Self-injurious unnatural death among Veterans with HIV.

IF 3.4 2区 医学 Q3 IMMUNOLOGY AIDS Pub Date : 2024-08-01 Epub Date: 2024-05-28 DOI:10.1097/QAD.0000000000003940
Alexandria C Smith, Joseph L Goulet, David Vlahov, Amy C Justice, Julie A Womack
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Abstract

Objective: People with HIV (PWH) are at an increased risk of suicide and death from unintentional causes compared with people living without HIV. Broadening the categorization of death from suicide to self-injurious unnatural death (SIUD) may better identify a more complete set of modifiable risk factors that could be targeted for prevention efforts among PWH.

Design: We conducted a nested case-control study using data from the Veterans Aging Cohort Study (VACS), a longitudinal, observational cohort of Veterans from 2006-2015. A total of 5036 Veterans with HIV, of whom 461 died by SIUD, were included in the sample.

Methods: SIUD was defined using the International Classification of Disease 10 th revision cause of death codes. Cases ( n  = 461) included individuals who died by SIUD (intentional, unintentional, and undetermined causes of death). Controls ( n  = 4575) were selected using incidence density sampling, matching on date of birth ± 1 year, race, sex, and HIV status. SIUD and suicide was estimated using conditional logistic regression.

Results: A previous suicide attempt, a diagnosis of an affective disorder, recent use of benzodiazepines, psychiatric hospitalization, and living in the western US significantly increased the risk of suicide and SIUD. Risk factors that appear more important for SIUD than for suicide included a drug use disorder, alcohol use disorder, Hepatitis C, VACS Index 2.0, current smoking, and high pain levels (7-10).

Conclusion: Limiting studies to known suicides obscures the larger public health burden of excess deaths from self-injurious behavior. Our findings demonstrate the benefit of expanding the focus to SIUD for the identification of modifiable risk factors that could be targeted for treatment.

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感染艾滋病毒的退伍军人中的自我伤害性非自然死亡:一项巢式病例对照研究。
目的:与未感染艾滋病病毒的人群相比,艾滋病病毒感染者(PWH)的自杀和意外死亡风险更高。将自杀死亡扩大到自我伤害性非自然死亡(SIUD)可能会更好地确定一套更完整的可改变的风险因素,从而有针对性地在艾滋病病毒感染者中开展预防工作:我们利用退伍军人老龄队列研究(VACS)的数据开展了一项嵌套病例对照研究,该研究是 2006-2015 年期间对退伍军人的纵向观察队列。样本中共包括 5036 名感染艾滋病毒的退伍军人,其中 461 人死于 SIUD:SIUD采用《国际疾病分类》第10次修订版死因代码进行定义。病例(n = 461)包括死于 SIUD 的个人(故意、非故意和死因不明)。对照组(n = 4,575 人)采用发病密度抽样法,根据出生日期 ± 1 年、种族、性别和 HIV 感染状况进行匹配。利用条件逻辑回归对 SIUD 和自杀进行了估计:结果表明:自杀未遂、情感障碍诊断、近期使用苯二氮卓类药物、精神病住院以及居住在美国西部会显著增加自杀和 SIUD 的风险。与自杀相比,对 SIUD 更为重要的风险因素包括药物使用障碍、酒精使用障碍、丙型肝炎、VACS 指数 2.0、当前吸烟和高疼痛水平(7-10):仅限于已知自杀案例的研究掩盖了自残行为导致过多死亡所造成的更大公共卫生负担。我们的研究结果表明,将研究重点扩大到 SIUD,有利于识别可改变的风险因素,从而有针对性地进行治疗。
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来源期刊
AIDS
AIDS 医学-病毒学
CiteScore
5.90
自引率
5.30%
发文量
478
审稿时长
3 months
期刊介绍: ​​​​​​​​​​​​​​​​​Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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