The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease.
The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease.
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DOI：
10.1007/s11606-020-06195-1
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发表时间：
2021-03
影响因子：
5.7
通讯作者：
Gundlapalli A
中科院分区：
文献类型：
--
作者：
Stewart IJ;Poltavskiy E;Howard JT;Janak JC;Pettey W;Zarzabal LA;Walker LE;Beyer CA;Sim A;Suo Y;Redd A;Chung KK;Gundlapalli A
更好地了解战斗伤害的长期健康影响对于国防部（DoD）和退伍军人事务部（VA）医疗保健系统中退伍军人健康的管理非常重要，并可能对平民创伤患者的初级保健管理产生影响。在调整社会人口统计学、健康行为和心理健康因素后，确定创伤性损伤对高血压（HTN）、糖尿病（DM）和冠状动脉疾病（CAD）后续发展的影响。回顾性队列研究的现任和前任美国军事人员从国防部和退伍军人管理局卫生保健系统获得的数据。从国防部创伤登记处随机选择的2002年2月1日至2016年6月14日期间的战斗受伤（n = 8727）服务人员，根据出生年份、性别和服务分支与部署到战区但未受伤的受试者1：1匹配。创伤性损伤，按严重程度分层，与无记录损伤相比。HTN、DM和CAD的诊断由国际疾病分类第9版或第10版临床修改代码定义。校正后，与无损伤相比，重度创伤性损伤与HTN（HR 2.78，95% CI 2.18-3.55）、DM（HR 4.45，95% CI 2.15-9.18）和CAD（HR 4.87，95% CI 2.11-11.25）显著相关。不太严重的损伤与HTN（HR 1.14，95% CI 1.05-1.24）和CAD（HR 1.62，95% CI 1.11-2.37）相关。严重创伤性损伤与HTN、DM和CAD的后续发展相关。这些发现对DoD/VA卫生系统中受伤服务人员的初级保健具有深远的影响，也可能适用于平民创伤患者。进一步探索创伤后的病理生理、健康行为和心理健康变化是必要的，以指导未来的干预策略。本文的在线版本（10.1007/s11606-020-06195-1）包含补充材料，可供授权用户使用。
A better understanding of the long-term health effects of combat injury is important for the management of veterans’ health in the Department of Defense (DoD) and Veterans Affairs (VA) health care systems and may have implications for primary care management of civilian trauma patients. To determine the impact of traumatic injury on the subsequent development of hypertension (HTN), diabetes mellitus (DM), and coronary artery disease (CAD) after adjustment for sociodemographic, health behavior, and mental health factors. Retrospective cohort study of current and former US military personnel with data obtained from both the DoD and VA health care systems. Combat injured (n = 8727) service members between 1 February 2002 and 14 June 2016 randomly selected from the DoD Trauma Registry matched 1:1 based on year of birth, sex, and branch of service to subjects that deployed to a combat zone but were not injured. Traumatic injury, stratified by severity, compared with no documented injury. Diagnoses of HTN, DM, and CAD defined by International Classification of Diseases 9th or 10th Revision Clinical Modification codes. After adjustment, severe traumatic injury was significantly associated with HTN (HR 2.78, 95% CI 2.18–3.55), DM (HR 4.45, 95% CI 2.15–9.18), and CAD (HR 4.87, 95% CI 2.11–11.25), compared with no injury. Less severe injury was associated with HTN (HR 1.14, 95% CI 1.05–1.24) and CAD (HR 1.62, 95% CI 1.11–2.37). Severe traumatic injury is associated with the subsequent development of HTN, DM, and CAD. These findings have profound implications for the primary care of injured service members in both the DoD/VA health systems and may be applicable to civilian trauma patients as well. Further exploration of pathophysiologic, health behavior, and mental health changes after trauma is warranted to guide future intervention strategies. The online version of this article (10.1007/s11606-020-06195-1) contains supplementary material, which is available to authorized users.
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作者：
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DOI：
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