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遭受创伤性应激会对健康产生影响 对于退伍军人来说，人们对长期健康风险（包括慢性病风险）中的性别差异知之甚少。 鉴于退伍军人身份可能对以后的健康产生重要影响，因此。 对于增进对可能对特定性别产生的影响的理解很重要，因为 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，以便更好地定制临床。 对于退伍军人服务，需要更多关于服兵役影响中的性别差异的信息—— 包括与战争相关的暴露的影响，以及部署人员不成比例地面临的经历 女性，例如军事性创伤（MST）及其心理健康后遗症——为了长期健康 结局，特别是慢性病发病率以及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相关文献中现有的空白 代表老年女性退伍军人，并利用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），一项针对 VNE 女退伍军人的研究， 退伍军人健康研究（CSP 569；N=5,598），一项针对 VNE 男性退伍军人的利用和建设的研究。 直接基于这两项 VA CSP 研究，该项目的目标是检查性别差异 服兵役的影响，包括与战争相关的暴露和 MST，以及心理健康后遗症—— 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）——关于晚年健康结果，重点关注心血管疾病 (CVD)、癌症和其他慢性病以及早期死亡风险。两项 CSP 研究均采用了邮寄调查的方式。 收集有关人口统计、军事经验、健康结果和心理社会因素的数据，并 电话访谈诊断精神疾病 除了利用这些重要的 VA 数据之外，这一点也至关重要。 CSP 参与者的状态记录也将通过国家死亡指数 (NDI) 获得。 考虑到显着的兵役特征和晚年心理社会因素，例如健康行为， 社会支持和自杀意念的健康结果加权患病率的性别比较。 进行，并将使用基于回归的模型（包括性别分层模型）对关联进行测试 结构方程模型（SEM）来检查长期健康结果风险的性别差异。 临床意义：随着 65 岁及以上接受 VA 医疗服务的退伍军人人数预计将增加 未来 10-20 年将迅速增加，因此提高对老年退伍军人健康状况和健康状况的了解至关重要 除了直接针对退伍军人管理局妇女外，还根据她们的军事经历来满足临床护理需求。 健康优先领域，该项目响应企业社会责任与发展 (CSR&D) 的号召，要求研究进展，以了解 PTSD 和常见的合并症（即 MDD 和 SUD），以及自杀和患有慢性疾病的疾病 退伍军人群体的高医疗负担，例如心血管疾病，该项目的重点是性别比较。 这是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，因为 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，以及长期服役的退伍军人的性别比较。 然而，关于女性的长期健康风险及其对临床护理的相关影响却很少进行。 军队经历与男性经历不同，女性退伍军人可能有不同的经历 该项目的最终目标是提供可行的临床护理需求。 可以向 VA 临床服务传播的信息，以满足老年女性的独特需求和 男性退伍军人，同时还提供预防性护理，以最大限度地提高跨时代退伍军人的长期健康。