Sex-Specific Associations Between Deployment-Related Traumatic Brain Injury and Nonfatal Drug Overdose Among a National Cohort of Post-9/11 Veterans.

IF 3.3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Head Trauma Rehabilitation Pub Date : 2025-08-21 DOI:10.1097/HTR.0000000000001098

Jennifer R Fonda, Lauren B Loeffel, Nicholas A Livingston, Aubrey A Knoff, Vladislav Bravman, Jaimie L Gradus, Rachel Sayko Adams

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引用次数: 0

Abstract

Objective: To determine whether there are sex-specific associations between traumatic brain injury (TBI) and nonfatal drug overdose, when considering psychiatric conditions as mediators of this association.

Setting: Veterans receiving care at national Department of Veterans Affairs (VA) facilities from April 2007 to December 2019.

Participants: 1 231 406 post-9/11 veterans aged 18 to 65, with 11.0% males and 2.9% females with confirmed TBI.

Design: Retrospective, longitudinal cohort study using VA medical record data.

Main measures: Deployment-related TBI was defined as a confirmed diagnosis according to the VA TBI comprehensive evaluation; no deployment-related TBI was defined as no deployment-related head injury. Nonfatal overdose (any drug, and opioid-specific) were defined using International Classification of Diseases, Ninth and Tenth Revision codes. We performed sex-specific Cox-proportional hazards regressions for any drug and opioid overdose outcomes, adjusted for demographic and military characteristics. Mediation analyses were conducted to examine the role of psychiatric conditions (substance use, anxiety, mood, and posttraumatic stress disorders).

Results: Compared to veterans without TBI, veterans with a history of TBI had approximately a 2-fold increased adjusted rate of any drug overdose (males: adjusted hazards ratio [aHR] = 1.93, 95% confidence interval [CI] = 1.84, 2.03; females: aHR = 1.82, 95% CI = 1.56, 2.12) and over a 2-fold increased adjusted rate of opioid-related overdose (males: aHR = 2.29, 95% CI = 2.03, 2.59; females: aHR = 2.43, 95% CI = 1.58, 3.74). The associations were partially attributable to comorbid psychiatric conditions, yet remained present after adjustment, for any drug overdose (males: aHR range, 1.38-1.86; females: aHR range, 1.45-1.89) and opioid-specific overdose (males: aHR range, 1.58-2.15; females: aHR range, 1.56-2.80) outcomes.

Conclusions: Veterans with deployment-related TBIs have a higher rate of nonfatal overdose, with similar associations for males and females. The associations were partially attributable to, but not fully explained by, comorbid psychiatric conditions.

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在9/11后退伍军人的国家队列中，部署相关的创伤性脑损伤和非致命药物过量之间的性别特异性关联。

目的：探讨创伤性脑损伤（TBI）与非致死性药物过量之间是否存在性别特异性关联，并将精神状况作为这种关联的中介因素。背景：2007年4月至2019年12月在国家退伍军人事务部（VA）设施接受护理的退伍军人。参与者：1 231 406名18至65岁的911后退伍军人，其中11.0%的男性和2.9%的女性确诊为TBI。设计：采用退伍军人事务部病历资料进行回顾性、纵向队列研究。主要措施：根据VA TBI综合评价，将部署相关性TBI定义为确诊诊断；没有部署相关的TBI被定义为没有部署相关的头部损伤。非致命性过量（任何药物和阿片类药物特异性）的定义使用《国际疾病分类》第九和第十次修订代码。我们对任何药物和阿片类药物过量的结果进行了性别特异性cox比例风险回归，并根据人口统计学和军事特征进行了调整。进行调解分析以检查精神状况（物质使用、焦虑、情绪和创伤后应激障碍）的作用。结果：与无创伤性脑损伤的退伍军人相比，有创伤性脑损伤史的退伍军人任何药物过量的调整率增加了约2倍（男性：调整危险比[aHR] = 1.93, 95%可信区间[CI] = 1.84, 2.03；女性：aHR = 1.82, 95% CI = 1.56, 2.12），阿片类药物过量的调整率增加了2倍以上（男性：aHR = 2.29, 95% CI = 2.03, 2.59；女性：aHR = 2.43, 95% CI = 1.58, 3.74）。这些关联部分可归因于精神疾病合并症，但在调整后，任何药物过量（男性：aHR范围，1.38-1.86；女性：aHR范围，1.45-1.89）和阿片类药物特异性过量（男性：aHR范围，1.58-2.15；女性：aHR范围，1.56-2.80）的结果仍然存在。结论：与部署相关的创伤性脑损伤的退伍军人有更高的非致命性过量发生率，男性和女性的相关性相似。这些关联部分归因于共病精神疾病，但不能完全解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Head Trauma Rehabilitation 医学-康复医学

CiteScore

4.80

自引率

4.20%

发文量

153

审稿时长

6-12 weeks

期刊介绍： The Journal of Head Trauma Rehabilitation is a leading, peer-reviewed resource that provides up-to-date information on the clinical management and rehabilitation of persons with traumatic brain injuries. Six issues each year aspire to the vision of “knowledge informing care” and include a wide range of articles, topical issues, commentaries and special features. It is the official journal of the Brain Injury Association of America (BIAA).