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：尽管越来越多的证据表明战时暴露于创伤性应激对健康的影响