Citation

Morral AR, Schell TL, Smart R. JAMA Netw. Open 2023; 6(7): e2324191.

Copyright

(Copyright © 2023, American Medical Association)

DOI

10.1001/jamanetworkopen.2023.24191

PMID

37462974

Abstract

The US Department of Veterans Affairs (VA) estimates that between 2017 and 2020 veteran suicide rates were 1.57 to 1.66 times greater than nonveterans in the US, after adjusting for age and sex differences.1 This finding does not mean that veteran suicide rates are 1.57 to 1.66 times greater than nonveterans with the same age and sex distributions. The US government approach to age and sex adjustment compares suicide rates under counterfactual conditions in which veteran and nonveteran populations share a common age and sex distribution, namely that of the population of the US in 2000. In this study we compare the relative risk of suicide among veterans and nonveterans using the government's method called direct standardization with an alternative approach that compares the true veteran population with an age- and sex-matched nonveteran population (indirect standardization).


Methods

We aggregated and used 4 years (2017-2020) of data published by the VA1 on suicide counts and population sizes for veterans and nonveterans to calculate their relative risk of suicide using 2 standard procedures. First, we compared suicide rates using a direct standardization approach, which weights mortality rates for each demographic stratum of veteran and nonveteran populations to match the US population age and sex distribution. Second, we compared these rates using indirect standardization, which weights nonveteran suicide rates to match the age and sex distribution of the veteran population. The study was determined to be not human participant research by the RAND institutional review board. As such, it was exempt from the requirement to obtain informed consent. This study follows SQUIRE 2.0 guidelines for quality improvement reporting excellence. Analyses were conducted using Excel version 16.67 (Microsoft Corp)...

Language: en