Resumen de Are We Undercounting the True Burden of Mortality Related to Suicide, Alcohol Use, or Drug Use? An Analysis Using Death Certificate Data From Colorado Veterans

Talia L Spark, Rachel Sayko Adams, Claire A Hoffmire, Jeri E. Forster, Lisa A. Brenner

• Abstract Knowledge regarding deaths due to suicide or alcohol- or drug-related causes may be limited by inconsistent and/or restrictive case definitions, resulting in concerns regarding validity of findings and underestimates of burden. In this proof-of-concept study, we assessed varying case definitions (suicide, alcohol-related, and drug-related mortality using underlying-cause-of-death (UCOD) versus multiple-cause-of-death (MCOD) International Classification of Diseases, Tenth Revision (ICD-10) codes) on the basis of counts and rates among Colorado veterans who died (2009–2020). Suicide, alcohol-related, or drug-related ICD-10 codes were identified, and 2 case definitions were compared: UCOD (qualifying ICD-10 code listed as the UCOD) and MCOD (qualifying ICD-10 code in any cause-of-death field). Of 109,314 decedents, the number of deaths and the age-adjusted mortality rate (per 100,000 persons) significantly increased when MCOD codes were included: n = 4,930 (110.3 deaths/100,000 persons) for UCOD versus n = 6,954 (138.4 deaths/100,000 persons) for MCOD. While rates of suicide mortality did not change, rates of alcohol-related mortality doubled with the more inclusive case definition: 1,752 (27.3 deaths/100,000 persons) for UCOD versus 3,847 (59.8 deaths/100,000 persons) for MCOD. Alcohol-use disorder codes accounted for 71% of additional alcohol-related deaths captured with the MCOD definition. Studies that rely on UCOD codes may be underestimating the burden of deaths, especially alcohol-related deaths. Increased effort is required to reevaluate current classifications of deaths associated with suicide, alcohol use, or drug use.