Association between social and environmental determinants of health with suicide-related death among veterans

xiange wang, Wenhuan Tan, Kaitlyn Martinez, Benjamin H. McMahon, Jean C. Beckham, Nathan A. Kimbrel, Silvia Crivelli
{"title":"Association between social and environmental determinants of health with suicide-related death among veterans","authors":"xiange wang, Wenhuan Tan, Kaitlyn Martinez, Benjamin H. McMahon, Jean C. Beckham, Nathan A. Kimbrel, Silvia Crivelli","doi":"10.1101/2024.07.02.24309854","DOIUrl":null,"url":null,"abstract":"<strong>Importance</strong> Social and environmental determinants of health (SDOH and EDOH) may contribute significantly to suicide rates among U.S. veterans. <strong>Objective</strong> To identify key predictive variables for assessing suicide related death rates (SRR), which include suicide deaths, suicide firearm deaths, and suicide nonfirearm deaths and vulnerability areas. <strong>Design, Setting, and Participants</strong> This case control study utilized Electronic Health Record (EHR) data, which included demographic and mental health information spanning from January 1, 2006, to December 31, 2016. The base cohort considered all veterans from the VHA outpatient database during the above period. Patients from the base cohort who died by suicide were identified through the National Death Index and considered as cases. Given the significantly larger number of alive patients compared to deceased patients, which caused the dataset to be extremely unbalanced and potentially biased, control participants were selected at a ratio of 4 controls to 1 case from those who were still alive. Cases of suicide related death were matched with four controls based on birth year, cohort entry date, sex, and follow up duration. Comprehensive data on social determinants (SDOH), geographic and gun related factors, quality of access to healthcare, environmental determinants (EDOH), and food insecurity were gathered from various sources at the midpoint of the study in 2011. Data analysis was carried out from January 2023 to January 2024.\n<strong>Exposures</strong> Suicide related deaths associated with SDOH and EDOH.\n<strong>Main Outcomes and Measures</strong> A hierarchical clustering method was employed to downselect the large number of variables, while Cox regression models were used to identify key predictive variables for SRR and areas of vulnerability.\n<strong>Results</strong> Out of a total of 9,819,080 veterans, 28,302 were identified as having died by suicide. These cases were matched with 113,208 control participants. The majority of the cohort was male (137,264 [97%]) and White (101,533 [72%]), with a significant portion being Black veterans (18,450 [13.12%]). The average age (SD) was 64.77 (17.56) years. We found that Social Determinants of Health (SDOH) and Environmental Determinants of Health (EDOH) were significantly associated with an increased risk of suicide. By incorporating SDOH and EDOH into the model, the performance (AUC) improved from 0.70 to 0.73. <strong>Conclusions and Relevance</strong> In this study, veterans who died by suicide using firearms exhibited distinct characteristics based on SDOH and EDOH, particularly in gun related variables, compared to those who died by nonfirearm methods. Our analysis indicated that veterans living in areas with more social issues, higher temperatures, and higher altitudes are at a higher risk of all means suicide. Furthermore, regions such as Montana, Wyoming, West Virgina and Arkansas, characterized by higher gun owernship are predicted to have the highest vulnerability based on veteran suicide firearm rates. Gun ownership and gun laws grades showed as strong predictors rather than rurality.