Objectives
A large-scale retrospective analysis of veterans with chronic pain was conducted to examine (1) the annual incidence of suicide attempts (SA) in veterans with chronic headache and other chronic pain conditions, and (2) the risk of SA in men and women with chronic headache and chronic headache concurrent with traumatic brain injury (TBI) as compared to non-headache chronic pain.
Methods
This retrospective study (N=3,247,621) analyzed National Veterans Affair Health Administrative data of patients diagnosed with chronic head, neck, back and other chronic pain from 2000 to 2010. Multivariable Poisson regression was used to explore the relative risks of SA in veterans with chronic headache and chronic headache concurrent with TBI as stratified by sex.
Results
Veterans with chronic headaches had the highest annual incidence of SA (329 to 491 per 100,000) each year among all identified types of chronic pain conditions. Compared to other non-headache chronic pain, chronic headache is associated with increased risk of SA [men RR (1.48), CI (1.37,1.59); women RR (1.64), CI (1.28,2.09)], after adjusting for demographic factors, TBI, and psychiatric comorbidities. The risk increased further when chronic headache is comorbid with TBI [men RR (2.82), CI (2.60, 3.05); women RR (2.16, CI (1.67–2.78)].
Conclusion
Veterans with chronic headache have a higher risk of SA than those with other chronic pain and women with chronic headache are at a higher risk than men with chronic headache. Chronic headache concurrent with TBI further heightened this risk, especially in men. Our data underscore the importance of identifying specific types of chronic pain in veterans with comorbid TBI and sex disparity associated with SA when targeting suicide prevention measures.
Background Evidence of whether people living with HIV (PLWH) are at elevated risk of adverse COVID-19 outcomes is limited. We aimed to investigate this association using the population-based National COVID Cohort Collaborative (N3C) data in the US.
Methods The harmonized, high-granularity electronic health record data from 54 clinical sites in N3C were used for this study. Logistic and multinomial logistic regression models were employed to estimate the association between HIV infection and hospitalization, mortality, and clinical severity of COVID-19, with models being initially adjusted for age and sex, then cumulatively adjusted for race and ethnicity, smoking and obesity, and a broad range of comorbidities. Interaction terms were added to assess the modification effect by age, sex, and race.
Findings Among a total of 1,436,622 adult COVID-19 cases between January 2020 and May 2021, 13,170 had HIV infection. A total of 26,130 deaths occurred, with 445 among PLWH. PLWH had a higher risk of COVID-19 death and hospitalization than non-PLWH after adjusting for age and sex. The associations were attenuated, but remained significant, after adjusting for lifestyle factors and comorbidities (COVID-19 death: [adjusted OR(AOR): 1.38; 95%CI: 1.25-1.54]; hospitalization: [AOR: 1.23; 95%CI: 1.18-1.28]). In terms of COVID-19 disease severity, PLWH were less likely to have mild/moderate illness but more likely to have a severe illness when only controlling for demographics, smoking and BMI, although the estimated risk was obviated after controlling for comorbidities. Interaction terms revealed that the elevated risk was higher among the older age group, males, and black/African American.
Interpretation PLWH in the US had an increased risk of COVID-19 hospitalization and mortality comparing with non-PLWH. The adverse COVID-19 outcomes might not only be accounted for by HIV but also by other risk factors that are highly prevalent in PLWH.
Funding National Center for Advancing Translational Sciences, National Institute of Allergy And Infectious Diseases, US
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