Cargando…

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

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....

Descripción completa

Detalles Bibliográficos
Autores principales: Stewart, Ian J., Poltavskiy, Eduard, Howard, Jeffrey T., Janak, Jud C., Pettey, Warren, Zarzabal, Lee Ann, Walker, Lauren E., Beyer, Carl A., Sim, Alan, Suo, Ying, Redd, Andrew, Chung, Kevin K., Gundlapalli, Adi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947104/
https://www.ncbi.nlm.nih.gov/pubmed/32959346
http://dx.doi.org/10.1007/s11606-020-06195-1
_version_ 1783663160984600576
author Stewart, Ian J.
Poltavskiy, Eduard
Howard, Jeffrey T.
Janak, Jud C.
Pettey, Warren
Zarzabal, Lee Ann
Walker, Lauren E.
Beyer, Carl A.
Sim, Alan
Suo, Ying
Redd, Andrew
Chung, Kevin K.
Gundlapalli, Adi
author_facet Stewart, Ian J.
Poltavskiy, Eduard
Howard, Jeffrey T.
Janak, Jud C.
Pettey, Warren
Zarzabal, Lee Ann
Walker, Lauren E.
Beyer, Carl A.
Sim, Alan
Suo, Ying
Redd, Andrew
Chung, Kevin K.
Gundlapalli, Adi
author_sort Stewart, Ian J.
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-020-06195-1) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-7947104
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-79471042021-03-28 The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease Stewart, Ian J. Poltavskiy, Eduard Howard, Jeffrey T. Janak, Jud C. Pettey, Warren Zarzabal, Lee Ann Walker, Lauren E. Beyer, Carl A. Sim, Alan Suo, Ying Redd, Andrew Chung, Kevin K. Gundlapalli, Adi J Gen Intern Med Original Research 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-020-06195-1) contains supplementary material, which is available to authorized users. Springer International Publishing 2020-09-21 2021-03 /pmc/articles/PMC7947104/ /pubmed/32959346 http://dx.doi.org/10.1007/s11606-020-06195-1 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Research
Stewart, Ian J.
Poltavskiy, Eduard
Howard, Jeffrey T.
Janak, Jud C.
Pettey, Warren
Zarzabal, Lee Ann
Walker, Lauren E.
Beyer, Carl A.
Sim, Alan
Suo, Ying
Redd, Andrew
Chung, Kevin K.
Gundlapalli, Adi
The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease
title The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease
title_full The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease
title_fullStr The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease
title_full_unstemmed The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease
title_short The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease
title_sort enduring health consequences of combat trauma: a legacy of chronic disease
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947104/
https://www.ncbi.nlm.nih.gov/pubmed/32959346
http://dx.doi.org/10.1007/s11606-020-06195-1
work_keys_str_mv AT stewartianj theenduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT poltavskiyeduard theenduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT howardjeffreyt theenduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT janakjudc theenduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT petteywarren theenduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT zarzaballeeann theenduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT walkerlaurene theenduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT beyercarla theenduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT simalan theenduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT suoying theenduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT reddandrew theenduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT chungkevink theenduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT gundlapalliadi theenduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT stewartianj enduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT poltavskiyeduard enduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT howardjeffreyt enduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT janakjudc enduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT petteywarren enduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT zarzaballeeann enduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT walkerlaurene enduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT beyercarla enduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT simalan enduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT suoying enduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT reddandrew enduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT chungkevink enduringhealthconsequencesofcombattraumaalegacyofchronicdisease
AT gundlapalliadi enduringhealthconsequencesofcombattraumaalegacyofchronicdisease