TY - JOUR
T1 - The Enduring Health Consequences of Combat Trauma
T2 - a Legacy of Chronic Disease
AU - Stewart, Ian J.
AU - Poltavskiy, Eduard
AU - Howard, Jeffrey T.
AU - Janak, Jud C.
AU - Pettey, Warren
AU - Zarzabal, Lee Ann
AU - Walker, Lauren E.
AU - Beyer, Carl A.
AU - Sim, Alan
AU - Suo, Ying
AU - Redd, Andrew
AU - Chung, Kevin K.
AU - Gundlapalli, Adi
N1 - Publisher Copyright:
© 2020, The Author(s).
PY - 2021/3
Y1 - 2021/3
N2 - 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.
AB - 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.
KW - Military Medicine
KW - cardiovascular disease
KW - diabetes mellitus
KW - traumatic injury
KW - veterans health
UR - http://www.scopus.com/inward/record.url?scp=85091312287&partnerID=8YFLogxK
U2 - 10.1007/s11606-020-06195-1
DO - 10.1007/s11606-020-06195-1
M3 - Article
C2 - 32959346
AN - SCOPUS:85091312287
SN - 0884-8734
VL - 36
SP - 713
EP - 721
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 3
ER -