Is war hard on the heart? Gender, wartime stress and late life cardiovascular conditions in a population of Vietnamese older adults.
Is war hard on the heart? Gender, wartime stress and late life cardiovascular conditions in a population of Vietnamese older adults.
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DOI：
10.1016/j.socscimed.2020.113380
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Zimmer Z
中科院分区：
文献类型：
--
作者：
Korinek K;Young Y;Teerawichitchainan B;Kim Chuc NT;Kovnick M;Zimmer Z
全球南方人口不成比例地暴露在发展、灾害和武装冲突的压力源之下，所有这些都增加了心血管疾病的风险。我们考虑与战争有关的压力因素如何对人口健康，特别是现已进入老年的战争幸存者的心血管健康产生持久影响。数据来自2018年越南健康与老龄化研究，该研究对2447名60岁及以上的越南北部成年人进行了调查。我们进行了调查调整后的逻辑回归分析，以检验受访者战时暴露于战斗和身体威胁、恶劣环境条件和四种心血管疾病（高血压、血脂异常、心脏病和中风）之间的关系。我们研究了创伤后应激障碍（PTSD）在战时应激暴露与晚年心血管疾病之间的中介作用，以及性别在战时应激源与心血管疾病之间的调节作用。我们发现，暴露在战争和暴力中，以及恶劣的生活条件，与心血管疾病表现出显著的正相关。这些关联是由近期PTSD症状的严重程度介导的。对于某些心血管疾病，特别是高血压，战时压力源与晚年心血管疾病之间的联系因性别而异，女性在暴露于战争相关压力源时比男性受到更大的惩罚。我们的结论是，战争的压力源和由此产生的创伤后应激障碍在越南老年人中广泛存在，他们在青年时期经历了无数形式的战争暴露，与晚年心血管疾病表现出适度但显著的关联。妇女，特别是那些遭受战时暴力和战斗的妇女，与男子一起承受着这一心血管疾病的负担。
Populations in the global south are disproportionately exposed to the stressors of development, disaster and armed conflict, all of which heighten cardiovascular disease (CVD) risk. We consider how war-related stressors exert a lasting influence upon population health, in particular the cardiovascular health of war survivors now entering older adulthood. Data come from the 2018 Vietnam Health and Aging Study conducted among 2,447 northern Vietnamese adults age 60 and older. We conduct survey-adjusted logistic regression analyses to examine the associations among respondents’ wartime exposure to combat and physical threat, malevolent environment conditions, and four CVD conditions (hypertension, dyslipidemia, heart disease, and stroke). We examine posttraumatic stress disorder (PTSD) as it mediates the association between wartime stress exposures and late life CVD, and gender as it moderates the relationship between wartime stressors and CVD. We find that exposure to wartime combat and violence, as well as malevolent living conditions, exhibit significant, positive associations with cardiovascular conditions. These associations are mediated by the severity of recent PTSD symptoms. For certain CVD conditions, particularly hypertension, the associations between wartime stressors and late life cardiovascular conditions diverge across gender with women experiencing a greater penalty for their exposure to war-related stressors than their male counterparts. We conclude that the stressors of war and resultant PTSD, widespread in this cohort of Vietnamese older adults who endured myriad forms of war exposure during their young adulthood, exhibit modest, yet significant associations with late-life cardiovascular conditions. Women, especially those exposed to wartime violence and combat, bear this CVD burden alongside men.
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