Association of short-term ambient environmental exposures with suicide and drug overdose deaths among U.S. Veterans

This study examined associations between short-term ambient environmental exposures and suicide (n = 3210) and overdose mortality (n = 4293; 2226 opioid-related) among U.S. Veterans from 2018-2019. Daily exposure to 24-hour maximum temperature, average atmospheric pressure, average PM2.5, 1-hour maximum NO2, and 8-hour maximum O3 was assessed at the decedent's county of residence on the day of death and up to six days prior. A national bi-directional, time-stratified case-crossover design was applied. Conditional logistic regression models estimated associations between each exposure and suicide or overdose deaths, overall, and stratified by season, region, elevation, and urbanicity. Over lag days 0-1, an interquartile range increase in maximum temperature was associated with increased suicide (19%) and overdose (27%) mortality, with stronger summer effects for suicide (55%) and overdose (71%). In winter, interquartile range increases in atmospheric pressure, PM2.5, and NO2 were associated with 104%, 15%, and 19% increases in suicide mortality. Maximum temperature was associated with a 22% increase in suicide risk in metropolitan areas and 57% in the Western U.S., while NO2 was associated with a 26% increase in overdose mortality in nonmetropolitan areas. Findings suggest environmental stressors contribute to suicide and overdose mortality among Veterans, supporting environmentally informed prevention efforts.