Changing attitudes about LGBTQ+ older adults: the Gen Silent Survey Project.

OBJECTIVES: Lesbian, gay, bisexual, transgender, queer, and more (LGBTQ+) older adults may experience challenges accessing services due to stigma. Aging service providers seeking to create an inclusive culture need training tools. This study examined if a film (Gen Silent) could increase provider's knowledge of and empathy for LGBTQ+ older adults. METHODS: A pretest - posttest survey was administered at film screenings in New Hampshire to assess knowledge and attitudes of participants (N = 108). Data were analyzed descriptively, Wilcoxon signed-rank test was used to compare matched samples, and linear and logistic regression models compared group differences. RESULTS: Scores on eight of the nine measures improved after watching Gen Silent. Most participants (83%) indicated their thoughts and views had changed after watching the film. Statistically significant between group differences are discussed. CONCLUSIONS: The documentary Gen Silent was found to be an adequate, introductory training tool about LGBTQ+ aging.

Differences in Risks for Recurrent Injury and Death Among Survivors of Violence by Homeless Status.

A better understanding of the unique risks for survivors of violence experiencing homelessness could enable more effective intervention methods. The aim of this study was to quantify the risks of death and reinjury for unhoused compared to housed survivors of violent injuries. This retrospective study included a cohort of patients with known housing status presenting to the Boston Medical Center Emergency Department between 2009 and 2018 with a violent penetrating injury. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the risks of all-cause mortality and violent reinjury. Of the 2330 patients included for analysis, 415 (17.8%) were unhoused at the time of index injury. Within 3 years of the index injury, there were 319 (13.9%) violent reinjuries and 55 (2.4%) deaths. Unhoused patients were more likely than housed patients to be violently reinjured by all causes (HR = 1.39, 95% CI = 1.06-1.83, p = 0.02), by stab wound (HR = 2.34, 95% CI = 1.33-4.11, p = 0.0003), and by blunt assault (HR = 1.52, 95% CI = 1.05-2.21, p = 0.03). Housed and unhoused patients were equally likely to die within 3 years of their index injury; however, unhoused patients were at greater risk of dying by homicide (HR = 2.89, 95% CI = 1.34-6.25, p = 0.006) or by a drug/alcohol overdose (HR = 2.86, 95% CI = 1.17-6.94, p = 0.02). In addition to the already high risks that all survivors of violence have for recurrent injuries, unhoused survivors of violence are at even greater risk for violent reinjury and death and fatal drug/alcohol overdose. Securing stable housing for survivors of violence experiencing homelessness, and connecting them with addiction treatment, is essential for mitigating these risks.

The Town-Level Prevalence of Chronic Lung Conditions and Death From COVID-19 Among Older Adults in Connecticut and Rhode Island.

INTRODUCTION: As of November 2021, older adults (aged ≥65 y) accounted for 81% of all deaths from COVID-19 in the US. Chronic lung diseases increase the risk for severe COVID-19 illness and death. The aim of this research was to examine the association between town-level rates of asthma and chronic obstructive pulmonary disease (COPD) and deaths from COVID-19 in 208 towns in Connecticut and Rhode Island. METHODS: We conducted a multistep analysis to examine the association between town-level chronic lung conditions and death from COVID-19. Pairwise correlations were estimated and bivariate maps were created to assess the relationship between COVID-19 deaths per 100,000 people and 1) asthma prevalence and 2) COPD prevalence among adults aged 65 years or older. We used multiple linear regression models to examine whether chronic lung conditions and other town-level factors were associated with COVID-19 death rates in Connecticut and Rhode Island. RESULTS: Initial bivariate correlation and mapping analyses suggested positive correlations between asthma and COPD prevalence and COVID-19 death rates. However, after controlling for town-level factors associated with chronic lung conditions and COVID-19 death rates, multiple linear regression models did not support an association, but town-level factors (African American race and Hispanic ethnicity, age ≥65 y, and low educational attainment) were significant predictors of COVID-19 death rates. CONCLUSION: We found significant associations between town-level factors and COVID-19, adding to the current understanding of the impact of social determinants of health on outcomes.

