title: Comorbidity Correlates of Death Among New Veterans of Iraq and Afghanistan Deployment.
abstract: BACKGROUND
  Veterans of the wars in Iraq and Afghanistan who receive care in the Veterans Health Administration (VA) have high disease burden. Distinct comorbidity patterns have been shown to be differentially associated with adverse outcomes, including death. This study determined correlates of 5-year mortality.
  
  
  METHODS
  VA demographic, military, homelessness, and clinical measures informed this retrospective analysis. Previously constructed comorbidity classifications over 3 years of care were entered into a Cox proportional hazards model of death.
  
  
  RESULTS
  There were 164,933 veterans in the cohort, including African Americans (16%), Hispanics (11%), and whites (65%). Most were in their 20s at baseline (60%); 12% were women; 4% had attempted suicide; 4% had been homeless. Having clustered disorders of pain, posttraumatic stress disorder, and traumatic brain injury was associated with death [hazard ratio (HR)=2.0]. Mental disorders including substance abuse were similarly associated (HR=2.1). Prior suicide attempt (HR=2.2) or drug overdose (HR=3.0) considerably increased risk of death over 5 years.
  
  
  CONCLUSIONS
  As congressional actions such as Veterans Choice Act offer more avenues to seek care outside of VA, coordination of care, and suicide prevention outreach for recent veterans may require innovative approaches to preserve life.
authors.affiliation: *Center for Applied Health Research, Central Texas Veterans Health Care System †Department of Medicine, Center for Applied Health Research, Baylor Scott & White Health ‡Department of Psychiatry, UT Health Science Center San Antonio §South Texas Veterans Health Care System ∥Department of Medicine, Division of Clinical Epidemiology ¶Department of Epidemiology and Biostatistics, UT Health Science Center San Antonio, San Antonio, TX #VA New England Health Care System, Bedford, MA.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
authors.forename: Erin P
authors.initials: EP
authors.lastname: Finley
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Bollinger
authors.forename: Megan E
authors.initials: ME
authors.lastname: Amuan
authors.forename: Mary Jo V
authors.initials: MJ
authors.lastname: Pugh
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000367:Age Factors; D000070642:Brain Injuries, Traumatic / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000401:mortality; D008875:Middle Aged; D009026:Mortality; D010146:Pain / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000401:mortality; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult