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Research ArticleRegular Article

Risk of Death for Veterans on Release From Prison

Hal S. Wortzel, Patrick Blatchford, Latoya Conner, Lawrence E. Adler and Ingrid A. Binswanger
Journal of the American Academy of Psychiatry and the Law Online September 2012, 40 (3) 348-354;
Hal S. Wortzel
Dr. Wortzel is Director of Neuropsychiatric Consultation, Veterans Integrated Service Network (VISN)-19 Mental Illness Research, Education, and Clinical Center (MIRECC), Denver Veterans Affairs Medical Center, Denver, CO, and Assistant Professor, Neurobehavioral Disorders Program and Division of Forensic Psychiatry, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Blatchford is Assistant Professor, Biostatistics and Informatics, Colorado School of Public Health and University of Colorado, Aurora, CO. Ms. Conner is a Professional Research Assistant and Dr. Adler is Director (retired), VISN 19 MIRECC, Denver, CO. Dr. Binswanger is Associate Professor, Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO.
MD
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Patrick Blatchford
Dr. Wortzel is Director of Neuropsychiatric Consultation, Veterans Integrated Service Network (VISN)-19 Mental Illness Research, Education, and Clinical Center (MIRECC), Denver Veterans Affairs Medical Center, Denver, CO, and Assistant Professor, Neurobehavioral Disorders Program and Division of Forensic Psychiatry, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Blatchford is Assistant Professor, Biostatistics and Informatics, Colorado School of Public Health and University of Colorado, Aurora, CO. Ms. Conner is a Professional Research Assistant and Dr. Adler is Director (retired), VISN 19 MIRECC, Denver, CO. Dr. Binswanger is Associate Professor, Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO.
PhD
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Latoya Conner
Dr. Wortzel is Director of Neuropsychiatric Consultation, Veterans Integrated Service Network (VISN)-19 Mental Illness Research, Education, and Clinical Center (MIRECC), Denver Veterans Affairs Medical Center, Denver, CO, and Assistant Professor, Neurobehavioral Disorders Program and Division of Forensic Psychiatry, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Blatchford is Assistant Professor, Biostatistics and Informatics, Colorado School of Public Health and University of Colorado, Aurora, CO. Ms. Conner is a Professional Research Assistant and Dr. Adler is Director (retired), VISN 19 MIRECC, Denver, CO. Dr. Binswanger is Associate Professor, Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO.
BA
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Lawrence E. Adler
Dr. Wortzel is Director of Neuropsychiatric Consultation, Veterans Integrated Service Network (VISN)-19 Mental Illness Research, Education, and Clinical Center (MIRECC), Denver Veterans Affairs Medical Center, Denver, CO, and Assistant Professor, Neurobehavioral Disorders Program and Division of Forensic Psychiatry, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Blatchford is Assistant Professor, Biostatistics and Informatics, Colorado School of Public Health and University of Colorado, Aurora, CO. Ms. Conner is a Professional Research Assistant and Dr. Adler is Director (retired), VISN 19 MIRECC, Denver, CO. Dr. Binswanger is Associate Professor, Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO.
MD
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Ingrid A. Binswanger
Dr. Wortzel is Director of Neuropsychiatric Consultation, Veterans Integrated Service Network (VISN)-19 Mental Illness Research, Education, and Clinical Center (MIRECC), Denver Veterans Affairs Medical Center, Denver, CO, and Assistant Professor, Neurobehavioral Disorders Program and Division of Forensic Psychiatry, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Blatchford is Assistant Professor, Biostatistics and Informatics, Colorado School of Public Health and University of Colorado, Aurora, CO. Ms. Conner is a Professional Research Assistant and Dr. Adler is Director (retired), VISN 19 MIRECC, Denver, CO. Dr. Binswanger is Associate Professor, Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO.
MD, MPH
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Article Figures & Data

Tables

    • View popup
    Table 1

    Veteran Demographics, Causes of Death and Frequency

    Variablen%
    Branch of service
        Air Force41310.85
        Army1,86649.03
        Marines44211.61
        Missing/unknown1884.94
        Navy85922.57
        Other381.00
    Service discharge
        Dishonorable882.31
        Honorable2,93777.17
        Missing/unknown3138.22
        Other46812.30
    VA benefits
        No3,23384.94
        Yes57315.06
    Deaths, total89
        Total deaths by self/others38
            Overdose21
            Motor vehicle6
            Homicide6
            Suicide5
        Total medical deaths41
            Cardiovascular16
            Cancer13
            Liver-related7
            Diabetes3
            Other medical (HIV or COPD)2
        Other10
    • View popup
    Table 2

    Demographic Characteristics of Veterans Versus Nonveterans

    Variablen%Mean ± SDp
    Age, y<.001
        Nonveteran26,43133.03 ± 9.53
        Veteran380640.51 ± 9.29
    Time in prison, y<.001
        Nonveteran26,4311.66 ± 2.84
        Veteran38062.11 ± 3.24
    Time since release, mo0.011
        Nonveteran26,43120.04 ± 15.52
        Veteran380620.72 ± 15.47
    Sex<.001
        Female, nonveteran3,91314.8
        Female, veteran541.4
        Male, nonveteran22,51885.2
        Male, veteran3,75298.6
    • View popup
    Table 3

    Crude Mortality Rates of Veterans and Nonveterans

    Cause of DeathTotal Deaths (n)Veteran Deaths (n)Veteran* Death Rate†Nonveteran Deaths (n)Nonveteran‡ Death Rate†Raw pAdjusted p
    All causes443891,195354714<.001<.001
    Self/others232385101943910.1660.994
        Overdose10321282821650.0490.424
        Suicide4056735711.0001.000
        Homicide5468148970.8631.000
        Motor vehicle3568129580.6061.000
    Medical1364155195192<.001<.001
        HIV71136121.0001.000
        Cardiovascular561621540810.0030.033
        Liver2379416320.0470.424
        Diabetes6340360.0650.458
        Cancer391317526520.0020.021
        COPD5113481.0001.000
    • ↵* Veteran person-time of risk, 7,447.

    • ↵† Per 100,000 person-years.

    • ↵‡ Non-veteran person-time of risk, 49,602.

    • View popup
    Table 4

    Veteran Status and Risk for Various Types of Death

    Cause of DeathHazard Ratio95% CI
    LowerUpper
    All causes1.080.851.38
    Self/others1.120.781.62
        Suicide0.890.342.37
        Overdose1.360.812.26
        Homicide0.770.321.86
    Medical1.340.911.98
        Cardiovascular1.220.662.24
        Cancer1.390.682.81
    • Rates adjusted for sex, race, age, and length of incarceration.

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Journal of the American Academy of Psychiatry and the Law Online: 40 (3)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 40, Issue 3
1 Sep 2012
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Risk of Death for Veterans on Release From Prison
Hal S. Wortzel, Patrick Blatchford, Latoya Conner, Lawrence E. Adler, Ingrid A. Binswanger
Journal of the American Academy of Psychiatry and the Law Online Sep 2012, 40 (3) 348-354;

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Risk of Death for Veterans on Release From Prison
Hal S. Wortzel, Patrick Blatchford, Latoya Conner, Lawrence E. Adler, Ingrid A. Binswanger
Journal of the American Academy of Psychiatry and the Law Online Sep 2012, 40 (3) 348-354;
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