Implementation of a Novel Home Visiting Nurse Pilot Program for Victims of Violent Penetrating Injury.

BACKGROUND: Survivors of violent injuries are at risk for readmission, rehospitalization, and reinjury. In 2017, a novel home visiting nurse pilot program was implemented within a hospital-based violence intervention program (HVIP) to address disparities in care and combat the limited health care literacy and access, and the general mistrust of health care institutions among much of this population. OBJECTIVE: The purpose of this study was to review the design and implementation of the home visiting nurse component of the HVIP and to report the demographics, clinical characteristics, home care needs, and short-term health outcomes of the pilot sample. METHODS: This retrospective study was performed using a cohort of patients presenting to the emergency department at an urban, Level I trauma center for a violent penetrating injury between 2017 and 2018. The χ2 and Wilcoxon rank sum tests were used to compare patient demographics and injury characteristics. Cox proportional hazards regression models were used to estimate health outcomes. RESULTS: Of the 742 victims of violence included in this analysis, the 57 patients enrolled in the home visiting nurse pilot program were more likely to have severe gunshot wounds (68.4% vs. 40.3%, p < .001) requiring hospitalization (80.7% vs. 53.3%, p < .001), with 3.5% requiring rehospitalization within 90 days. The primary interventions provided by the home visiting nurse involved medical navigation and education, wound care, and consultation, underscoring the critical importance of health literacy and outreach for this vulnerable population. CONCLUSION: The nurse-advocate partnership provides the foundation for this novel program to aid a marginalized population in overcoming health inequities.

Introducing students to healthy aging within their own communities: An online applied research experience.

Engaging gerontology students in research that hits "close-to-home" can have lasting benefits for them and their communities both professionally and personally. Since 2016, cohorts of undergraduate/certificate students in an online applied research in aging course have explored healthy aging in their Massachusetts' (MA) communities. The students utilized both primary and secondary data sources. First, they extracted data from the 2014-2015 healthy aging data report (HADR) community profiles of 367 MA communities. Then they conducted in-person interviews with a diverse set of stakeholders in their respective communities. The interviews were designed to examine the profiles, identify challenges and/or strengths, and highlight community resources and intervention strategies. Over three academic semesters, a total of 67 interviews were conducted in 13 communities. The top three health indicators of concern raised by the stakeholders, that the students learned about, were the high rates of Alzheimer's disease or related dementias, congestive heart failure, and diabetes. Other non-health related challenges were transportation, affordable housing, wellness/prevention, and the built environment. The student reflections on their research experience highlight the value of providing opportunities to collect and analyze data, to learn about a substantive issue, and the needs of local older adults.

PI3K mediated activation of GSK-3ß reduces at-level primary afferent growth responses associated with excitotoxic spinal cord injury dysesthesias.

