Spark Talia L, Reid Colleen E, Adams Rachel Sayko, Schneider Alexandra L, Forster Jeri, Denneson Lauren M, Bollinger Mary, Brenner Lisa A
VISN 19 VA Rocky Mountain MIRECC for Veteran Suicide Prevention, Rocky Mountain Regional VA Medical Center, Veterans Health Administration, 1700 North Wheeling St., Aurora, CO, 80045, USA.
Department of Physical Medicine and Rehabilitation, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA.
Inj Epidemiol. 2023 Feb 10;10(1):8. doi: 10.1186/s40621-023-00416-x.
In the USA, deaths due to suicide, alcohol, or drug-related causes (e.g., alcohol-related liver disease, overdose) have doubled since 2002. Veterans appear disproportionately impacted by growing trends. Limited research has been conducted regarding the relationship between community-level factors (e.g., rurality, community distress resulting from economic conditions) and the presence of spatial clustering of suicide, alcohol-related, or drug-related deaths. We explored community-level relationships in Colorado Veterans and compared suicide, alcohol-, and drug-related death rates between the Colorado adult population and Veterans.
2009-2020 suicide, alcohol-related, and/or drug-related deaths were identified using qualifying multiple cause-of-death International Classification of Disease (ICD)-10 codes in CDC WONDER for the general adult population and Colorado death data for Veteran populations. Age and race adjusted rates were calculated to compare risk overall and by mortality type (i.e., suicide, alcohol-related, drug-related). In Veteran decedents, age-adjusted rates were stratified by rurality and community distress, measured by the Distressed Communities Index. Standardized mortality ratios were calculated to measure spatial autocorrelation and identify clusters using global and local Moran's I, respectively.
6.4% of Colorado Veteran deaths (n = 6948) were identified as being related to suicide, alcohol, or drugs. Compared to rates in the general population of Colorado adults, Veterans had 1.8 times higher rates of such deaths overall (2.1 times higher for suicide, 1.8 times higher for alcohol-related, 1.3 times higher for drug-related). Among Veterans, community distress was associated with an increased risk of alcohol-related [age-adjusted rate per 100,000 (95% CI) = 129.6 (89.9-193.1)] and drug-related deaths [95.0 (48.6-172.0)]. This same significant association was not identified among those that died by suicide. Rurality was not associated with risk for any of the deaths of interest. There was significant spatial clustering for alcohol-related deaths in southeast Colorado.
Colorado Veterans have higher rates of deaths due to suicide, alcohol-related, and drug-related causes compared to members of the general adult population. Upstream prevention efforts, such as community-based interventions targeting alcohol-use and community economic distress, are warranted. More research is also needed to understand how community distress and other social determinants of health impact the community burden of suicide, alcohol-related, and drug-related mortality.
在美国，自2002年以来，因自杀、酒精或药物相关原因（如酒精性肝病、药物过量）导致的死亡人数增加了一倍。退伍军人似乎受到这一增长趋势的影响尤为严重。关于社区层面因素（如农村地区、经济状况导致的社区困境）与自杀、酒精相关或药物相关死亡的空间聚集之间的关系，相关研究有限。我们探讨了科罗拉多州退伍军人中社区层面的关系，并比较了科罗拉多州成年人口和退伍军人中自杀、酒精和药物相关的死亡率。
利用疾病控制与预防中心（CDC）的WONDER数据库中符合条件的多种死因国际疾病分类（ICD）-10编码，确定2009年至2020年期间一般成年人口的自杀、酒精相关和/或药物相关死亡情况，以及科罗拉多州退伍军人人口的死亡数据。计算年龄和种族调整后的死亡率，以比较总体风险和按死亡类型（即自杀、酒精相关、药物相关）划分的风险。在退伍军人死亡者中，年龄调整后的死亡率按农村地区和社区困境进行分层，社区困境由困境社区指数衡量。计算标准化死亡率以测量空间自相关性，并分别使用全局和局部莫兰指数识别聚集情况。
科罗拉多州退伍军人死亡中有6.4%（n = 6948）被确定与自杀、酒精或药物有关。与科罗拉多州成年人口的总体死亡率相比，退伍军人此类死亡的发生率总体高出1.8倍（自杀高出2.1倍，酒精相关高出1.8倍，药物相关高出1.3倍）。在退伍军人中，社区困境与酒精相关死亡风险增加有关[每10万人年龄调整后的发生率（95%可信区间）= 129.6（89.9 - 193.1）]和药物相关死亡风险增加有关[95.0（48.6 - 172.0）]。在自杀死亡者中未发现这种显著关联。农村地区与任何感兴趣的死亡风险均无关联。科罗拉多州东南部酒精相关死亡存在显著的空间聚集。
与一般成年人口相比，科罗拉多州退伍军人因自杀、酒精相关和药物相关原因导致的死亡率更高。有必要开展上游预防工作，如针对酒精使用和社区经济困境的社区干预措施。还需要更多研究来了解社区困境和其他健康社会决定因素如何影响自杀、酒精相关和药物相关死亡率的社区负担。
