Predictors of injury-related and non-injury-related mortality among veterans with alcohol use disorders.
ABSTRACT 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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ABSTRACT: AIMS: To conduct a systematic review and meta-analysis on all-cause mortality in people with alcohol use disorders. METHODS: Using the MOOSE guidelines, studies were identified through MEDLINE, EMBASE, and Web of Science up to August, 2012. Prospective and historical cohort studies including a comparison of alcohol use disorder with a control group investigating all-cause mortality risk were included. RESULTS: This meta-analysis included 81 observational studies with 221 683 observed deaths among 853 722 people with alcohol use disorder. In men, the relative risk (RR) among clinical samples was 3.38 (95% confidence interval [CI]: 2.98-3.84); in women it was 4.57 (95% CI: 3.86-5.42). Alcohol use disorders identified in general population surveys showed a 2-fold higher risk compared with no alcohol use disorder in men; no data were available for women. RRs were markedly higher for those ≤40 years old (8-fold in men, 13-fold in women) while still being at least 2-fold among those 60 years or older. CONCLUSIONS: Mortality in people with alcohol use disorders is markedly higher than previously thought. Women have generally higher mortality risks than men. Among all people with alcohol use disorders, people in younger age groups and people in treatment show substantially higher mortality risk than others in that group.Addiction 04/2013; · 4.58 Impact Factor
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ABSTRACT: The VA Healthcare System has made progress implementing evidence-based care for unhealthy alcohol use, but whether there are differences in care across race/ethnicity is unclear. We describe alcohol-related care for 3 racial/ethnic groups among VA outpatients with unhealthy alcohol use. This cross-sectional study utilized secondary quality improvement data collected for the VA Office of Quality and Performance (July 2006 to June 2007) to identify a sample of 9,194 black (n = 1,436), Hispanic (n = 500), and white (n = 7,258) VA outpatients who screened positive for unhealthy alcohol use (AUDIT-C score ≥4 men; ≥3 women). Alcohol-related care was defined as medical record documentation of brief intervention (advice or feedback) and/or referral (discussion of or scheduled). Logistic regression models estimated the prevalence of alcohol-related care among black, Hispanic, and white patients after adjustment for sociodemographic characteristics, alcohol use severity, other substance use, and mental health comorbidity. Among all eligible patients, 2,903 (32%) had documented alcohol-related care. Adjusted prevalences were 35.3% (95% CI 30.0 to 40.5) for black, 27.3% (95% CI 21.1 to 33.5) for Hispanic, and 28.9% (95% CI 25.5 to 32.3) for white patients. Differences in documented alcohol-related care between all racial/ethnic groups were significant (p-values all < 0.05). Among VA patients with unhealthy alcohol use, black patients had the highest, and Hispanic the lowest, prevalence of documented alcohol-related care. Future research should evaluate contextual and system-, provider-, or patient-level factors that may attenuate racial/ethnic differences in documented alcohol-related care, as well as whether differences in documented care are associated with differences in outcomes.Alcoholism Clinical and Experimental Research 03/2012; 36(9):1614-22. · 3.42 Impact Factor
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ABSTRACT: Suicide attempts and non-fatal overdoses are both associated with substance use. The aim of the present study was to examine correlates of suicide attempts and non-fatal overdoses simultaneously among individuals seeking addictions treatment. A large U.S. national sample of individuals entering addictions treatment participated in a cross-sectional survey (n=5892). Multinomial logistic regression modeling tested the adjusted associations of violence, injection drug use, specific substances, and depressive symptoms with a four-category outcome variable based on prior histories of suicide attempt and non-fatal overdose (neither, suicide attempt only, overdose only, both), adjusting for demographic and treatment characteristics. Sexual and physical victimization was associated with suicide attempts with or without overdoses (ORs 1.25-2.84), while perpetrating violence was associated with having experienced either or both outcomes (ORs 1.25-1.56). Depressive symptoms had a stronger association with suicide attempts (OR=3.05) than overdoses (OR=1.29). Injection drug use was associated with overdoses with or without suicide attempts (ORs 2.65-3.22). Individuals seeking treatment for marijuana use were less likely have overdosed or attempted suicide (ORs 0.39-0.67), while individuals seeking treatment for heroin use were more likely to have overdosed (OR=1.46). Seeking treatment for use of more than one substance was associated with overdose and overdose and suicide attempt (ORs 1.58-2.51), but not suicide attempt alone. The present findings indicate that suicide and overdose are connected yet distinct problems. Individuals who have had a history of both may be a group with particularly poor psychological functioning as well as more severe drug-related problems.Drug and alcohol dependence 06/2011; 119(1-2):106-12. · 3.60 Impact Factor