The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease
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Clinical Investigation Facility, David Grant USAF Medical Center, Travis AFB, Fairfield, CA, USA; 2Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 3University of Texas San Antonio, San Antonio, TX, USA; 4Bexar Data, San Antonio, TX, USA; 5VA Salt Lake City Health Care System, Salt Lake City, UT, USA; 6University of Utah School of Medicine, Salt Lake City, UT, USA; 7Defense Health Agency/J6, Randolph AFB, Universal City, TX, USA; 8University of California Davis Medical Center, Sacramento, CA, USA.
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 (https://doi.org/10.1007/s11606-020-06195-1) contains supplementary material, which is available to authorized users. Received May 1, 2020 Accepted August 27, 2020
KEY WORDS: traumatic injury; cardiovascular disease; diabetes mellitus; veterans health; Military Medicine. J Gen Intern Med DOI: 10.1007/s11606-020-06195-1 © The Author(s) 2020
INTRODUCTION
An emerging body of evidence indicates that trauma is associated with chronic medical conditions.1, 2 This complements evidence in other populations of patients t
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