Long-Term Health Impact of Vietnam Era Service: Examining Gender Differences in Risk of Mortality and Chronic Disease

越南时代服务的长期健康影响：检查死亡和慢性病风险的性别差异

• 批准号: 10426237
• 负责人: Brian N Smith
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10426237
• 关键词: Age; Aging; Anxiety; Area; Cardiovascular Diseases; Cessation of life; Characteristics; Chronic; Chronic Disease; Clinical; Clinical Services; Data; Data Analyses; Disease; Disease model; Elderly; Equation; Ethnic Origin; Exposure to; Feeling suicidal; Female; Foundations; Funding; Gender; Generalized Anxiety Disorder; Health; Health Priorities; Health behavior; Healthcare; Link; Literature; Location; Major Depressive Disorder; Malignant Neoplasms; Measures; Mediating; Mental Depression; Mental Health; Mental disorders; Methods; Military Personnel; Modeling; Morbidity - disease rate; Occupations; Older Population; Outcome; Participant; Pathway interactions; Pattern; Play; Post-Traumatic Stress Disorders; Prevalence; Prevention; Preventive care; Provider; Psychiatric Diagnosis; Psychosocial Factor; Public Health; Race; Records; Research; Research Design; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Services; Social support; Stress; Substance Use Disorder; Substance abuse problem; Suicide; Surveys; Telephone Interviews; Testing; Trauma; Twin Multiple Birth; Veterans; Vietnam; Vital Status; War; Woman; Women' s Health; cardiovascular disorder risk; cardiovascular risk factor; care burden; clinical care; cohort; combat trauma; comorbidity; cooperative study; demographics; epidemiology study; experience; gender difference; health difference; human old age (65+); indexing; insight; long-term sequelae; male; men; military service; military veteran; mortality; mortality risk; negative affect; older women; poor health outcome; sexual trauma; trauma exposure; traumatic stress

Background: Despite increasing evidence of the health impact of exposure to traumatic stress during wartime for veterans, less is known about gender differences in long-term health risks, including risks for chronic disease and early mortality. Given that veteran status can be an important influence on later health, it is important to advance understanding of what are likely to be gender-specific effects, as much of what is currently known about veterans’ long-term health is based on male veteran samples. To better tailor clinical services for veterans, more information is needed on gender differences in the implications of military service— including the effects of warfare-related exposures, as well as experiences disproportionately facing deployed women, such as military sexual trauma (MST), and their mental health sequelae—for long-term health outcomes, especially chronic disease morbidity and all-cause and cause-specific mortality, including suicide. Study Design: The proposed retrospective research will overcome existing gaps in the literature related to representing older women veterans and examining long-term health risk by leveraging data from two national cohorts of Vietnam Era (VNE) veterans: HealthViEWS (CSP 579; N=4,219), a study of VNE women veterans, and the Veteran Health Study (CSP 569; N=5,598), a study of male VNE veterans. Leveraging and building directly on these two VA CSP studies, the objective of this project is to examine gender differences in the impact of military service, including warfare-related exposures and MST, and mental health sequelae— posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and substance use disorder (SUD)—on later-life health outcomes, with a focus on cardiovascular disease (CVD), cancer, and other chronic conditions and early mortality risk. Both CSP studies used a mail survey to collect data on demographics, military experiences, health outcomes, and psychosocial factors, and a telephone interview to diagnose psychiatric disorders. In addition to leveraging these important VA data, vital status records on CSP participants will be obtained via the National Death Index (NDI). This study will also account for salient military service characteristics and later-life psychosocial factors, such as health behaviors, social support, and suicidal ideation. Gender comparisons in the weighted prevalence of health outcomes will be conducted, and associations will be tested using regression-based models, including gender-stratified structural equation modeling (SEM) to examine gender differences in risk for long-term health outcomes. Clinical Implications: As the number of veterans age 65 and older accessing VA healthcare is expected to rapidly increase over the next 10-20 years, it is crucial to advance understanding of aging veterans’ health and clinical care needs in the context of their military experiences. In addition to directly targeting the VA Women’s Health priority area, this project is responsive to CSR&D calls for research that advances understanding of PTSD and commonly occurring co-morbidities (i.e., MDD and SUD), as well as suicide and diseases with a high healthcare burden in the veteran population, such as CVD. This project’s focus on gender comparisons represents a critical step forward in the understanding of the lasting effects of military service for veterans, as the vast majority of studies on older veterans to date have focused on men, and gender comparisons of long- term health risk and associated implications for clinical care have rarely been conducted. Yet women’s experiences in the military are distinct from men’s experiences, and women veterans may have different clinical care needs than their male counterparts. This project’s ultimate objective is to provide actionable information that can be disseminated to VA clinical services to target the unique needs of aging female and male veterans, while also informing preventive care to maximize long-term health for veterans across eras.

