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

背景：尽管越来越多的证据表明战争期间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。考虑到退伍军人身份可能对以后的健康产生重要影响， 重要的是要促进了解哪些可能是针对性别的影响， 目前对退伍军人长期健康状况的了解是基于男性退伍军人样本。为了更好地定制临床 在为退伍军人提供服务方面，需要提供更多关于兵役影响方面的性别差异的信息， 包括与战争有关的暴露的影响，以及部署在阿富汗的部队不成比例地面临的 妇女，如军事性创伤（MST），及其心理健康后遗症-长期健康 结果，特别是慢性病发病率和全因和特定原因死亡率，包括自杀。 研究设计：拟议的回顾性研究将克服现有文献中的空白， 代表老年妇女退伍军人，并利用来自两个国家的数据， 越南战争时期（VNE）退伍军人的队列：HealthViEWS（CSP 579; N= 4，219），一项针对越南战争时期女性退伍军人的研究， 以及退伍军人健康研究（CSP 569; N= 5，598），一项针对VNE男性退伍军人的研究。杠杆作用和建设 直接在这两个VA CSP研究，本项目的目标是检查性别差异， 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）、重度抑郁症（MDD）、广泛性焦虑症（GAD）、 和物质使用障碍（SUD）-晚年健康结果，重点是心血管疾病 (CVD)癌症和其他慢性疾病以及早期死亡风险。CSP的两项研究都使用了邮件调查， 收集有关人口统计学、军事经历、健康结果和心理社会因素的数据， 电话采访以诊断精神疾病。除了利用这些重要的VA数据， CSP参与者的状态记录将通过国家死亡指数（NDI）获得。本研究还将 考虑到突出的兵役特征和晚年的心理社会因素，如健康行为， 社会支持和自杀意念健康结果加权流行率的性别比较将 将使用基于回归的模型，包括性别分层模型， 结构方程模型（SEM）研究长期健康结果风险的性别差异。 临床意义：随着65岁及以上的退伍军人获得VA医疗保健的人数预计将 在未来10-20年内迅速增加，这是至关重要的，以促进了解老年退伍军人的健康， 临床护理需要在他们的军事经验的背景下。除了直接针对退伍军人事务部妇女 健康优先领域，该项目是响应CSR&D要求的研究，促进对 创伤后应激障碍和常见的合并症（即，MDD和SUD），以及自杀和 退伍军人群体的高医疗负担，如心血管疾病。该项目的重点是性别比较 这是在理解退伍军人服兵役的持久影响方面迈出的关键一步， 迄今为止，绝大多数关于老年退伍军人的研究都集中在男性身上，长期以来， 长期健康风险和临床护理的相关影响很少进行。然而，妇女的 在军队中的经历与男性的经历不同，女性退伍军人可能有不同的经历。 临床护理需求高于男性。该项目的最终目标是提供可操作的 可以传播到VA临床服务的信息，以满足老年女性的独特需求， 男性退伍军人，同时也告知预防保健，以最大限度地提高各个时代的退伍军人的长期健康。

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.