Drug overdose deaths among homeless veterans in the United States Department of Veterans Affairs healthcare system.

IF 5.2 1区医学 Q1 PSYCHIATRY Addiction Pub Date : 2024-10-17 DOI:10.1111/add.16689

Jack Tsai, Dorota Szymkowiak, Hind A Beydoun

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Abstract

Background and aims: With an epidemic of drug overdoses, contemporary research is needed to examine drug overdose deaths among homeless populations. This study measured rates, types and correlates of drug overdose deaths occurring over a 5-year study period among veterans experiencing homelessness (VEH) and non-homeless veterans (NHV) in the US Department of Veterans Affairs (VA) healthcare system.

Design: Retrospective cohort study.

Setting: USA.

Participants: A total of 6 128 921 veterans. We followed 399 125 VEH and 5 729 796 NHV between 2017 and 2021 using linked administrative VA and National Death Index data.

Measurements: Multivariable Cox regression models were constructed to estimate hazard ratios (HRs) for homelessness as a predictor of time-to-occurrence of overdose deaths with 95% confidence interval (CIs), sequentially controlling for demographic, medical, substance use and mental health characteristics.

Findings: Among overdose deaths, 8653 [93.7%, 95% confidence interval (CI) = 93.2-94.2%] were unintentional and 5378 (57.8%, 95% CI = 56.8-58.8%) involved opioids. The overdose-specific mortality rate (per 100 000 person-years) was 227.3 among VEH and 23.2 among NHV (HR = 9.76, 95% CI = 9.36, 10.16), with rates 7-14 times higher among VEH than NHV, depending on the drug involved. In fully adjusted models, homelessness was associated with greater risk of drug overdose death (HR = 3.33, 95% CI = 3.18, 3.49), with the greatest risk involving psychostimulants (HR = 4.19), followed by antiepileptic/sedative/hypnotic drugs (HR = 3.69), synthetic opioids (HR = 3.50) and natural and semi-synthetic opioids (HR = 2.79).

Conclusions: US veterans experiencing homelessness appear to have three times the risk for drug overdose deaths than non-homeless veterans. There may be specific risks associated with psychostimulant, antiepileptic, sedative and hypnotic drugs in this population that deserve greater attention.

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美国退伍军人事务部医疗保健系统中无家可归的退伍军人吸毒过量死亡的情况。

背景和目的：随着吸毒过量的流行，当代需要对无家可归人群中吸毒过量死亡的情况进行研究。这项研究测量了美国退伍军人事务部（VA）医疗保健系统中无家可归的退伍军人（VEH）和非无家可归的退伍军人（NHV）在 5 年研究期内吸毒过量死亡的比率、类型和相关因素：设计：回顾性队列研究：地点：美国：共有 6 128 921 名退伍军人。2017年至2021年期间，我们利用退伍军人事务部和国家死亡指数的关联行政数据，对399 125名VEH和5 729 796名NHV进行了追踪调查：我们构建了多变量考克斯回归模型，以估算无家可归作为吸毒过量死亡发生时间预测因素的危险比（HRs）及95%置信区间（CIs），并依次控制人口统计、医疗、药物使用和心理健康特征：在过量死亡中，8653 例[93.7%，95% 置信区间 (CI) = 93.2-94.2%]为非故意死亡，5378 例（57.8%，95% CI = 56.8-58.8%）涉及阿片类药物。过量用药特异性死亡率（每 10 万人年）在无家可归者中为 227.3，在无家可归者中为 23.2（HR = 9.76，95% CI = 9.36，10.16），无家可归者的死亡率比无家可归者高 7-14 倍，具体取决于所涉及的药物。在完全调整模型中，无家可归与药物过量死亡的更大风险相关（HR = 3.33，95% CI = 3.18，3.49），其中涉及精神兴奋剂的风险最大（HR = 4.19），其次是抗癫痫/镇静/催眠药（HR = 3.69）、合成类阿片（HR = 3.50）以及天然和半合成类阿片（HR = 2.79）：结论：无家可归的美国退伍军人吸毒过量死亡的风险似乎是非无家可归退伍军人的三倍。在这一人群中，精神兴奋药、抗癫痫药、镇静药和催眠药可能存在特殊风险，值得更多关注。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.