TY - JOUR
T1 - Excess mortality associated with mental illness and substance use disorders among veteran clinic users with spinal cord injury
AU - Findley, Patricia A.
AU - Banerjea, Ranjana
AU - Sambamoorthi, Usha
N1 - Funding Information:
This research was supported by grants from the Department of Veterans Affairs-Health Services Research and Development Service: IAE 05-255; IIR-05-016; Diabetes Epidemiology Cohort Study. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
PY - 2011
Y1 - 2011
N2 - Purpose. Among veterans with traumatic spinal cord injury (SCI) or disease aetiologies, examine the association between diagnosed mental illness (MI) and substance use disorders (SUD) on mortality after controlling for demographic and socioeconomic factors, SCI severity, injury duration and chronic physical illnesses. Method. Longitudinal analysis of Veteran Health Administration(VHA) administrative data and Medicare claims for FY 19992004 matched with Spinal Cord Dysfunction-Registry (SCD-R) of VHA clinic users (N = 8334) with SCI. SCI was identified through SCD-R; individual MIs (anxiety, bipolar, depressive disorders, psychoses, post-traumatic disorder and schizophrenia) and SUDs (tobacco, alcohol and/or drug) were identified through ICD-9-CM codes. Cox-proportional hazards regressions were used to examine association between MI and SUD and time to death in years. Results. Among veterans with SCI, 17% died by the end of FY 2004. Veterans with psychosis (35%), depression (22%) and alcohol and/or drug use (20%) had significantly higher rates of mortality compared to those without these diagnoses. After adjusting for other independent variables in the study, hazards ratios for psychosis was 1.47 (95%CI = 1.24, 1.75), for alcohol and/or drug use was 1.30 (95% CI = 1.11, 1.53). Conclusions. Some types of MI and SUD were associated with excess mortality among veterans with SCI. Care for MI and SUD needs to be routinely integrated into SCI management. Future research is needed to determine whether depression and SUD treatment provides opportunity to improve survival.
AB - Purpose. Among veterans with traumatic spinal cord injury (SCI) or disease aetiologies, examine the association between diagnosed mental illness (MI) and substance use disorders (SUD) on mortality after controlling for demographic and socioeconomic factors, SCI severity, injury duration and chronic physical illnesses. Method. Longitudinal analysis of Veteran Health Administration(VHA) administrative data and Medicare claims for FY 19992004 matched with Spinal Cord Dysfunction-Registry (SCD-R) of VHA clinic users (N = 8334) with SCI. SCI was identified through SCD-R; individual MIs (anxiety, bipolar, depressive disorders, psychoses, post-traumatic disorder and schizophrenia) and SUDs (tobacco, alcohol and/or drug) were identified through ICD-9-CM codes. Cox-proportional hazards regressions were used to examine association between MI and SUD and time to death in years. Results. Among veterans with SCI, 17% died by the end of FY 2004. Veterans with psychosis (35%), depression (22%) and alcohol and/or drug use (20%) had significantly higher rates of mortality compared to those without these diagnoses. After adjusting for other independent variables in the study, hazards ratios for psychosis was 1.47 (95%CI = 1.24, 1.75), for alcohol and/or drug use was 1.30 (95% CI = 1.11, 1.53). Conclusions. Some types of MI and SUD were associated with excess mortality among veterans with SCI. Care for MI and SUD needs to be routinely integrated into SCI management. Future research is needed to determine whether depression and SUD treatment provides opportunity to improve survival.
KW - Spinal cord injury
KW - mental illness
KW - mortality
KW - substance abuse disorders
KW - veterans
UR - http://www.scopus.com/inward/record.url?scp=79960772739&partnerID=8YFLogxK
U2 - 10.3109/09638288.2010.540294
DO - 10.3109/09638288.2010.540294
M3 - Article
C2 - 21184627
AN - SCOPUS:79960772739
SN - 0963-8288
VL - 33
SP - 1608
EP - 1615
JO - Disability and Rehabilitation
JF - Disability and Rehabilitation
IS - 17-18
ER -