Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford.
Department of Health Law, Policy and Management, Boston University School of Public Health.
Med Care. 2021 Apr 1;59(Suppl 2):S165-S169. doi: 10.1097/MLR.0000000000001437.
Compared with non-Veterans, Veterans are at higher risk of experiencing homelessness, which is associated with opioid overdose.
To understand how homelessness and Veteran status are related to risks of nonfatal and fatal opioid overdose in Massachusetts.
A cross-sectional study.
All residents aged 18 years and older during 2011-2015 in the Massachusetts Department of Public Health's Data Warehouse (Veterans: n=144,263; non-Veterans: n=6,112,340). A total of 40,036 individuals had a record of homelessness, including 1307 Veterans and 38,729 non-Veterans.
The main independent variables were homelessness and Veteran status. Outcomes included nonfatal and fatal opioid overdose.
A higher proportion of Veterans with a record of homelessness were older than 45 years (77% vs. 48%), male (80% vs. 62%), or receiving high-dose opioid therapy (23% vs. 15%) compared with non-Veterans. The rates of nonfatal and fatal opioid overdose in Massachusetts were 85 and 16 per 100,000 residents, respectively. Among individuals with a record of homelessness, these rates increased 31-fold to 2609 and 19-fold to 300 per 100,000 residents. Homelessness and Veteran status were independently associated with higher odds of nonfatal and fatal opioid overdose. There was a significant interaction between homelessness and Veteran status in their effects on risk of fatal overdose.
Both homelessness and Veteran status were associated with a higher risk of fatal opioid overdoses. An understanding of health care utilization patterns can help identify treatment access points to improve patient safety among vulnerable individuals both in the Veteran population and among those experiencing homelessness.
与非退伍军人相比，退伍军人更有可能无家可归，而无家可归与阿片类药物过量有关。
了解马萨诸塞州无家可归和退伍军人身份与非致命和致命阿片类药物过量风险的关系。
横断面研究。
2011-2015 年期间，马萨诸塞州公共卫生部数据仓库中所有年龄在 18 岁及以上的居民（退伍军人：n=144263；非退伍军人：n=6112340）。共有 40036 人有记录表明他们无家可归，其中包括 1307 名退伍军人和 38729 名非退伍军人。
主要自变量为无家可归和退伍军人身份。结果包括非致命和致命阿片类药物过量。
与非退伍军人相比，有记录表明无家可归的退伍军人中，年龄超过 45 岁的比例更高（77% vs. 48%）、男性比例更高（80% vs. 62%）或接受高剂量阿片类药物治疗的比例更高（23% vs. 15%）。马萨诸塞州非致命和致命阿片类药物过量的发生率分别为每 10 万人 85 例和 16 例。在有记录表明无家可归的人群中，这些比率增加了 31 倍，达到每 10 万人 2609 例和 19 倍，达到每 10 万人 300 例。无家可归和退伍军人身份与非致命和致命阿片类药物过量的风险增加独立相关。无家可归和退伍军人身份对致命阿片类药物过量风险的影响存在显著交互作用。
无家可归和退伍军人身份都与致命阿片类药物过量的风险增加有关。了解卫生保健利用模式可以帮助确定治疗途径，以改善退伍军人和无家可归人群中脆弱个体的患者安全。
