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Differential mortality among US veterans: Social determinants of health, substance use disorder, and substance use treatment
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DOI：10.1111/ajad.70158.png)
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Abstract
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Background and Objectives: Veterans face disproportionate suicide and mortality risks driven by intersecting social determinants of health (SDH), including housing instability, unemployment, and justice involvement, and co-occurring substance use disorders (SUD). This study examined how these intersecting factors influence mortality and whether SUD treatment mitigated mortality risks among US veterans. Methods: Using national Veterans Health Administration data (2014-2019), we identified 215,944 veterans with SUD and an indicator of one of three adverse SDH: housing instability, justice involvement, or unemployment. We tracked suicide and all-cause mortality for 1 year following SDH exposure. We used discrete-time survival models to assess associations between month-specific SUD treatment and mortality outcomes, controlling for demographic, clinical (i.e., mental health conditions, suicidal behavior), and contextual covariates. Results: Nearly half of veterans (48%) received SUD treatment. Those who received treatment had lower all-cause mortality (2.1% vs. 4.3%; p < .001) but no significant difference in suicide mortality (0.1% vs. 0.6%; p = .75). SUD treatment was associated with a 24% (aOR = 1.24; 95% CI: 1.16-1.34) reduction in all-cause mortality, though its interaction with each adverse SDH was not statistically significant. Suicide deaths remained concentrated among White veterans, those aged 18-34, with no service connection, and with time-varying suicidal ideation or attempts (p < .001). Discussion and Conclusions: Engagement in SUD treatment reduces all-cause mortality among veterans facing compounded social adversity but does not independently mitigate suicide deaths.
Keywords:
Substance use disorder
Social determinants of health
Mortality
Veterans
Treatment engagement
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