High Risk of Substance Use Disorder-Related Outcomes in Veterans Released from Correctional Facilities in Mid to Late Life.
High Risk of Substance Use Disorder-Related Outcomes in Veterans Released from Correctional Facilities in Mid to Late Life.
复制标题
从惩教所释放的中晚年退伍军人中，药物使用障碍相关后果的风险很高。
DOI：
10.1007/s11606-023-08057-y
复制
发表时间：
2023
影响因子：
5.7
通讯作者：
Byers,AmyL
中科院分区：
文献类型：
--
作者：
Barry,LisaC;Steffens,DavidC;Covinsky,KennethE;Conwell,Yeates;Boscardin,John;Li,Yixia;Byers,AmyL
退伍军人事务部（VA）可能会遇到越来越多的退伍军人在被监禁后的中后期重返社区（即经历重返社会）。然而，在这一人群中，由于物质使用障碍（sud）导致的负面健康结果的比率尚不清楚。目的确定老年重返社会退伍军人与未入狱退伍军人相比猝死相关急诊科就诊和住院（ED/IPH）及服药过量死亡的风险和危险因素。设计回顾性队列研究，使用国家退伍军人管理局和医疗保健系统数据。参与者年龄≥50岁，连续监禁≤5年，并在2010年10月1日至2017年9月30日期间释放的退伍军人（N= 18803），与从未监禁的退伍军人（N= 94,015）在人口统计学特征、医疗保险资格原因和SUD病史上进行1:5倾向评分匹配。主要测量方法：在发布日期/索引日期（至2018年9月30日）之后的一年内，从VA门诊医疗服务和CMS数据中获得与sud相关的ED/IPH（总体和特定物质）。使用国家死亡率数据库确定1年内过量死亡。细灰色比例风险回归比较了两组之间sud相关ED/IPH和过量死亡的风险。结果再入组与药物过量相关的ED/IPHs和死亡分别为2470例（13.1%）和72例（0.38%），未入组分别为4402例（4.7%）和198例（0.21%）。中晚期再入与任何与sud相关的ED/IPH （13,136.2 vs. 2252.8 / 100,000/年；校正风险比[AHR] = 2.19； 95%可信区间[CI] = 2.08, 2.30）和过量死亡（382.9 vs. 210.6 / 100,000/年；AHR = 2.24, 95% CI = 1.63, 3.08）相关。结论：即使考虑到SUD病史和其他可能的混杂因素，退伍军人发生与SUD相关的ED/IPH（总体和特定物质）和过量死亡的风险仍超过两倍。这些发现突出了这一人群的脆弱性。提高对与sud相关的负面健康结果的认识可能有助于制定退伍军人重返社会的规划。
BackgroundVeterans Affairs (VA) is likely to encounter a growing number of veterans returning to the community in mid to late life following incarceration (i.e., experiencing reentry). Yet, rates of negative health outcomes due to substance use disorders (SUDs) in this population are unknown.ObjectiveTo determine risk of and risk factors for SUD-related emergency department visits and inpatient hospitalizations (ED/IPH) and overdose death among older reentry veterans compared with never-incarcerated veterans.DesignRetrospective cohort study using national VA and Medicare healthcare systems data.ParticipantsVeterans age ≥50, incarcerated for ≤5 consecutive years, and released between October 1, 2010, and September 30, 2017 (N= 18,803), were propensity score–matched 1:5 with never-incarcerated veterans (N= 94,015) on demographic characteristics, reason for Medicare eligibility, and SUD history.Main MeasuresSUD-related ED/IPH (overall and substance-specific) were obtained from in-/outpatient VA health services and CMS data within the year following release date/index date (through September 30, 2018). Overdose death within 1 year was identified using the National Mortality Data Repository. Fine-Gray proportional hazards regression compared risk of SUD-related ED/IPH and overdose death between the two groups.ResultsThe number of SUD-related ED/IPHs and overdose deaths was 2470 (13.1%) and 72 (0.38%) in the reentry sample versus 4402 (4.7%) and 198 (0.21%) in the never-incarcerated sample, respectively. Mid-to-late-life reentry was associated with higher risk of any SUD-related ED/IPH (13,136.2 vs. 2252.8 per 100,000/year; adjusted hazard ratio [AHR] = 2.19; 95% confidence interval [CI] = 2.08, 2.30) and overdose death (382.9 vs. 210.6 per 100,000/year; AHR = 2.24, 95% CI = 1.63, 3.08).ConclusionsOlder reentry veterans have more than double the risk of experiencing SUD-related ED/IPH (overall and substance-specific) and overdose death, even after accounting for SUD history and other likely confounders. These findings highlight the vulnerability of this population. Improved knowledge regarding SUD-related negative health outcomes may help to tailor VA reentry programming.