Copeland Laurel A, Finley Erin P, Bollinger Mary J, Amuan Megan E, Pugh Mary Jo V
*Center for Applied Health Research, Central Texas Veterans Health Care System †Department of Medicine, Center for Applied Health Research, Baylor Scott & White Health ‡Department of Psychiatry, UT Health Science Center San Antonio §South Texas Veterans Health Care System ∥Department of Medicine, Division of Clinical Epidemiology ¶Department of Epidemiology and Biostatistics, UT Health Science Center San Antonio, San Antonio, TX #VA New England Health Care System, Bedford, MA.
Med Care. 2016 Dec;54(12):1078-1081. doi: 10.1097/MLR.0000000000000588.
Veterans of the wars in Iraq and Afghanistan who receive care in the Veterans Health Administration (VA) have high disease burden. Distinct comorbidity patterns have been shown to be differentially associated with adverse outcomes, including death. This study determined correlates of 5-year mortality.
VA demographic, military, homelessness, and clinical measures informed this retrospective analysis. Previously constructed comorbidity classifications over 3 years of care were entered into a Cox proportional hazards model of death.
There were 164,933 veterans in the cohort, including African Americans (16%), Hispanics (11%), and whites (65%). Most were in their 20s at baseline (60%); 12% were women; 4% had attempted suicide; 4% had been homeless. Having clustered disorders of pain, posttraumatic stress disorder, and traumatic brain injury was associated with death [hazard ratio (HR)=2.0]. Mental disorders including substance abuse were similarly associated (HR=2.1). Prior suicide attempt (HR=2.2) or drug overdose (HR=3.0) considerably increased risk of death over 5 years.
As congressional actions such as Veterans Choice Act offer more avenues to seek care outside of VA, coordination of care, and suicide prevention outreach for recent veterans may require innovative approaches to preserve life.
在退伍军人健康管理局（VA）接受治疗的伊拉克和阿富汗战争退伍军人疾病负担较重。已显示不同的共病模式与包括死亡在内的不良后果存在不同程度的关联。本研究确定了5年死亡率的相关因素。
VA的人口统计学、军事、无家可归情况及临床指标为此次回顾性分析提供了依据。将先前构建的3年治疗期共病分类纳入死亡的Cox比例风险模型。
队列中有164,933名退伍军人，包括非裔美国人（16%）、西班牙裔（11%）和白人（65%）。大多数人在基线时为20多岁（60%）；12%为女性；4%曾尝试自杀；4%曾无家可归。患有疼痛、创伤后应激障碍和创伤性脑损伤的聚类性疾病与死亡相关[风险比（HR）=2.0]。包括药物滥用在内的精神障碍也有类似关联（HR=2.1）。既往自杀未遂（HR=2.2）或药物过量（HR=3.0）会使5年内的死亡风险大幅增加。
随着诸如《退伍军人选择法案》等国会行动提供了更多在VA之外寻求治疗护理的途径，对于近期退伍军人而言，护理协调及自杀预防推广可能需要创新方法来挽救生命。