BACKGROUND: Neuropathic pain and sensory abnormalities are a debilitating secondary consequence of spinal cord injury (SCI). Maladaptive structural plasticity is gaining recognition for its role in contributing to the development of post SCI pain syndromes. We previously demonstrated that excitotoxic induced SCI dysesthesias are associated with enhanced dorsal root ganglia (DRG) neuronal outgrowth. Although glycogen synthase kinase-3ß (GSK-3ß) is a known intracellular regulator neuronal growth, the potential contribution to primary afferent growth responses following SCI are undefined. We hypothesized that SCI triggers inhibition of GSK-3ß signaling resulting in enhanced DRG growth responses, and that PI3K mediated activation of GSK-3ß can prevent this growth and the development of at-level pain syndromes. RESULTS: Excitotoxic SCI using intraspinal quisqualic acid (QUIS) resulted in inhibition of GSK-3ß in the superficial spinal cord dorsal horn and adjacent DRG. Double immunofluorescent staining showed that GSK-3ß(P) was expressed in DRG neurons, especially small nociceptive, CGRP and IB4-positive neurons. Intrathecal administration of a potent PI3-kinase inhibitor (LY294002), a known GSK-3ß activator, significantly decreased GSK-3ß(P) expression levels in the dorsal horn. QUIS injection resulted in early (3 days) and sustained (14 days) DRG neurite outgrowth of small and subsequently large fibers that was reduced with short term (3 days) administration of LY294002. Furthermore, LY294002 treatment initiated on the date of injury, prevented the development of overgrooming, a spontaneous at-level pain related dysesthesia. CONCLUSIONS: QUIS induced SCI resulted in inhibition of GSK-3ß in primary afferents and enhanced at-level DRG intrinsic growth (neurite elongation and initiation). Early PI3K mediated activation of GSK-3ß attenuated QUIS-induced DRG neurite outgrowth and prevented the development of at-level dysesthesias.

Noninvasive prenatal screening for aneuploidy: positive predictive values based on cytogenetic findings.

OBJECTIVE: We sought to determine the positive predictive value (PPV) of noninvasive prenatal screening (NIPS) for various aneuploidies based on cases referred for follow-up cytogenetic testing. Secondarily, we wanted to determine the false-negative (FN) rate for those cases with a negative NIPS result. STUDY DESIGN: We compared the cytogenetic findings (primarily from chromosome analysis) from 216 cases referred to our laboratories with either a positive or negative NIPS result, and classified NIPS results as true positive, false positive, true negative, or FN. Diagnostic cytogenetic testing was performed on the following tissue types: amniotic fluid (n = 137), chorionic villi (n = 69), neonatal blood (n = 6), and products of conception (n = 4). RESULTS: The PPV for NIPS were as follows: 93% for trisomy (T)21 (n = 99; 95% confidence interval [CI], 86-97.1%), 58% for T18 (n = 24; 95% CI, 36.6-77.9%), 45% for T13 (n = 11; 95% CI, 16.7-76.6%), 23% for monosomy X (n = 26; 95% CI, 9-43.6%), and 67% for XXY (n = 6; 95% CI, 22.3-95.7%). Of the 26 cases referred for follow-up cytogenetics after a negative NIPS result, 1 (4%) was FN (T13). Two cases of triploidy, a very serious condition but one not claimed to be detectable by the test providers, were among those classified as true negatives. CONCLUSION: T21, which has the highest prevalence of all aneuploidies, demonstrated a high true-positive rate, resulting in a high PPV. However, the other aneuploidies, with their lower prevalence, displayed relatively high false-positive rates and, therefore, lower PPV. Patients and physicians must fully understand the limitations of this screening test and the need in many cases to follow up with appropriate diagnostic testing to obtain an accurate diagnosis.

How large is the gap between self-report and assessed mental health and does it impact older adult mental health service utilization?

We examined the relationship between self-reported and assessed mental health status and service use, using data from the Health and Retirement Study (N = 9,547). Twelve percent and thirty percent had inaccurate perceptions of their mood and memory status, respectively. No significant difference was found in the likelihood of service use between older adults who were unaware of current depressive symptoms and those who self-reported problems but had no assessed symptoms. Older adults who scored low in cognitive test were more likely to use services, regardless of self-reported memory status. Discrepancies between self-reported and assessed status may contribute to service utilization.

US policies to enhance older driver safety: a systematic review of the literature.

