Center of Excellence for Suicide Prevention, Department of Veterans Affairs, 400 Fort Hill Avenue, Canandaigua, NY, 14424, USA; Department of Epidemiology, School of Public Health, West Virginia University, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506, USA; Injury Control Research Center, West Virginia University, 3606 Collins Ferry Rd, Suites 201 & 202, Morgantown, WV 26505, USA.
Center of Excellence for Suicide Prevention, Department of Veterans Affairs, 400 Fort Hill Avenue, Canandaigua, NY, 14424, USA; Injury Control Research Center, West Virginia University, 3606 Collins Ferry Rd, Suites 201 & 202, Morgantown, WV 26505, USA; Department of Psychiatry, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Drug Alcohol Depend. 2021 Feb 1;219:108484. doi: 10.1016/j.drugalcdep.2020.108484. Epub 2021 Jan 1.
For over a decade, there has been a surge in opioid-related morbidity and mortality among Veterans. To better understand the impact of the growing epidemic, it is important to identify the cause-specific mortality rates among Veterans with a prior nonfatal opioid overdose.
We followed 8370 Veterans who received medical care for a nonfatal opioid overdose between 2011 through 2015.Mortality records were linked to clinical records from the Veterans Health Administration (VHA). We compared the mortality rates among those with a nonfatal opioid overdose to a 5 % stratified random sample of patients accessing services during the same time period. SMRs were calculated using age-adjusted cause-specific mortality rates for the l U.S. population obtained from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER).
The crude mortality for Veterans with a history of a nonfatal overdose was 370.6 per 10,000 person years. Those with a prior nonfatal overdose had a higher risk of substance-related mortality (aHR [adjusted Hazard Ratio] 5.0), including a higher risk of death from drugs (aHR 6.9) and alcohol (aHR 2.7). Similarly, cause-specific mortalities assessed between Veterans and the U.S. population, SMRs were also highest for deaths associated with substances (114.0).
Veterans with a prior nonfatal overdose experienced substantially higher mortality rates compared to other Veterans or the general U.S.
Causes of death related to substance use and mental health were significantly higher than other causes of death, highlighting the importance of integrated treatment and substance use services.
十多年来，退伍军人的阿片类药物相关发病率和死亡率一直在上升。为了更好地了解这一不断蔓延的疫情的影响，重要的是要确定先前经历过非致命性阿片类药物过量的退伍军人的特定病因死亡率。
我们跟踪了 8370 名在 2011 年至 2015 年期间因非致命性阿片类药物过量接受医疗护理的退伍军人。将死亡率记录与退伍军人健康管理局（VHA）的临床记录相关联。我们将非致命性阿片类药物过量患者的死亡率与同期接受服务的患者的 5%分层随机样本进行比较。使用从疾病控制与预防中心的广泛在线数据用于流行病学研究（CDC WONDER）获得的美国人口年龄调整后的特定病因死亡率计算标准化死亡率比（SMR）。
有非致命性过量用药史的退伍军人的粗死亡率为每 10000 人年 370.6 人。先前有非致命性过量用药的退伍军人有更高的物质相关死亡率风险（调整后的危险比[aHR]5.0），包括死于药物（aHR 6.9）和酒精（aHR 2.7）的风险更高。同样，退伍军人与美国人群之间评估的特定病因死亡率，与物质相关的死亡率的标准化死亡率比（SMR）也最高（114.0）。
与其他退伍军人或一般美国人群相比，先前有非致命性过量用药史的退伍军人的死亡率要高得多。死亡原因与物质使用和心理健康有关的明显高于其他原因，突出了综合治疗和物质使用服务的重要性。
