ArticleThe American journal on addictions2026
Differential mortality among US veterans: Social determinants of health, substance use disorder, and substance use treatment.
Article in The American journal on addictions, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Interpreting divergent mortality outcomes in veterans with substance use disorder and adverse social determinants of health.The American journal on addictions · 2026Article
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5 authors.
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Abstract
BACKGROUND AND
objectivesVeterans 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.
methodsUsing 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.
resultsNearly 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 (0.14% vs. 0.15%; p = .75). [Correction added on 22 April 2026, after first online publication: The preceding sentence has been revised in this version.] 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
conclusionsEngagement in SUD treatment reduces all-cause mortality among veterans facing compounded social adversity but does not independently mitigate suicide deaths. SCIENTIFIC SIGNIFICANCE: Integrated approaches that embed suicide prevention within addiction and SDH-focused care are essential to address the multifactorial drivers of veterans' suicidal mortality.
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