Midlife mortality in White non-Hispanic male veterans enrolled in Department of Veterans Affairs primary care, 2003–2014

Abstract Background After years of decline in mortality rates in the United States, there have been increases in mortality rates in White non-Hispanic Americans ages 45–54, due to increases in deaths from suicide, poisoning, and alcoholic liver disease. Objectives To determine whether White non-Hispanic middle age male Veterans enrolled in Department of Veterans Affairs (VA) primary care had increased mortality, as found in the general population. Research design Repeated cross-sectional analysis over 12 years to describe trends in death rates for men across 3 race/ethnicity groups (White non-Hispanic, Black non-Hispanic, Hispanic) and 2 age groups (45–54, 55–64) for the Veteran and general US male populations. Subjects 60 million patient-years for Veterans enrolled in VA primary care from 2003 to 2014 and 1.8 million who died during the study period. Measures All-cause and cause specific death rates for alcoholic liver disease, poisoning, and suicide. Results For White non-Hispanic male Veterans ages 55–64, the increase in all-cause mortality from 2003 to 2014 (+309 deaths/100,000) was accompanied by significant changes in deaths due to poisoning (+30/100,000), alcoholic liver disease (+23/100,000), and suicide (+17/100,000). For US men ages 55–64, all-cause mortality decreased slightly from 2003-2014 (-22 deaths/100,000). However, there were increases in death rates due to poisoning (+17/100,000), alcoholic liver disease (+14/100,000) and suicide (+11/100,000). Conclusions These disturbing findings for White non-Hispanic Veteran men ages 55–64 suggest the critical importance of suicide prevention programs as well as the importance of high quality integrated health care for both Veteran and non-Veteran men.