Mortality Rates and Predictors of Mortality Among Late-Middle-Aged and Older Substance Abuse Patients

Authors

  • Rudolf H. Moos,

    Corresponding author
    1. Center for Health Care Evaluation and Program Evaluation and Resource Center, Department of Veterans Affairs and Stanford University Medical Centers, Palo Alto, California.
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  • Penny L. Brennan,

    1. Center for Health Care Evaluation and Program Evaluation and Resource Center, Department of Veterans Affairs and Stanford University Medical Centers, Palo Alto, California.
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  • Jennifer R. Mertens

    1. Center for Health Care Evaluation and Program Evaluation and Resource Center, Department of Veterans Affairs and Stanford University Medical Centers, Palo Alto, California.
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  • This work was supported in part by the Department of Veterans Affairs Medical and Health Services Research and Development Services Research Funds and by NIAAA Grants AA02863 and AA06699.

Reprint requests: Rudolf H. Moos, Ph.D., Center for Health Care Evaluation (152), Department of Veterans Affairs Medical Center, 3801 Miranda Avenue, Palo Alto. CA 94304.

Abstract

This study describes mortality rates and predictors of mortality among late-middle-aged and older (55+) substance abuse inpatients (n= 21, 139) in Department of Veterans Affairs (VA) Medical Centers in the 4 years after an index episode of care. A total of 24% of the patients died; this mortality rate was 2.64 times higher than expected. Predictors of earlier mortality included older age and nonmarried status, alcohol psychosis and organic brain disorder diagnoses, and several medical diagnoses, including neoplasms, liver cirrhosis, respiratory, endocrine and metabolic, and blood system disorders. Three proxy indicators of illness severity also predicted mortality: more prior inpatient and outpatient medical care and an index episode in an extended care unit. In contrast, more prior outpatient mental health care and remitted status predicted lower mortality. These diagnostic and treatment indicators can be used to identify patients at heightened risk for premature mortality. Moreover, they show that intensive mental health aftercare and remission of substance abuse may delay mortality, even among older patients who have longstanding substance abuse problems.

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