Mortality and Cause of Death in Younger Homeless Veterans
Mortality and Cause of Death in Younger Homeless Veterans
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DOI：
10.1177/0033354918755709
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发表时间：
2018-03-01
影响因子：
3.3
通讯作者：
Casey, Roger
中科院分区：
文献类型：
--
作者：
Schinka, John A.;Leventhal, Katherine C.;Casey, Roger
目的：在老年无家可归的退伍军人中，死亡率有所增加。这项回顾性研究调查了一群年轻和中年无家可归的退伍军人的死亡率和死因。方法：我们检查了2000-2003年美国退伍军人事务部关于无家可归和医疗保健的记录，并确定了23898名无家可归的现役退伍军人和65198名年龄在30-54岁的非无家可归的现役退伍军人。我们使用国家死亡指数记录来确定生存状态。我们比较了两组在10年随访期间的生存率和死亡原因。结果：在随访期间，无家可归退伍军人的死亡比例（3905/23898,16.3%）高于非无家可归退伍军人（4143/65198,6.1%），死亡风险风险比为2.9。无家可归退伍军人的平均死亡年龄（52.3岁）比非无家可归退伍军人的平均死亡年龄（53.2岁）大约年轻1岁。无家可归退伍军人（3431/3905,87.9%）和非无家可归退伍军人（3725/4143,89.9%）的死亡主要归因于《国际疾病分类第十版》中的7个死因类别（心血管系统、肿瘤、外因、消化系统、呼吸系统、传染病、内分泌、营养和代谢疾病）。暴力致死很少见，但无家可归退伍军人的暴力致死风险明显高于非无家可归退伍军人（自杀风险比= 2.7；他杀风险比= 7.6）。结论：中青年无家可归老兵死亡率高于非无家可归老兵。我们的研究结果表明，在整个成年年龄段，无家可归大大增加了退伍军人的死亡风险。健康评估对于评估无家可归的退伍军人的死亡风险很有价值，无论年龄如何。
Objectives: Increased mortality has been documented in older homeless veterans. This retrospective study examined mortality and cause of death in a cohort of young and middle-aged homeless veterans.Methods: We examined US Department of Veterans Affairs records on homelessness and health care for 2000-2003 and identified 23898 homeless living veterans and 65198 non-homeless living veterans aged 30-54. We used National Death Index records to determine survival status. We compared survival rates and causes of death for the 2 groups during a 10-year follow-up period.Results: A greater percentage of homeless veterans (3905/23898, 16.3%) than non-homeless veterans (4143/65198, 6.1%) died during the follow-up period, with a hazard ratio for risk of death of 2.9. The mean age at death (52.3 years) for homeless veterans was approximately 1 year younger than that of non-homeless veterans (53.2 years). Most deaths among homeless veterans (3431/3905, 87.9%) and non-homeless veterans (3725/4143, 89.9%) were attributed to 7 cause-of-death categories in the International Classification of Diseases, 10th Revision (cardiovascular system; neoplasm; external cause; digestive system; respiratory system; infectious disease; and endocrine, nutritional, and metabolic diseases). Death by violence was rare but was associated with a significantly higher risk among homeless veterans than among non-homeless veterans (suicide hazard ratio = 2.7; homicide hazard ratio = 7.6).Conclusions: Younger and middle-aged homeless veterans had higher mortality rates than those of their non-homeless veteran peers. Our results indicate that homelessness substantially increases mortality risk in veterans throughout the adult age range. Health assessment would be valuable for assessing the mortality risk among homeless veterans regardless of age.