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Predictors of injury-related and non-injury-related mortality among veterans with alcohol use disorders

Authors

  • Sylwia Fudalej,

    1. Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland,
    2. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA and
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  • Amy Bohnert,

    1. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA and
    2. Department of Veterans Affairs National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA
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  • Karen Austin,

    1. Department of Veterans Affairs National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA
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  • Kristen Barry,

    1. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA and
    2. Department of Veterans Affairs National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA
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  • Frederic Blow,

    1. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA and
    2. Department of Veterans Affairs National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA
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  • Mark Ilgen

    Corresponding author
    1. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA and
    2. Department of Veterans Affairs National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA
      Mark Ilgen, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA. E-mail: marki@umich.edu
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Mark Ilgen, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA. E-mail: marki@umich.edu

ABSTRACT

Aims  To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all-cause, injury-related and non-injury-related mortality among those diagnosed with an AUD.

Setting  Department of Veterans Affairs, Veterans Health Administration (VHA).

Participants  A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 (n = 3 944 778), followed from the beginning of FY02 through the end of FY06.

Measurements  Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index.

Findings  Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury-related (HR = 3.29) and by non-injury-related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury-related than non-injury-related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non-injury related compared to injury-related mortality.

Conclusions  In users of a large health-care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non-injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non-injury-related death.

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