Ian J Stewart1,2, Eduard Poltavskiy3, Jeffrey T Howard4, Jud C Janak5, Warren Pettey6,7, Lee Ann Zarzabal8, Lauren E Walker3, Carl A Beyer3,9, Alan Sim8, Ying Suo6,7, Andrew Redd6,7, Kevin K Chung10, Adi Gundlapalli6,7. 1. Clinical Investigation Facility, David Grant USAF Medical Center, Travis AFB, 101 Bodin Circle, Fairfield, CA, 94535, USA. ian.j.stewart6.mil@mail.mil. 2. Uniformed Services University of the Health Sciences, Bethesda, MD, USA. ian.j.stewart6.mil@mail.mil. 3. Clinical Investigation Facility, David Grant USAF Medical Center, Travis AFB, 101 Bodin Circle, Fairfield, CA, 94535, USA. 4. University of Texas San Antonio, San Antonio, TX, USA. 5. Bexar Data, San Antonio, TX, USA. 6. VA Salt Lake City Health Care System, Salt Lake City, UT, USA. 7. University of Utah School of Medicine, Salt Lake City, UT, USA. 8. Defense Health Agency/J6, Randolph AFB, Universal City, TX, USA. 9. University of California Davis Medical Center, Sacramento, CA, USA. 10. Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Abstract
BACKGROUND: A better understanding of the long-term health effects of combat injury is important for the management of veterans' health in the Department of Defense (DoD) and Veterans Affairs (VA) health care systems and may have implications for primary care management of civilian trauma patients. OBJECTIVE: To determine the impact of traumatic injury on the subsequent development of hypertension (HTN), diabetes mellitus (DM), and coronary artery disease (CAD) after adjustment for sociodemographic, health behavior, and mental health factors. DESIGN: Retrospective cohort study of current and former US military personnel with data obtained from both the DoD and VA health care systems. PARTICIPANTS: Combat injured (n = 8727) service members between 1 February 2002 and 14 June 2016 randomly selected from the DoD Trauma Registry matched 1:1 based on year of birth, sex, and branch of service to subjects that deployed to a combat zone but were not injured. MAIN MEASURES: Traumatic injury, stratified by severity, compared with no documented injury. Diagnoses of HTN, DM, and CAD defined by International Classification of Diseases 9th or 10th Revision Clinical Modification codes. KEY RESULTS: After adjustment, severe traumatic injury was significantly associated with HTN (HR 2.78, 95% CI 2.18-3.55), DM (HR 4.45, 95% CI 2.15-9.18), and CAD (HR 4.87, 95% CI 2.11-11.25), compared with no injury. Less severe injury was associated with HTN (HR 1.14, 95% CI 1.05-1.24) and CAD (HR 1.62, 95% CI 1.11-2.37). CONCLUSIONS: Severe traumatic injury is associated with the subsequent development of HTN, DM, and CAD. These findings have profound implications for the primary care of injured service members in both the DoD/VA health systems and may be applicable to civilian trauma patients as well. Further exploration of pathophysiologic, health behavior, and mental health changes after trauma is warranted to guide future intervention strategies.
BACKGROUND: A better understanding of the long-term health effects of combat injury is important for the management of veterans' health in the Department of Defense (DoD) and Veterans Affairs (VA) health care systems and may have implications for primary care management of civilian traumapatients. OBJECTIVE: To determine the impact of traumatic injury on the subsequent development of hypertension (HTN), diabetes mellitus (DM), and coronary artery disease (CAD) after adjustment for sociodemographic, health behavior, and mental health factors. DESIGN: Retrospective cohort study of current and former US military personnel with data obtained from both the DoD and VA health care systems. PARTICIPANTS: Combat injured (n = 8727) service members between 1 February 2002 and 14 June 2016 randomly selected from the DoD Trauma Registry matched 1:1 based on year of birth, sex, and branch of service to subjects that deployed to a combat zone but were not injured. MAIN MEASURES: Traumatic injury, stratified by severity, compared with no documented injury. Diagnoses of HTN, DM, and CAD defined by International Classification of Diseases 9th or 10th Revision Clinical Modification codes. KEY RESULTS: After adjustment, severe traumatic injury was significantly associated with HTN (HR 2.78, 95% CI 2.18-3.55), DM (HR 4.45, 95% CI 2.15-9.18), and CAD (HR 4.87, 95% CI 2.11-11.25), compared with no injury. Less severe injury was associated with HTN (HR 1.14, 95% CI 1.05-1.24) and CAD (HR 1.62, 95% CI 1.11-2.37). CONCLUSIONS: Severe traumatic injury is associated with the subsequent development of HTN, DM, and CAD. These findings have profound implications for the primary care of injured service members in both the DoD/VA health systems and may be applicable to civilian traumapatients as well. Further exploration of pathophysiologic, health behavior, and mental health changes after trauma is warranted to guide future intervention strategies.
Entities:
Keywords:
Military Medicine; cardiovascular disease; diabetes mellitus; traumatic injury; veterans health
Authors: Chi-yuan Hsu; Raymond K Hsu; Jingrong Yang; Juan D Ordonez; Sijie Zheng; Alan S Go Journal: J Am Soc Nephrol Date: 2015-07-01 Impact factor: 10.121
Authors: Andrea L Roberts; Jessica C Agnew-Blais; Donna Spiegelman; Laura D Kubzansky; Susan M Mason; Sandro Galea; Frank B Hu; Janet W Rich-Edwards; Karestan C Koenen Journal: JAMA Psychiatry Date: 2015-03 Impact factor: 21.596
Authors: Anna J Dare; Hyacinth Irving; Carlos Manuel Guerrero-López; Leah K Watson; Patrycja Kolpak; Luz Myriam Reynales Shigematsu; Marcos Sanches; David Gomez; Hellen Gelband; Prabhat Jha Journal: Lancet Public Health Date: 2019-05-21
Authors: Alicia A Swan; Jeremy T Nelson; Terri K Pogoda; Megan E Amuan; Faith W Akin; Mary Jo Pugh Journal: Brain Inj Date: 2018-07-19 Impact factor: 2.311
Authors: Vicente F Corrales-Medina; Karina N Alvarez; Lisa A Weissfeld; Derek C Angus; Julio A Chirinos; Chung-Chou H Chang; Anne Newman; Laura Loehr; Aaron R Folsom; Mitchell S Elkind; Mary F Lyles; Richard A Kronmal; Sachin Yende Journal: JAMA Date: 2015-01-20 Impact factor: 56.272
Authors: Jeffrey T Howard; Jonathan A Sosnov; Jud C Janak; Adi V Gundlapalli; Warren B Pettey; Lauren E Walker; Ian J Stewart Journal: Hypertension Date: 2018-03-19 Impact factor: 10.190
Authors: Mary Jo Pugh; Alicia A Swan; Megan E Amuan; Blessen C Eapen; Carlos A Jaramillo; Roxana Delgado; David F Tate; Kristine Yaffe; Chen-Pin Wang Journal: PLoS One Date: 2019-09-20 Impact factor: 3.240