High Risk of Substance Use Disorder-Related Outcomes in Veterans Released from Correctional Facilities in Mid to Late Life

Lisa C Barry; David C Steffens; Kenneth E Covinsky; Yeates Conwell; John Boscardin; Yixia Li; Amy L Byers

doi:10.1007/s11606-023-08057-y

High Risk of Substance Use Disorder-Related Outcomes in Veterans Released from Correctional Facilities in Mid to Late Life

J Gen Intern Med. 2023 Apr;38(5):1109-1118. doi: 10.1007/s11606-023-08057-y. Epub 2023 Feb 13.

Authors

Lisa C Barry^{1

2}, David C Steffens³, Kenneth E Covinsky^{4

5}, Yeates Conwell⁶, John Boscardin^{4

5}, Yixia Li^{4

7}, Amy L Byers^{4

5

8}

Affiliations

¹ Department of Psychiatry, UCONN School of Medicine, Farmington, CT, USA. libarry@uchc.edu.
² UCONN Center On Aging, Farmington, CT, USA. libarry@uchc.edu.
³ Department of Psychiatry, UCONN School of Medicine, Farmington, CT, USA.
⁴ San Francisco VA Healthcare System, San Francisco, CA, USA.
⁵ Department of Medicine, Division of Geriatrics, University of California, San Francisco, USA.
⁶ Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA.
⁷ Northern California Institute for Research and Education, San Francisco, CA, USA.
⁸ Department of Psychiatry, University of California, San Francisco, CA, USA.

Abstract

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.

Keywords: aging; incarceration; substance use disorder.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Aged
Child, Preschool
Drug Overdose* / epidemiology
Humans
Medicare
Retrospective Studies
Substance-Related Disorders* / epidemiology
United States / epidemiology
United States Department of Veterans Affairs
Veterans*

Abstract

Publication types

MeSH terms

Grants and funding