84\u2009226 person\u2010years of follow\u2010up, 43.9% were deceased by 2018. Among all deaths, 30.5% were HIV\/ID deaths, 24.4% drug\u2010related deaths and 33.3% chronic disease deaths. Age\u2010standardized all\u2010cause mortality increased from 23 to 45 per 1000\u2009person\u2010years from 1988 to 1996, declined from 1996 to 2014, then trended upward to 2018. HIV\/ID deaths peaked in 1996 coincident with the availability of cART, then continuously declined. Chronic disease deaths increased continuously as the cohort aged. Drug\u2010related deaths declined until 2011, but increased more than fourfold by 2018. HIV\/HCV infection and active injecting were independently associated with HIV\/ID and drug\u2010related deaths. Female and black participants had a higher risk of dying from HIV\/ID deaths and a lower risk of dying from drug\u2010related deaths than male and non\u2010black participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Deaths in Baltimore, MD, USA attributable to HIV\/ID appear to have declined following the widespread use of combination antiretroviral therapy. Increases in the rates of drug\u2010related deaths in Baltimore were observed prior to and continue in conjunction with national mortality rates associated with the opiate crisis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.15659","type":"journal-article","created":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T06:19:41Z","timestamp":1627885181000},"page":"646-655","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Mortality among people who inject drugs: a prospective cohort followed over three\u2009decades in Baltimore, MD, USA"],"prefix":"10.1111","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3741-0962","authenticated-orcid":false,"given":"Jing","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shruti 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