背景：尽管越来越多的证据表明战时暴露于创伤应激对健康的影响 对于退伍军人来说，对长期健康风险方面的性别差异知之甚少，包括慢性疾病的风险 疾病和早期死亡率。考虑到退伍军人的身份可能会对以后的健康产生重要影响，它是 重要的是促进对什么可能是性别特有的影响的理解，以及对什么是 目前已知的退伍军人长期健康状况是基于男性退伍军人样本。更好地为临床量身定制 为退伍军人提供服务，需要更多关于服兵役影响的性别差异的信息- 包括与战争有关的暴露的影响，以及面对部署的不成比例的体验 女性，如军人性创伤(MST)及其精神健康后遗症--长期健康 结果，特别是慢性病发病率和包括自杀在内的所有原因和特定原因的死亡率。 研究设计：拟议的回溯性研究将克服现有文献中与以下方面相关的空白 代表老年女性退伍军人，并通过利用来自两个国家的数据来检查长期健康风险 越战时期(VNE)退伍军人队列：HealthViEWS(CSP 579；N=4,219)，一项对越南退伍军人女性的研究， 以及退伍军人健康研究(CSP 569；N=5,598)，这是一项针对男性VNE退伍军人的研究。利用和构建 直接基于这两项退伍军人事务部CSP研究，本项目的目标是检查性别差异在 服兵役的影响，包括与战争有关的暴露和MST，以及精神健康后遗症- 创伤后应激障碍(PTSD)、严重抑郁障碍(MDD)、广泛性焦虑症(GAD)、 和物质使用障碍(SUD)--对晚年健康结果的影响，重点是心血管疾病 心血管疾病、癌症和其他慢性病以及早期死亡风险。CSP的两项研究都使用了邮件调查 收集关于人口统计、军事经历、健康结果和心理社会因素的数据，并 通过电话采访来诊断精神疾病。除了利用这些重要的退伍军人事务部数据外，至关重要的 CSP参与者的状态记录将通过国家死亡指数(NDI)获得。这项研究还将 考虑到显著的兵役特征和晚年的心理社会因素，如健康行为， 社会支持和自杀念头。健康结果加权患病率中的性别比较将 将使用基于回归的模型来测试关联，包括按性别分层 结构方程模型(SEM)检验长期健康结果风险的性别差异。 临床影响：随着65岁及以上退伍军人获得退伍军人保健的数量预计将 在未来10-20年内迅速增长，关键是促进对老年退伍军人健康和 在他们的军事经历背景下的临床护理需求。除了直接瞄准退伍军人事务部的 健康优先领域，该项目响应CSR&D号召进行研究，以促进对 创伤后应激障碍和常见的并存疾病(如MDD和SUD)，以及自杀和与 退伍军人群体的高医疗负担，如心血管疾病。这个项目的重点是性别比较 代表着在理解服兵役对退伍军人的持久影响方面向前迈出的关键一步， 到目前为止，绝大多数关于老年退伍军人的研究都集中在男性，以及对长期退伍军人的性别比较 足月健康风险和与临床护理相关的影响很少被进行。然而，女性的 在军队中的经历与男性的不同，女退伍军人可能有不同的经历 临床护理需求高于男性同龄人。该项目的最终目标是提供可操作的 可向退伍军人管理局临床服务机构传播的信息，以针对老年女性和 男性退伍军人，同时告知预防护理，以最大限度地提高退伍军人跨时代的长期健康。