The purpose of this study was to conduct a systematic review of the literature related to state policies concerning older drivers and to draw policy conclusions about which policies appear to work to reduce older driver crashes and to identify areas needed for further research. Specific policies examined in this paper concern medical reporting and medical review, license renewal processes, and driver testing. A study was included in the systematic review if it met the following criteria: published in English between 1991and January 2013; included data on human subjects aged 65 and older residing in the United States; included information on at least one policy related to older drivers; and had a transportation-related outcome variable (e.g., crash, fatality, renewal). A total of 29 studies met inclusion criteria. Twenty-two studies investigated license renewal and seven articles examined medical reporting. In-person license renewal requirements were associated with reduced risk for fatal crashes. Restricted licenses were associated with reduced number of miles driven per week. More intensive renewal requirements and being the subject of a medical report to the licensing authority was associated with delicensure. Given the importance of driving to mobility, quality of life, and public safety, more research is needed.

Attenuation of SCI-Induced Hypersensitivity by Intensive Locomotor Training and Recombinant GABAergic Cells.

The underlying mechanisms of spinal cord injury (SCI)-induced chronic pain involve dysfunctional GABAergic signaling and enhanced NMDA signaling. Our previous studies showed that SCI hypersensitivity in rats can be attenuated by recombinant rat GABAergic cells releasing NMDA blocker serine-histogranin (SHG) and by intensive locomotor training (ILT). The current study combines these approaches and evaluates their analgesic effects on a model of SCI pain in rats. Cells were grafted into the spinal cord at 4 weeks post-SCI to target the chronic pain, and ILT was initiated 5 weeks post-SCI. The hypersensitivity was evaluated weekly, which was followed by histological and biochemical assays. Prolonged effects of the treatment were evaluated in subgroups of animals after we discontinued ILT. The results show attenuation of tactile, heat and cold hypersensitivity in all of the treated animals and reduced levels of proinflammatory cytokines IL1ß and TNFα in the spinal tissue and CSF. Animals with recombinant grafts and ILT showed the preservation of analgesic effects even during sedentary periods when the ILT was discontinued. Retraining helped to re-establish the effect of long-term training in all of the groups, with the greatest impact being in animals with recombinant grafts. These findings suggest that intermittent training in combination with cell therapy might be an efficient approach to manage chronic pain in SCI patients.

Racial and Ethnic Disparities in Violent Penetrating Injuries and Long-Term Adverse Outcomes.

Violent injury is known to be a chronic, recurrent issue, with high rates of recidivism following initial injury. While the burden of violence is disproportionately felt among young Black men and in communities of color, examination of distinct risk factors and long-term outcomes for other racial and ethnic groups could lead to improved violence intervention strategies. In this study, we examined the risk of violent penetrating injury and long-term adverse outcomes by race and ethnicity. This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a violent penetrating injury between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) for the risk of all-cause mortality and violent re-injury at one and 3 years after surviving a penetrating injury.Of the 4191 victims of violent injury, 12% were White, 18% were Hispanic, and the remaining 70% self-identified as Black. Within 3 years after initial injury, Black patients were at the greatest risk of all-cause violent re-injury (vs. Hispanic: HR = 1.46, 95%CI[1.15,1.85], p = 0.002; vs. White: HR = 1.89, 95%CI[1.40,2.57], p < 0.0001), particularly by gunshot wound (vs. Hispanic: HR = 2.04, 95%CI[1.29,3.22] p = 0.002; vs. White: HR = 2.34, 95%CI[1.19,4.60], p = 0.01). At 3-years following initial injury, White patients were at 2.03 times the risk for all-cause mortality, likely due to a 4.96 times greater risk of death by drug or alcohol overdose for White patients compared to Black patients (HR = 4.96, 95%CI[2.25,10.96], p < 0.0001). In conclusion, Black survivors of violent injury have a significantly higher risk of violent re-injury, particularly by gun violence, while White patients are at the highest risk for mortality due to the incidence of drug and alcohol overdose. Violence intervention programs with similar patient populations should explore options to collaborate with drug treatment programs to reach this vulnerable population.

Aging on the Autism Spectrum: Physical Activity in Individuals Receiving State Services in the United States.

