Differential mortality among US veterans: Social determinants of health, substance use disorder, and substance use treatment
Document Type
Article
Publication Date
4-3-2026
Publication Title
American Journal on Addictions
Abstract
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. 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.
PubMed ID
41931032
Rights
Public Domain
Recommended Citation
Pandit, Kashfi; deRussy, Aerin; Blosnich, John; true, Gala; and Montgomery, Ann E., "Differential mortality among US veterans: Social determinants of health, substance use disorder, and substance use treatment" (2026). School of Medicine Faculty Publications. 4685.
https://digitalscholar.lsuhsc.edu/som_facpubs/4685
10.1111/ajad.70158