Predictors of injury-related and non-injury-related mortality among veterans with alcohol use disorders

Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland.
Addiction (Impact Factor: 4.74). 10/2010; 105(10):1759-66. DOI: 10.1111/j.1360-0443.2010.03024.x
Source: PubMed


To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all-cause, injury-related and non-injury-related mortality among those diagnosed with an AUD.
Department of Veterans Affairs, Veterans Health Administration (VHA).
A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 (n = 3,944,778), followed from the beginning of FY02 through the end of FY06.
Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index.
Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury-related (HR = 3.29) and by non-injury-related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury-related than non-injury-related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non-injury related compared to injury-related mortality.
In users of a large health-care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non-injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non-injury-related death.

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    • "We observed a similar SMR for suicide mortality in our population to that previously reported (Gual et al., 1999), although it was slightly higher than that reported for other countries (Wilcox et al., 2004), especially among women. One explanation for this difference could be that suicide rates in the general Spanish population are lower than those in Northern European countries or the United States (Chishti et al., 2003; Ruiz-P erez and Olry de Labry-Lima, 2006), such that if our cohort had similar CMR to those of other studies (Fudalej et al., 2010; Noda et al., 2001), the excess of mortality with respect to the general population would be higher. "
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    ABSTRACT: Background The goal of this study was to estimate excess death due to external causes among 18- to 64-year-olds with alcohol use disorder (AUD) who were treated at public outpatient treatment centers, and the time elapsed from treatment initiation to death.Methods We conducted a retrospective longitudinal study among 7,012 outpatients aged 18 to 64 years who began treatment for AUD between 1997 and 2007. Deaths due to external causes (intentional and unintentional injuries) were monitored until the end of 2008. Person-years (PY) of follow-up and crude mortality rates (CMRs) were calculated for all study variables, for each sex, and for 2 age groups (18 to 34 and 35 to 64 years). Standardized mortality ratios (SMRs) were estimated by age group and sex. Survival was analyzed using the Kaplan–Meier method and Cox regression.ResultsWe recorded 114 deaths due to external causes. The CMR was 2.7 per 1,000 PY (95% confidence interval [CI]: 2.2 to 3.2), with significant gender differences only among younger individuals (CMR for males = 3.9 per 1,000 PY [95% CI: 2.2 to 5.5] and CMR for females = 2.8 per 1,000 PY [95% CI: 0.1 to 5.6]). Unintentional injury was the most common cause of death (n = 65), of which acute poisoning (n = 25; 38.5%) and traffic accidents (n = 15; 23.1%) were the most prevalent. Suicide accounted for 91.8% (n = 49) of deaths from intentional injuries. The excess of mortality between the AUD group and the general population (SMR) was 9.5 higher than in the general population (95% CI: 7.9 to 11.4), with significant differences between genders (SMR = 6.1 [95% CI: 4.9 to 7.5] in males and SMR = 20.4 [95% CI: 13.9 to 29.9] in females). Approximately 35% of deaths among individuals aged <35 years and 60% among women occurred within a year of initiating treatment.Conclusions This study highlights the importance of excess of mortality among people with AUD and patients' vulnerability during the initial years of treatment. Preventing premature deaths due to external causes among women and younger patients with AUD is a priority.
    Alcoholism Clinical and Experimental Research 05/2015; 39(7). DOI:10.1111/acer.12755 · 3.21 Impact Factor
    • "Mortality related to alcohol use disorders is one measure of the impact of the disease on society. Observational studies of untreated patients have shown that those with alcohol dependence have increased mortality rates compared with the general population (Fudalej et al., 2010; de Wit et al., 2011). The results of a recent study in Spain (Guitart et al., 2011) indicate that mortality in adults aged 18 to 64 years with alcohol use disorders was 8 times higher than that observed in the general population. "
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    ABSTRACT: The association between alcohol use disorders and increased risk of mortality is well known; however, there have been few systematic evaluations of alcohol-related organ damage and its impact on survival in younger alcoholics. Therefore, we assessed medical comorbidity with a clinical index to identify subgroups of alcoholic patients at high risk of premature death. Hospital-based cohort of alcohol-dependent patients admitted for detoxification between 1999 and 2008 in Barcelona, Spain. At admission, sociodemographic characteristics and a history of alcohol dependence and abuse of illegal drugs were obtained through clinical interviews and questionnaires. Medical comorbidity was assessed with the Cumulative Illness Rating Scale (Substance Abuse) (CIRS-SA). Dates and causes of death were obtained from clinical records and death registers. Survival was analyzed using Kaplan-Meier methods, and Cox regression models were used to analyze the risk factors for premature death. Median age of the patients (686 total, 79.7% men) was 43.5 years (interquartile range [IQR], 37.8 to 50.4), average alcohol consumption was 200 g/d (IQR, 120 to 280 g/d), and duration of alcohol use disorder was 18 years (IQR, 11 to 24). Medical comorbidity by CIRS-SA at admission showed that the organs/systems most affected were liver (99%), respiratory (86%), and cardiovascular (58%). After median follow-up of 3.1 years (IQR, 1.5 to 5.1), 78 (11.4%) patients died with a mortality rate of 3.28 × 100 person-years; according to Kaplan-Meier estimates, 50% (95% confidence interval [95% CI], 24 to 69%) of patients with severe medical comorbidity died in the first decade after treatment. In multivariate analysis, severe medical comorbidity (hazard ratio [HR], 5.5; 95% CI, 3.02 to 10.07) and being treated with methadone at admission (HR, 2.60; 95% CI, 1.50 to 4.51) were independent risk factors for premature death. Systematic assessment of alcohol-related organ damage is relevant for the identification and treatment of those at increased risk of death.
    Alcoholism Clinical and Experimental Research 01/2013; 37 Suppl 1(suppl 1):E221-7. DOI:10.1111/j.1530-0277.2012.01861.x · 3.21 Impact Factor
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