Finally, we created counts of past 12-month externalizing codes from the time of MVP enrollment (N = 840,865 as of 12/31/2021, overlapping with NDI time frames). Demographic information is presented in Supplemental Table 11. Of these participants, 13.8% (N = 116,365) were deceased by the end of 2021. Of the deceased, N = 1,268 were classified as suicides, while the more expansive definition for deaths of despair (which includes suicide) made up N = 4,410 of the deaths. The results from the competing risk models are presented in Table 2. Externalizing codes were associated with both death by suicide (HR = 1.39, 95% CI = 1.33, 1.45) and the broader deaths of despair category (HR = 1.96, 95% CI = 1.93, 2.00). In both models, the externalizing was associated with all other causes of mortality (HR = 1.42, 95% CI = 1.41, 1.43; HR = 1.38, 95% CI = 1.38, 1.39). For those with 4+ past year externalizing codes (compared to those with none), the 5-year cumulative incidence for suicide death was nearly 5x greater and the 5-year cumulative incidence for deaths of despair was almost 20x greater.