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"medRxiv - Health Economics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1101/2024.07.02.24309854","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Importance Social and environmental determinants of health (SDOH and EDOH) may contribute significantly to suicide rates among U.S. veterans. Objective To identify key predictive variables for assessing suicide related death rates (SRR), which include suicide deaths, suicide firearm deaths, and suicide nonfirearm deaths and vulnerability areas. Design, Setting, and Participants This case control study utilized Electronic Health Record (EHR) data, which included demographic and mental health information spanning from January 1, 2006, to December 31, 2016. The base cohort considered all veterans from the VHA outpatient database during the above period. Patients from the base cohort who died by suicide were identified through the National Death Index and considered as cases. Given the significantly larger number of alive patients compared to deceased patients, which caused the dataset to be extremely unbalanced and potentially biased, control participants were selected at a ratio of 4 controls to 1 case from those who were still alive. Cases of suicide related death were matched with four controls based on birth year, cohort entry date, sex, and follow up duration. Comprehensive data on social determinants (SDOH), geographic and gun related factors, quality of access to healthcare, environmental determinants (EDOH), and food insecurity were gathered from various sources at the midpoint of the study in 2011. Data analysis was carried out from January 2023 to January 2024. Exposures Suicide related deaths associated with SDOH and EDOH. Main Outcomes and Measures A hierarchical clustering method was employed to downselect the large number of variables, while Cox regression models were used to identify key predictive variables for SRR and areas of vulnerability. Results Out of a total of 9,819,080 veterans, 28,302 were identified as having died by suicide. These cases were matched with 113,208 control participants. The majority of the cohort was male (137,264 [97%]) and White (101,533 [72%]), with a significant portion being Black veterans (18,450 [13.12%]). The average age (SD) was 64.77 (17.56) years. We found that Social Determinants of Health (SDOH) and Environmental Determinants of Health (EDOH) were significantly associated with an increased risk of suicide. By incorporating SDOH and EDOH into the model, the performance (AUC) improved from 0.70 to 0.73. Conclusions and Relevance In this study, veterans who died by suicide using firearms exhibited distinct characteristics based on SDOH and EDOH, particularly in gun related variables, compared to those who died by nonfirearm methods. Our analysis indicated that veterans living in areas with more social issues, higher temperatures, and higher altitudes are at a higher risk of all means suicide. Furthermore, regions such as Montana, Wyoming, West Virgina and Arkansas, characterized by higher gun owernship are predicted to have the highest vulnerability based on veteran suicide firearm rates. Gun ownership and gun laws grades showed as strong predictors rather than rurality.
退伍军人健康的社会和环境决定因素与自杀相关死亡之间的关系
重要性 健康的社会和环境决定因素(SDOH 和 EDOH)可能是导致美国退伍军人自杀率的重要原因。目标 找出评估自杀相关死亡率(SRR)的关键预测变量,其中包括自杀死亡、自杀性枪支致死、自杀性非枪支致死和易发领域。设计、环境和参与者 本病例对照研究利用了电子健康记录(EHR)数据,其中包括 2006 年 1 月 1 日至 2016 年 12 月 31 日期间的人口统计学和心理健康信息。基础队列包括在上述期间来自退伍军人管理局门诊数据库的所有退伍军人。基础队列中自杀身亡的患者是通过国家死亡指数确定的,并被视为病例。鉴于存活患者人数远远多于死亡患者人数,导致数据集极度不平衡并可能存在偏差,因此从仍存活的患者中以 4 对 1 的比例选取了对照组参与者。根据出生年份、队列加入日期、性别和随访时间,将自杀相关死亡病例与四个对照组进行配对。在 2011 年研究中期,从各种渠道收集了有关社会决定因素(SDOH)、地理和枪支相关因素、医疗质量、环境决定因素(EDOH)和食品不安全的综合数据。主要结果和测量方法 采用分层聚类法来减少变量数量,同时使用 Cox 回归模型来确定 SRR 的关键预测变量和易受影响的领域。结果 在总共 9,819,080 名退伍军人中,28,302 人被确定为死于自杀。这些病例与 113 208 名对照参与者进行了配对。其中大部分为男性(137,264 人 [97%])和白人(101,533 人 [72%]),还有相当一部分是黑人退伍军人(18,450 人 [13.12%])。平均年龄(标清)为 64.77 (17.56) 岁。我们发现,健康的社会决定因素(SDOH)和健康的环境决定因素(EDOH)与自杀风险的增加密切相关。将 SDOH 和 EDOH 纳入模型后,性能(AUC)从 0.70 提高到 0.73。结论与意义 在本研究中,与使用非枪支自杀的退伍军人相比,使用枪支自杀的退伍军人在 SDOH 和 EDOH 方面表现出不同的特征,尤其是在与枪支相关的变量方面。我们的分析表明,生活在社会问题较多、气温较高和海拔较高地区的退伍军人采用各种方式自杀的风险较高。此外,蒙大拿州、怀俄明州、西弗吉尼亚州和阿肯色州等地区的枪支拥有率较高,根据这些地区的退伍军人枪支自杀率预测,这些地区的退伍军人自杀风险最高。枪支拥有率和枪支法律等级显示出比乡村地区更强的预测能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信