Amy L Byers1,2, Yixia Li1,3, Deborah E Barnes1,2,4, Karen H Seal1,2,5, W John Boscardin1,4,5, Kristine Yaffe1,2,4,6. 1. San Francisco VA Health Care System, San Francisco, California, USA. 2. Department of Psychiatry, University of California, San Francisco, California, USA. 3. Northern California Institute for Research and Education, San Francisco, California, USA. 4. Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA. 5. Department of Medicine, University of California, San Francisco, California, USA. 6. Department of Neurology, University of California, San Francisco, California, USA.
Abstract
Objective: Evidence guiding suicide-prevention efforts in patients with traumatic brain injury (TBI) is imperative. We evaluated association between TBI and risk of death by drug overdose and firearms, including suicide and unintentional injury. Methods: Cohort study of all patients 18 years and older in Veterans Health Administration databases from October 1, 2001 to December 31, 2014 with TBI diagnosis (N = 230,200), and age-matched 1:1 to random sample of patients without TBI (N = 230,200). Results: After adjusting for demographics, comorbidities, and accounting for competing risk of other deaths, hazard ratios for death by drug overdose were 1.40 (95% CI = 1.21-1.62) for mild TBI and 1.51 (95% CI = 1.31-1.74) for moderate-to-severe TBI, while hazard ratios for death by firearms were 1.09 (95% CI = 0.89-1.33) for mild TBI and 1.33 (95% CI = 1.10-1.60) for moderate-to-severe TBI. Risk of overdose death due to TBI severity was mainly observed for middle and older age groups.Conclusions: Findings suggest that veterans with mild and moderate-to-severe TBI are at increased risk of death by drug overdose and firearms, with overdose risk heightened with age. Data indicate that prevention efforts in patients with TBI include targeted means reduction.
Objective: Evidence guiding suicide-prevention efforts in patients with traumatic brain injury (TBI) is imperative. We evaluated association between TBI and risk of death by drug overdose and firearms, including suicide and unintentional injury. Methods: Cohort study of all patients 18 years and older in Veterans Health Administration databases from October 1, 2001 to December 31, 2014 with TBI diagnosis (N = 230,200), and age-matched 1:1 to random sample of patients without TBI (N = 230,200). Results: After adjusting for demographics, comorbidities, and accounting for competing risk of other deaths, hazard ratios for death by drug overdose were 1.40 (95% CI = 1.21-1.62) for mild TBI and 1.51 (95% CI = 1.31-1.74) for moderate-to-severe TBI, while hazard ratios for death by firearms were 1.09 (95% CI = 0.89-1.33) for mild TBI and 1.33 (95% CI = 1.10-1.60) for moderate-to-severe TBI. Risk of overdose death due to TBI severity was mainly observed for middle and older age groups.Conclusions: Findings suggest that veterans with mild and moderate-to-severe TBI are at increased risk of death by drug overdose and firearms, with overdose risk heightened with age. Data indicate that prevention efforts in patients with TBI include targeted means reduction.
Entities:
Keywords:
Suicide; firearms; overdose; traumatic brain injury; unintended death
Authors: Raj G Kumar; Katherine A Ornstein; John D Corrigan; Rachel Sayko Adams; Kristen Dams-O'Connor Journal: J Neurotrauma Date: 2021-03-11 Impact factor: 4.869