Donna L Washington1, Chloe E Bird2, Michael J LaMonte3, Karen M Goldstein4, Eileen Rillamas-Sun5, Marcia L Stefanick6, Nancy F Woods7, Lori A Bastian8, Margery Gass9, Julie C Weitlauf10. 1. VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, California. University of California Los Angeles, Geffen School of Medicine. donna.washington@va.gov. 2. RAND Corporation, Pardee Rand Graduate School, Santa Monica, California. 3. Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo. 4. Durham VA Health Care System, North Carolina. 5. Fred Hutchinson Cancer Research Center, Seatle, Washington. 6. Stanford University School of Medicine, Stanford Center for Health Research on Women & Sex Differences in Medicine, California. 7. Division of Biobehavioral Nursing & Health Systems, University of Washington School of Nursing, Seattle. 8. VA Connecticut, and University of Connecticut Health Center, West Haven. 9. The North American Menopause Society, Mayfield Heights, Ohio. 10. VA Palo Alto Health Care System, Sierra Pacific MIRECC and Center for Innovation to Implementation, California. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California.
Abstract
PURPOSE OF THE STUDY: Women's military roles, exposures, and associated health outcomes have changed over time. However, mortality risk-within military generations or compared with non-Veteran women-has not been assessed. Using data from the Women's Health Initiative (WHI), we examined all-cause and cause-specific mortality by Veteran status and military generation among older women. DESIGN AND METHODS: WHI participants (3,719 Veterans; 141,802 non-Veterans), followed for a mean of 15.2 years, were categorized into pre-Vietnam or Vietnam/after generations based on their birth cohort. We used cox proportional hazards models to examine the association between Veteran status and mortality by generation. RESULTS: After adjusting for sociodemographic characteristics and WHI study arm, all-cause mortality hazard rate ratios (HRs) for Veterans relative to non-Veterans were 1.16 (95% CI: 1.09-1.23) for pre-Vietnam and 1.16 (95% CI: 0.99-1.36) for Vietnam/after generations. With additional adjustment for health behaviors and risk factors, this excess mortality rate persisted for pre-Vietnam but attenuated for Vietnam/after generations. After further adjustment for medical morbidities, across both generations, Veterans and non-Veterans had similar all-cause mortality rates. Relative to non-Veterans, adjusting for sociodemographics and WHI study arm, pre-Vietnam generation Veterans had higher cancer, cardiovascular, and trauma-related morality rates; Vietnam/after generation Veterans had the highest trauma-related mortality rates (HR = 2.93, 1.64-5.23). IMPLICATIONS: Veterans' higher all-cause mortality rates were limited to the pre-Vietnam generation, consistent with diminution of the healthy soldier effect over the life course. Mechanisms underlying Vietnam/after generation Veteran trauma-related mortality should be elucidated. Efforts to modify salient health risk behaviors specific to each military generation are needed. Published by Oxford University Press on behalf of the Gerontological Society of America 2016.
PURPOSE OF THE STUDY: Women's military roles, exposures, and associated health outcomes have changed over time. However, mortality risk-within military generations or compared with non-Veteran women-has not been assessed. Using data from the Women's Health Initiative (WHI), we examined all-cause and cause-specific mortality by Veteran status and military generation among older women. DESIGN AND METHODS: WHI participants (3,719 Veterans; 141,802 non-Veterans), followed for a mean of 15.2 years, were categorized into pre-Vietnam or Vietnam/after generations based on their birth cohort. We used cox proportional hazards models to examine the association between Veteran status and mortality by generation. RESULTS: After adjusting for sociodemographic characteristics and WHI study arm, all-cause mortality hazard rate ratios (HRs) for Veterans relative to non-Veterans were 1.16 (95% CI: 1.09-1.23) for pre-Vietnam and 1.16 (95% CI: 0.99-1.36) for Vietnam/after generations. With additional adjustment for health behaviors and risk factors, this excess mortality rate persisted for pre-Vietnam but attenuated for Vietnam/after generations. After further adjustment for medical morbidities, across both generations, Veterans and non-Veterans had similar all-cause mortality rates. Relative to non-Veterans, adjusting for sociodemographics and WHI study arm, pre-Vietnam generation Veterans had higher cancer, cardiovascular, and trauma-related morality rates; Vietnam/after generation Veterans had the highest trauma-related mortality rates (HR = 2.93, 1.64-5.23). IMPLICATIONS: Veterans' higher all-cause mortality rates were limited to the pre-Vietnam generation, consistent with diminution of the healthy soldier effect over the life course. Mechanisms underlying Vietnam/after generation Veteran trauma-related mortality should be elucidated. Efforts to modify salient health risk behaviors specific to each military generation are needed. Published by Oxford University Press on behalf of the Gerontological Society of America 2016.
Entities:
Keywords:
Cohort effect; Longitudinal study; Mortality; Women Veterans
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