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

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.