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High Risk of Substance Use Disorder-Related Outcomes in Veterans Released from Correctional Facilities in Mid to Late Life.
Barry, Lisa C; Steffens, David C; Covinsky, Kenneth E; Conwell, Yeates; Boscardin, John; Li, Yixia; Byers, Amy L.
Afiliação
  • Barry LC; Department of Psychiatry, UCONN School of Medicine, Farmington, CT, USA. libarry@uchc.edu.
  • Steffens DC; UCONN Center On Aging, Farmington, CT, USA. libarry@uchc.edu.
  • Covinsky KE; Department of Psychiatry, UCONN School of Medicine, Farmington, CT, USA.
  • Conwell Y; San Francisco VA Healthcare System, San Francisco, CA, USA.
  • Boscardin J; Department of Medicine, Division of Geriatrics, University of California, San Francisco, USA.
  • Li Y; Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA.
  • Byers AL; San Francisco VA Healthcare System, San Francisco, CA, USA.
J Gen Intern Med ; 38(5): 1109-1118, 2023 04.
Article em En | MEDLINE | ID: mdl-36781577
BACKGROUND: Veterans Affairs (VA) is likely to encounter a growing number of veterans returning to the community in mid to late life following incarceration (i.e., experiencing reentry). Yet, rates of negative health outcomes due to substance use disorders (SUDs) in this population are unknown. OBJECTIVE: To determine risk of and risk factors for SUD-related emergency department visits and inpatient hospitalizations (ED/IPH) and overdose death among older reentry veterans compared with never-incarcerated veterans. DESIGN: Retrospective cohort study using national VA and Medicare healthcare systems data. PARTICIPANTS: Veterans age ≥50, incarcerated for ≤5 consecutive years, and released between October 1, 2010, and September 30, 2017 (N = 18,803), were propensity score-matched 1:5 with never-incarcerated veterans (N = 94,015) on demographic characteristics, reason for Medicare eligibility, and SUD history. MAIN MEASURES: SUD-related ED/IPH (overall and substance-specific) were obtained from in-/outpatient VA health services and CMS data within the year following release date/index date (through September 30, 2018). Overdose death within 1 year was identified using the National Mortality Data Repository. Fine-Gray proportional hazards regression compared risk of SUD-related ED/IPH and overdose death between the two groups. RESULTS: The number of SUD-related ED/IPHs and overdose deaths was 2470 (13.1%) and 72 (0.38%) in the reentry sample versus 4402 (4.7%) and 198 (0.21%) in the never-incarcerated sample, respectively. Mid-to-late-life reentry was associated with higher risk of any SUD-related ED/IPH (13,136.2 vs. 2252.8 per 100,000/year; adjusted hazard ratio [AHR] = 2.19; 95% confidence interval [CI] = 2.08, 2.30) and overdose death (382.9 vs. 210.6 per 100,000/year; AHR = 2.24, 95% CI = 1.63, 3.08). CONCLUSIONS: Older reentry veterans have more than double the risk of experiencing SUD-related ED/IPH (overall and substance-specific) and overdose death, even after accounting for SUD history and other likely confounders. These findings highlight the vulnerability of this population. Improved knowledge regarding SUD-related negative health outcomes may help to tailor VA reentry programming.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Veteranos / Transtornos Relacionados ao Uso de Substâncias / Overdose de Drogas Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Child, preschool / Humans País/Região como assunto: America do norte Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Veteranos / Transtornos Relacionados ao Uso de Substâncias / Overdose de Drogas Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Child, preschool / Humans País/Região como assunto: America do norte Idioma: En Ano de publicação: 2023 Tipo de documento: Article