Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave., Portland, OR, 97227-1110, USA.
Public Health Sciences, Henry Ford Health System, Detroit, USA.
Addict Sci Clin Pract. 2020 Feb 21;15(1):14. doi: 10.1186/s13722-020-0181-1.
Prior research suggests that substance use disorders (SUDs) are associated with risk of suicide mortality, but most previous work has been conducted among Veterans Health Administration patients. Few studies have examined the relationship between SUDs and suicide mortality in general populations. Our study estimates the association of SUDs with suicide mortality in a general US population of men and women who receive care across eight integrated health systems.
We conducted a case-control study using electronic health records and claims data from eight integrated health systems of the Mental Health Research Network. Participants were 2674 men and women who died by suicide between 2000-2013 and 267,400 matched controls. The main outcome was suicide mortality, assessed using data from the health systems and confirmed by state death data systems. Demographic and diagnostic data on substance use disorders and other health conditions were obtained from each health system. First, we compared descriptive statistics for cases and controls, including age, gender, income, and education. Next, we compared the rate of each substance use disorder category for cases and controls. Finally, we used conditional logistic regression models to estimate unadjusted and adjusted odds of suicide associated with each substance use disorder category.
All categories of substance use disorders were associated with increased risk of suicide mortality. Adjusted odds ratios ranged from 2.0 (CI 1.7, 2.3) for patients with tobacco use disorder only to 11.2 (CI 8.0, 15.6) for patients with multiple alcohol, drug, and tobacco use disorders. Substance use disorders were associated with increased relative risk of suicide for both women and men across all categories, but the relative risk was more pronounced in women.
Substance use disorders are associated with significant risk of suicide mortality, especially for women, even after controlling for other important risk factors. Experiencing multiple substance use disorders is particularly risky. These findings suggest increased suicide risk screening and prevention efforts for individuals with substance use disorders are needed.
先前的研究表明，物质使用障碍（SUD）与自杀死亡率相关，但大多数先前的研究都集中在退伍军人健康管理局的患者中。很少有研究在一般人群中检查 SUD 与自杀死亡率之间的关系。我们的研究估计了 SUD 在接受八项综合卫生系统护理的美国男女一般人群中与自杀死亡率的关联。
我们使用心理健康研究网络的八项综合卫生系统的电子健康记录和索赔数据进行了病例对照研究。参与者是 2000 年至 2013 年间自杀的 2674 名男性和女性以及 267400 名匹配的对照者。主要结局是自杀死亡率，使用卫生系统的数据进行评估，并通过州死亡数据系统确认。从每个卫生系统获取物质使用障碍和其他健康状况的人口统计学和诊断数据。首先，我们比较了病例和对照者的描述性统计数据，包括年龄、性别、收入和教育。接下来，我们比较了病例和对照者中每种物质使用障碍类别的发生率。最后，我们使用条件逻辑回归模型估计与每种物质使用障碍类别的自杀相关的未经调整和调整的比值比。
所有类别的物质使用障碍都与自杀死亡率增加相关。调整后的比值比范围从仅患有烟草使用障碍的患者的 2.0（CI 1.7，2.3）到患有多种酒精、药物和烟草使用障碍的患者的 11.2（CI 8.0，15.6）。物质使用障碍与所有类别的女性和男性的自杀相对风险增加相关，但女性的相对风险更为明显。
物质使用障碍与自杀死亡率显著相关，尤其是对女性而言，即使在控制了其他重要的风险因素之后也是如此。经历多种物质使用障碍的风险尤其高。这些发现表明，需要针对物质使用障碍患者增加自杀风险筛查和预防工作。
