J Emerg Med. 2018 May;54(5):711-718. doi: 10.1016/j.jemermed.2017.12.060. Epub 2018 Apr 14.


Background: Mental illness, substance abuse, and poverty are risk factors for violent injury, and violent injury is a risk factor for early mortality that can be attenuated through hospital-based violence intervention programs. Most of these programs focus on victims under the age of 30 years. Little is known about risk factors or long-term mortality among older victims of violent injury.

Objectives: To explore the prevalence of risk factors for violent injury among younger (age < 30 years) and older (age 30 ≥ years) victims of violent injury, to determine the long-term mortality rates in these age groups, and to explore the association between risk factors for violent injury and long-term mortality.

Methods: Adults with violent injuries were enrolled between 2001 and 2004. Demographic and injury data were recorded on enrollment. Ten-year mortality rates were measured. Descriptive analysis and logistic regression were used to compare older and younger subjects.

Results: Among 541 subjects, 70% were over age 30. The overall 10-year mortality rate was 15%, and was much higher than in the age-matched general population in both age groups. Risk factors for violent injury including mental illness, substance abuse, and poverty were prevalent, especially among older subjects, and were each independently associated with increased risk of long-term mortality.

Conclusion: Mental illness, substance abuse, and poverty constitute a "lethal triad" that is associated with an increased risk of long-term mortality among victims of violent injury, including both younger adults and those over age 30 years. Both groups may benefit from targeted risk-reduction efforts. Emergency department visits offer an invaluable opportunity to engage these vulnerable patients.

Keywords: injury prevention; mental illness; poverty; substance abuse; violence.

MeSH terms

  • Adult
  • Cohort Studies
  • Emergency Service, Hospital / organization & administration
  • Female
  • Humans
  • Interpersonal Relations
  • Male
  • Mental Disorders / complications*
  • Mental Disorders / psychology
  • Middle Aged
  • Physical Abuse / psychology
  • Poverty / psychology*
  • Prevalence
  • Retrospective Studies
  • Risk Factors
  • Substance-Related Disorders / complications*
  • Substance-Related Disorders / psychology
  • Wounds and Injuries / etiology*
  • Wounds and Injuries / psychology