This study explores factors associated with participation in moderate physical activity and muscle strengthening activity in adults with autism receiving state services (age: 18-78 years). Researchers analyzed the National Core Indicators-In Person Survey (2017-2018) data using multilevel mixed effects logistic regression. Older adults on the autism spectrum engaged in both moderate physical activity and muscle strengthening activity less often than younger adults on the autism spectrum (OR 0.99; p < 0.05; OR 0.98; p < 0.001). Individuals reportedly in fair/poor health had 50% lower odds of engaging in moderate physical activity and 30% lower odds of engaging in muscle strengthening compared to those in good/ excellent health (OR 0.50; p < 0.001; OR 0.70; p < 0.001). Moderate physical activity/muscle strengthening initiatives may help foster this group's healthy aging.

Exposure to Neighborhood Racialized Economic Segregation and Reinjury and Violence Perpetration Among Survivors of Violent Injuries.

Importance: Much is unknown about how individual and neighborhood factors converge in the association with risk for violent reinjury and violence perpetration. Objectives: To investigate the association of exposure to neighborhood racialized economic segregation with reinjury and use of violence against others among survivors of violent penetrating injury. Design, Setting, and Participants: This retrospective cohort study was performed using data obtained from hospital, police, and state vital records. The study was performed at Boston Medical Center, an urban, level I trauma center that is the largest safety-net hospital and busiest trauma center in New England. The cohort included all patients treated for a nonfatal violent penetrating injury from 2013 to 2018. Patients with no Boston metropolitan area home address were excluded. Individuals were followed up through 2021. Data were analyzed from February to August 2022. Exposure: American Community Survey data were used to measure neighborhood deprivation using the racialized economic Index of Concentration at the Extremes (ICE) for patient residential address upon hospital discharge. ICE was measured on a scale from -1 (most deprived) to 1 (most privileged). Main Outcomes and Measures: Primary outcomes were violent reinjury and police-reported perpetration of violence within 3 years of an index injury. Results: Of 1843 survivors of violence (median [IQR] age, 27 [22-37] years; 1557 men [84.5%]; 351 Hispanic [19.5%], 1271 non-Hispanic Black [70.5%], and 149 non-Hispanic White [8.3%] among 1804 patients with race and ethnicity data), the cohort was skewed toward residing in neighborhoods with higher racialized economic segregation (median [IQR] ICE = -0.15 [-0.22 to 0.07]) compared with the state overall (ICE = 0.27). There were police encounters for violence perpetration among 161 individuals (8.7%) and violent reinjuries among 214 individuals (11.6%) within 3 years after surviving a violent penetrating injury. For each 0.1-unit increase in neighborhood deprivation, there was a 13% (hazard ratio [HR], 1.13; 95% CI, 1.03 to 1.25; P = .01) increase in risk of violence perpetration but no difference in risk for violent reinjury (HR, 1.03; 95% CI, 0.96 to 1.11; P = .38). The greatest occurrence for each outcome was within the first year after index injury; for example, incidents of violence perpetration occurred among 48 of 614 patients (7.8%) at year 1 vs 10 of 542 patients (1.8%) at year 3 in tertile 3 of neighborhood deprivation. Conclusions and Relevance: This study found that living in a more economically deprived and socially marginalized area was associated with increased risk of using violence against others. The finding suggests that interventions may need to include investments in neighborhoods with the highest levels of violence to help reduce downstream transmission of violence.

Trends in Violent Penetrating Injuries During the First Year of the COVID-19 Pandemic.

