Differential mortality among US veterans: Social determinants of health, substance use disorder, and substance use treatment

IF 2.2 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions Pub Date : 2026-08-18 Epub Date: 2026-04-03 DOI:10.1111/ajad.70158

Kashfi Pandit MPH, Aerin deRussy MPH, John Blosnich PhD, Gala True PhD, Ann E. Montgomery PhD

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引用次数: 0

Abstract

Background and Objectives

Veterans face disproportionate suicide and mortality risks driven by intersecting social determinants of health (SDH), including housing instability, unemployment, and justice involvement, and co-occurring substance use disorders (SUD). This study examined how these intersecting factors influence mortality and whether SUD treatment mitigated mortality risks among US veterans.

Methods

Using national Veterans Health Administration data (2014–2019), we identified 215,944 veterans with SUD and an indicator of one of three adverse SDH: housing instability, justice involvement, or unemployment. We tracked suicide and all-cause mortality for 1 year following SDH exposure. We used discrete-time survival models to assess associations between month-specific SUD treatment and mortality outcomes, controlling for demographic, clinical (i.e., mental health conditions, suicidal behavior), and contextual covariates.

Results

Nearly half of veterans (48%) received SUD treatment. Those who received treatment had lower all-cause mortality (2.1% vs. 4.3%; p < .001) but no significant difference in suicide mortality (0.14% vs. 0.15%; p = .75). [Correction added on 22 April 2026, after first online publication: The preceding sentence has been revised in this version.] SUD treatment was associated with a 24% (aOR = 1.24; 95% CI: 1.16–1.34) reduction in all-cause mortality, though its interaction with each adverse SDH was not statistically significant. Suicide deaths remained concentrated among White veterans, those aged 18-34, with no service connection, and with time-varying suicidal ideation or attempts (p < .001).

Discussion and Conclusions

Engagement in SUD treatment reduces all-cause mortality among veterans facing compounded social adversity but does not independently mitigate suicide deaths.

Scientific Significance

Integrated approaches that embed suicide prevention within addiction and SDH-focused care are essential to address the multifactorial drivers of veterans' suicidal mortality.

查看原文本刊更多论文

美国退伍军人的死亡率差异：健康的社会决定因素、物质使用障碍和物质使用治疗。

背景和目的：退伍军人面临着由交叉的健康社会决定因素（SDH）驱动的不成比例的自杀和死亡风险，包括住房不稳定、失业、司法介入以及共同发生的物质使用障碍（SUD）。本研究调查了这些交叉因素如何影响死亡率，以及SUD治疗是否减轻了美国退伍军人的死亡风险。方法：使用国家退伍军人健康管理局（2014-2019）的数据，我们确定了215,944名患有SUD的退伍军人，并确定了三种不良SDH之一的指标：住房不稳定、司法介入或失业。我们追踪SDH暴露后1年的自杀和全因死亡率。我们使用离散时间生存模型来评估特定月份的SUD治疗与死亡率结果之间的关系，控制人口统计学、临床（即精神健康状况、自杀行为）和背景协变量。结果：近一半（48%）的退伍军人接受了SUD治疗。讨论和结论：参与SUD治疗降低了面临复杂社会逆境的退伍军人的全因死亡率，但不能单独降低自杀死亡率。科学意义：将自杀预防纳入成瘾和以sdh为重点的护理的综合方法对于解决退伍军人自杀死亡率的多因素驱动因素至关重要。

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

American Journal on Addictions SUBSTANCE ABUSE-

CiteScore

5.00

自引率

0.00%

发文量

118

期刊介绍： The American Journal on Addictions is the official journal of the American Academy of Addiction Psychiatry. The Academy encourages research on the etiology, prevention, identification, and treatment of substance abuse; thus, the journal provides a forum for the dissemination of information in the extensive field of addiction. Each issue of this publication covers a wide variety of topics ranging from codependence to genetics, epidemiology to dual diagnostics, etiology to neuroscience, and much more. Features of the journal, all written by experts in the field, include special overview articles, clinical or basic research papers, clinical updates, and book reviews within the area of addictions.