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: 10249645
• 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 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10249645
• 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; Psychiatric Diagnosis; Psychosocial Factor; Public Health; Race; Records; Research; Research Design; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Services; Social support; Stress; Structure; Substance Use Disorder; Substance abuse problem; Suicide; Surveys; Telephone Interviews; Testing; Trauma; Twin Multiple Birth; Veterans; Vietnam; Vital Status; Woman; Women' s Health; base; cardiovascular disorder risk; cardiovascular risk factor; clinical care; cohort; combat trauma; comorbidity; cooperative study; demographics; epidemiology study; experience; gender difference; health difference; human old age (65+); indexing; insight; male; men; military service; military veteran; mortality; mortality risk; negative affect; older women; service providers; 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：尽管有越来越多的证据表明战时暴露于创伤压力的健康影响 对于退伍军人而言，对长期健康风险的性别差异的了解少，包括慢性风险 疾病和早期死亡率。鉴于退伍军人身份可能对以后的健康有重要影响，这是 重要的是要了解可能是性别特定效果的理解， 目前，有关退伍军人的长期健康状况的知名度是基于男性退伍军人样本。更好地量身定制临床 为退伍军人服务，需要更多有关兵役含义的性别差异的信息 - 包括与战争相关的暴露的影响，以及部署的经历不成比例 妇女，例如军事性创伤（MST）及其心理健康后遗症，用于长期健康 结局，尤其是慢性疾病发病率和全因病因，并引起特定的死亡率，包括自杀。 研究设计：拟议的回顾性研究将克服与 代表老年女性退伍军人并通过利用两个国家的数据来检查长期健康风险 越南时代（VNE）退伍军人的同伙：Healthviews（CSP 579; n = 4,219），一项对VNE妇女退伍军人的研究， 以及资深卫生研究（CSP 569; n = 5,598），一项对男性VNE退伍军人的研究。利用和建造 直接在这两项VA CSP研究上，该项目的目的是检查性别差异 兵役的影响，包括与战争有关的暴露和MST，以及心理健康后遗症 - 创伤后应激障碍（PTSD），主要抑郁症（MDD），广义动画障碍（GAD）， 和药物使用障碍（SUD） - 以后的健康状况，重点是心血管疾病 （CVD），癌症和其他慢性病和早期死亡风险。两项CSP研究都使用了邮件调查 收集有关人口统计学，军事经验，健康成果和社会心理因素的数据，以及 电话采访以诊断精神疾病。除了利用这些重要的VA数据外， CSP参与者的状态记录将通过国家死亡指数（NDI）获得。这项研究也将 考虑了显着的兵役特征和后期生活的社会心理因素，例如健康行为， 社会支持和自杀想法。健康结果的加权患病率的性别比较将 进行，并将使用基于回归的模型（包括性别分层）对关联进行测试 结构方程建模（SEM），以检查长期健康结果风险中的性别差异。 临床意义：随着65岁及以上的退伍军人人数预计将获得VA Healthcare 在接下来的10 - 20年中，迅速增加，至关重要 在他们的军事经验的背景下，临床护理需求。除了直接针对VA妇女 健康优先领域，该项目对CSR＆d的呼吁响应研究，以促进对了解的理解 PTSD和通常发生的合并症（即MDD和SUD），以及自杀和疾病 老兵人口中的高医疗保健伯恩（CVD）。该项目专注于性别比较 在理解对退伍军人的持久影响的持久影响方面，这是向前迈的关键一步 迄今为止对老年退伍军人的绝大多数研究都集中在男性上，以及长期的性别比较 很少进行健康风险和对临床护理的相关影响。却是女性 军队的经历与男性的经历不同，而女退伍军人可能有不同 临床护理需要比男性同行。该项目的最终目标是提供可行的 可以将可以传播到VA临床服务的信息，以针对衰老女性的独特需求和 男性退伍军人，同时还通知预防性护理，以最大程度地提高整个时代的退伍军人的长期健康。