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Publication Briefs

All-Cause Deaths and Those Due to Poisoning, Suicide, and Alcoholic Liver Disease Higher among White Veterans Ages 55-64

After years of declining mortality rates across all age groups in the United States, increasing mortality rates in White non-Hispanic Americans ages 45–54 were reported. This change was attributed to dramatic increases in deaths due to poisoning, suicide, and alcoholic liver disease. This study sought to determine whether White non-Hispanic middle-aged male Veterans enrolled in VA primary care experienced similar increases in all-cause and select-cause death rates as was observed in the general population. Using VA data, in addition to data from the National Death Index and CDC Wonder (public health database), investigators performed a cross-sectional analysis over 12 years to describe trends in mortality rates across three race/ethnicity groups (White non-Hispanic, Black non-Hispanic, and Hispanic) for two age groups (45-54 and 55-64 years old). Investigators also assessed trends by geographic location: West, Midwest, South, and Northeast. All-cause mortality rates were calculated as the number of deaths per 100,000 patients per year by age group and race/ethnicity.


  • White non-Hispanic male Veterans ages 55-64 had a significant increase in all-cause death rates from 2003 through 2014 (+309 deaths/100,000), accompanied by increases in deaths due to suicide (+17 death/100,000), poisoning (+30 deaths/100,000), and alcoholic liver disease (+23 deaths/100,000). Changes were not evident in the younger (45-54) Veteran age group.
  • For White non-Hispanic males ages 55–64 who were not Veterans, 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).
  • For all three race/ethnicity groups in the 55–64 age category, trends in death rates for alcoholic liver disease, poisoning, and suicide did not differ according to rural or urban location. Also, for White non-Hispanic male Veterans 55–64, the increases in mortality due to these causes were observed across all four geographic regions.


  • Findings suggest the critical importance of suicide prevention programs, as well as the importance of high-quality integrated healthcare, for both Veteran and non-Veteran white men.


  • Death rates did not account for Veterans' military service experience, including rank, service branch, period of service, or combat exposure.
  • There are always concerns about the determination of intent in distinguishing accidental deaths from suicide.

All authors are part of HSR&D’s Center for Innovation for Veteran-Centered & Value-Driven Care.

PubMed Logo Liu C, Hebert P, Wong E, Nelson K, and Maynard C. Midlife Mortality in White Non-Hispanic Male Veterans Enrolled in Department of Veterans Affairs Primary Care, 2003-2014. Heliyon. Open Access. January 30, 2020;6(1).

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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