Importance: Public health measures instituted to reduce the spread of COVID-19 led to severe disruptions to the structure of daily life, and the resultant social and financial impact may have contributed to an increase in violence. Objective: To examine the trends in violent penetrating injuries during the first COVID-19 pandemic year compared with previous years. Design, Setting, and Participants: This retrospective cross-sectional study was performed to compare the prevalence of violent penetrating injuries during the first COVID-19 pandemic year, March 2020 to February 2021, with the previous 5 years, March 2015 to February 2020. This study was performed among all patients with a violent penetrating injury presenting at Boston Medical Center, an urban, level I trauma center that is the largest safety-net hospital and busiest trauma center in New England. Data were analyzed from January 4 to November 29, 2021. Main Outcomes and Measures: The primary outcomes were the incidence and timing of emergency department presentation for violent penetrating injuries during the first year of the COVID-19 pandemic compared with the previous 5 years. Patient demographics and injury characteristics were also assessed. Results: A total of 2383 patients (median [IQR] age, 29.5 [23.4-39.3] years; 2032 [85.4%] men and 351 [14.6%] women) presenting for a violent penetrating injury were evaluated, including 1567 Black patients (65.7%), 448 Hispanic patients (18.8%), and 210 White patients (8.8%). There was an increase in injuries during the first pandemic year compared with the previous 5 years, with an increase in shootings (mean [SD], 0.61 [0.89] injuries per day vs 0.46 [0.76] injuries per day; P = .002) but not stabbings (mean [SD], 0.60 [0.79] injuries per day vs 0.60 [0.82] injuries per day; P = .78). This surge in firearm violence began while Massachusetts was still under a stay-at-home advisory and before large-scale racial justice protests began. Patients presenting with violent penetrating injuries in the pandemic surge months (April-October 2020) compared with the same period in previous years were disproportionately male (153 patients [93.3%] vs 510 patients [87.6%]; P = .04), unemployed (70 patients [57.4%] vs 221 patients [46.6%]; P = .03), and Hispanic (40 patients [26.0%] vs 99 patients [17.9%]; P = .009), with a concurrent decrease in White patients (0 patients vs 26 patients [4.7%]), and were more likely to have no previous history of violent penetrating injury (146 patients [89.0%] vs 471 patients [80.9%]; P = .02). Conclusions and Relevance: These findings suggest that unprecedented measures implemented to mitigate the spread of COVID-19 were associated with an increase in gun violence. As the pandemic abates, efforts at community violence prevention and intervention must be redoubled to defend communities against the epidemic of violence.

Healthy Aging Data Reports: Measures of Community Health to Identify Disparities and Spur Age-Friendly Progress.

BACKGROUND AND OBJECTIVES: This translational research had 2 aims: first, to analyze and translate data from multiple original data sources to provide accurate, unbiased local community and statewide information about healthy aging; second, to work with stakeholders to use the tools to identify disparities in healthy aging and to support their efforts to advance healthy aging. RESEARCH DESIGN AND METHODS: Data sources from the Centers for Medicare and Medicaid Services, Behavioral Risk Factor Surveillance System, U.S. Census American Community Survey, and other sources were analyzed using small area estimation techniques to determine age/gender-adjusted local community rates in Connecticut (CT), Massachusetts (MA), New Hampshire (NH), and Rhode Island (RI). RESULTS: State-level analyses revealed gender and racial/ethnic disparities in healthy aging. A factor analysis identified 4 dimensions of community population healthy aging/morbidity: serious complex chronic disease, indolent conditions, physical disability, and psychological disability. DISCUSSION AND IMPLICATIONS: Healthy Aging Data Reports now exist for MA (2014, 2015, and 2018), NH (2019), RI (2016 and 2020), and CT (2021) and demonstrate differences in health by place. Each report includes community profiles for every city, town, and some urban neighborhoods with more than 170-197 indicators. The reports include maps of the statewide distribution of rates, an infographic, highlights report with state-specific multivariate analyses, and 18 interactive web maps, 18 regional interactive web maps, and technical documentation about data sources and methods. Overall, the research has identified variations in healthy aging and provided tools to track change over time to support age-friendly efforts in the region.

A New Measure of Community Health: Findings From the Healthy Aging Data Reports.

