Geography, rurality, and community distress: deaths due to suicide, alcohol-use, and drug-use among Colorado Veterans

Injury Epidemiology

Original Contribution

Colleen E. Reid¹  Mary Bollinger²  Lauren M. Denneson³  Alexandra L. Schneider⁴  Jeri Forster⁵  Talia L. Spark⁶  Lisa A. Brenner⁷  Rachel Sayko Adams⁸ 

[1] Geography Department, University of Colorado Boulder, Boulder, CO, USA;VA HSR&D Center for Mental Healthcare and Outcomes Research, North Little Rock, AR, USA;VA HSR&D Suicide Prevention Impact Network, Little Rock, AR, USA;Center for Health Services Research, University of Arkansas for Medical Sciences, Little Rock, AR, USA;VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA;Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA;VISN 19 VA Rocky Mountain MIRECC for Veteran Suicide Prevention, Rocky Mountain Regional VA Medical Center, Veterans Health Administration, 1700 North Wheeling St., 80045, Aurora, CO, USA;VISN 19 VA Rocky Mountain MIRECC for Veteran Suicide Prevention, Rocky Mountain Regional VA Medical Center, Veterans Health Administration, 1700 North Wheeling St., 80045, Aurora, CO, USA;Department of Physical Medicine and Rehabilitation, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA;VISN 19 VA Rocky Mountain MIRECC for Veteran Suicide Prevention, Rocky Mountain Regional VA Medical Center, Veterans Health Administration, 1700 North Wheeling St., 80045, Aurora, CO, USA;Department of Physical Medicine and Rehabilitation, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA;Injury and Violence Prevention Center, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA;VISN 19 VA Rocky Mountain MIRECC for Veteran Suicide Prevention, Rocky Mountain Regional VA Medical Center, Veterans Health Administration, 1700 North Wheeling St., 80045, Aurora, CO, USA;Department of Physical Medicine and Rehabilitation, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA;Injury and Violence Prevention Center, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA;Department of Psychiatry, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA;Department of Neurology, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA;VISN 19 VA Rocky Mountain MIRECC for Veteran Suicide Prevention, Rocky Mountain Regional VA Medical Center, Veterans Health Administration, 1700 North Wheeling St., 80045, Aurora, CO, USA;Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA;

关键词: Suicide;    Substance use disorder;    Overdose;    Alcohol-related liver disease;    Veterans;    Rurality;    Geography;    Community distress;   

DOI  :  10.1186/s40621-023-00416-x

 received in 2022-05-27, accepted in 2023-01-12,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIn the USA, deaths due to suicide, alcohol, or drug-related causes (e.g., alcohol-related liver disease, overdose) have doubled since 2002. Veterans appear disproportionately impacted by growing trends. Limited research has been conducted regarding the relationship between community-level factors (e.g., rurality, community distress resulting from economic conditions) and the presence of spatial clustering of suicide, alcohol-related, or drug-related deaths. We explored community-level relationships in Colorado Veterans and compared suicide, alcohol-, and drug-related death rates between the Colorado adult population and Veterans.Methods2009–2020 suicide, alcohol-related, and/or drug-related deaths were identified using qualifying multiple cause-of-death International Classification of Disease (ICD)-10 codes in CDC WONDER for the general adult population and Colorado death data for Veteran populations. Age and race adjusted rates were calculated to compare risk overall and by mortality type (i.e., suicide, alcohol-related, drug-related). In Veteran decedents, age-adjusted rates were stratified by rurality and community distress, measured by the Distressed Communities Index. Standardized mortality ratios were calculated to measure spatial autocorrelation and identify clusters using global and local Moran’s I, respectively.Results6.4% of Colorado Veteran deaths (n = 6948) were identified as being related to suicide, alcohol, or drugs. Compared to rates in the general population of Colorado adults, Veterans had 1.8 times higher rates of such deaths overall (2.1 times higher for suicide, 1.8 times higher for alcohol-related, 1.3 times higher for drug-related). Among Veterans, community distress was associated with an increased risk of alcohol-related [age-adjusted rate per 100,000 (95% CI) = 129.6 (89.9–193.1)] and drug-related deaths [95.0 (48.6–172.0)]. This same significant association was not identified among those that died by suicide. Rurality was not associated with risk for any of the deaths of interest. There was significant spatial clustering for alcohol-related deaths in southeast Colorado.ConclusionsColorado Veterans have higher rates of deaths due to suicide, alcohol-related, and drug-related causes compared to members of the general adult population. Upstream prevention efforts, such as community-based interventions targeting alcohol-use and community economic distress, are warranted. More research is also needed to understand how community distress and other social determinants of health impact the community burden of suicide, alcohol-related, and drug-related mortality.

【 授权许可】

CC BY   
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023

【 图 表 】

Fig. 1

13731_2023_266_Article_IEq20.gif