The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease

Ian J. Stewart*, Eduard Poltavskiy, Jeffrey T. Howard, Jud C. Janak, Warren Pettey, Lee Ann Zarzabal, Lauren E. Walker, Carl A. Beyer, Alan Sim, Ying Suo, Andrew Redd, Kevin K. Chung, Adi Gundlapalli

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


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.

Original languageEnglish
Pages (from-to)713-721
Number of pages9
JournalJournal of General Internal Medicine
Issue number3
StatePublished - Mar 2021
Externally publishedYes


  • Military Medicine
  • cardiovascular disease
  • diabetes mellitus
  • traumatic injury
  • veterans health


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