BACKGROUND AND OBJECTIVES: The purpose of this study was to develop a multidimensional measure of community healthy aging that is more nuanced than existing measures. The social-ecological framework guided this analysis of the latent structure of community prevalence rates of chronic diseases and functional impairments. RESEARCH DESIGN AND METHODS: The sample was 471 communities in Massachusetts (n = 319) and New Hampshire (n = 152). Data were drawn from publicly available healthy aging data reports for both states. Community prevalence rates for 45 chronic conditions, rates of mortality, and Medicare service utilization were estimated with the 2014-2015 Centers for Medicare & Medicaid Services (CMS) Medicare Beneficiary Summary Files and used in factor analyses to explore the latent structure of community healthy aging. RESULTS: Results revealed a multidimensional structure composed of 4 latent population health components: serious complex chronic disease, indolent chronic disease, physical disability, and psychological disability. We found that while lower community socioeconomic status is a major determinant of all 4 components of population health, it is predictably associated with higher levels of serious complex chronic disease and physical disability and yet surprisingly with lower levels of indolent chronic disease and psychological disability. DISCUSSION AND IMPLICATIONS: The 4-dimensional model provides a more nuanced measure of community healthy aging than mortality rate, and it identifies community health disparities that otherwise may go undetected. Understanding the multiple levels that influence community healthy aging may reveal new interventions or programs to improve it and allow policymakers or other stakeholders to more accurately tailor interventions to match the conditions of need.

Mechanism of penetrating injury mediates the risk of long-term adverse outcomes for survivors of violent trauma.

BACKGROUND: While hospital-based violence intervention programs are primarily designed to aid youth victims of gun violence at high risk for reinjury, the root causes and complex outcomes of community violence are varied. In this study, we examined the risk factors for violent penetrating injury and how the risk of adverse outcomes for survivors differs by injury type (stabbing vs. gunshot wound). METHODS: This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a penetrating injury due to community violence between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the risk of all-cause mortality and violent reinjury within 3 years after surviving a penetrating injury. RESULTS: Of the 4,280 survivors of the initial violent penetrating injury, there were 88 deaths (2.1%) and 568 violent reinjuries (13.3%) within 3 years. Compared with gunshot wound victims, stab wound victims were 31% less likely to be reinjured with a gunshot wound (HR, 0.69; 95% CI, 0.51-0.93), 72% more likely to be reinjured with a stab wound (HR, 1.72; 95% CI, 1.21-2.43), and 49% more likely to be reinjured by assault (HR, 1.49; 95% CI, 1.14-1.94). While survivors of stabbing and firearm injuries were equally at risk for 3-year all-cause mortality, stab wound victims were 3.75 times more likely to die by a drug/alcohol overdose (HR, 3.75; 95% CI, 1.11-20.65). CONCLUSION: Patients surviving a stab wound have a significantly higher risk of violent reinjury by stabbing or assault, and risk of death by drug/alcohol overdose. Hospital-based violence intervention programs with similar patient populations should explore options to expand partnerships with drug treatment programs. These results illustrate two distinct populations of victims of violence-gunshot victims and stabbing/assault victims-with separate risk factors and outcomes, mediated by substance use disorder. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; level III.

Social Characteristics, Health, and Mortality Among Male Centenarians Using Veterans Affairs (VA) Health Care.

We studied male centenarian Veterans using VA health care to understand the impact of social characteristics on their annual mortality rate, adjusting for prevalent health conditions. This longitudinal study used VA Electronic Health Record data from 1997 to 2012 (n = 1,858). Covariates included age, race, marital status, and periods of military service. The mean age was 100.4 ± 1.4 years, 76% were white, and 49% were married. The average annual mortality rate was 32 per 100 person-years. The annual mortality rate was stable and not affected by race but did vary by marital status. Divorced or separated centenarians had a 21% higher rate of death than married centenarians. A diagnosis of dementia or of congestive heart failure each increased the mortality risk by 37%. Providers should consider prevalent health conditions, as well as marital status, in managing care of centenarian Veterans.