Iheanacho Theddeus, Stefanovics Elina, Rosenheck Robert
Assistant Professor, Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut.
Associate Research Scientist, Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut.
J Opioid Manag. 2018 May/Jun;14(3):171-182. doi: 10.5055/jom.2018.0447.
The aim of this study is to estimate the prevalence and sociodemographic and clinical correlates of opioid use disorder (OUD), a major cause of morbidity and mortality in the United States, among homeless veterans nationally in the Veterans Health Administration (VHA).
Administrative data on 256,404 veterans who were homeless and/or had OUD in fiscal year 2012 were analyzed to evaluate OUD as a risk factor for homelessness along with associated characteristics, comorbidities, and patterns of service use. Bivariate analyses and logistic regression were used to compare homeless veterans with OUD to veterans with OUD but no homelessness and homeless veterans with no OUD.
Altogether 17.9 percent of homeless VHA users were diagnosed with OUD and 34.6 percent of veterans with OUD were homeless. The risk ratio (RR) for homelessness among veterans with OUD was 28.7. Homeless veterans with OUD, compared to nonhomeless veterans with OUD showed extensive multimorbidity with greater risk for HIV (RR = 1.57), schizophrenia (RR = 1.62), alcohol use disorder (RR = 1.67), and others. Homeless veterans with OUD also showed more multimorbidity and used more services than homeless veterans without OUD. Homeless and nonhomeless OUD veterans used opiate agonist therapy at similar, but very low rates (13 and 15 percent).
OUD is a major risk factor for homelessness. Homeless veterans with OUD have high levels of multimorbidity and greater service use than veterans with either condition alone. Tailored, facilitated access to opioid agonist therapy may improve outcomes for these vulnerable veterans.
本研究旨在评估美国退伍军人健康管理局（VHA）全国范围内无家可归退伍军人中阿片类物质使用障碍（OUD）的患病率及其社会人口学和临床相关因素，OUD是美国发病和死亡的主要原因。
分析了2012财年256,404名无家可归和/或患有OUD的退伍军人的行政数据，以评估OUD作为无家可归风险因素以及相关特征、合并症和服务使用模式。采用双变量分析和逻辑回归比较患有OUD的无家可归退伍军人与患有OUD但无家可归的退伍军人以及没有OUD的无家可归退伍军人。
VHA无家可归使用者中共有17.9%被诊断为OUD，患有OUD的退伍军人中有34.6%无家可归。患有OUD的退伍军人无家可归的风险比（RR）为28.7。与无家可归的OUD退伍军人相比，患有OUD的非无家可归退伍军人表现出广泛的多种合并症，感染艾滋病毒（RR = 1.57）、精神分裂症（RR = 1.62）、酒精使用障碍（RR = 1.67）及其他疾病的风险更高。患有OUD的无家可归退伍军人也比没有OUD的无家可归退伍军人表现出更多的合并症且使用更多的服务。无家可归和非无家可归的OUD退伍军人使用阿片类激动剂治疗的比例相似，但非常低（分别为13%和15%）。
OUD是无家可归的主要风险因素。患有OUD的无家可归退伍军人比仅患有一种疾病的退伍军人有更高水平的多种合并症且使用更多的服务。量身定制、便利获取阿片类激动剂治疗可能改善这些弱势退伍军人的治疗效果。
