Prospective Analysis of Health and Mortality Risk in Veteran and Non-Veteran Participants in the Women's Health Initiative

Published:September 29, 2015DOI:https://doi.org/10.1016/j.whi.2015.08.006

      Abstract

      Background

      The health of postmenopausal women veterans is a neglected area of study. A stronger empirical evidence base is needed, and would inform the provision of health care for the nearly 1 million U.S. women veterans currently 50 years of age or older. To this end, the present work compares salient health outcomes and risk of all-cause mortality among veteran and non-veteran participants of the Women's Health Initiative (WHI).

      Methods

      This study features prospective analysis of long-term health outcomes and mortality risk (average follow-up, 8 years) among the 3,706 women veterans and 141,009 non-veterans who participated in the WHI Observational Study or Clinical Trials. Outcome measurements included confirmed incident cases of cardiovascular disease (CVD), cancer, diabetes, hip fractures, and all-cause mortality.

      Results

      We identified 17,968 cases of CVD, 19,152 cases of cancer, 18,718 cases of diabetes, 2,817 cases of hip fracture, and 13,747 deaths. In Cox regression models adjusted for age, sociodemographic variables, and health risk factors, veteran status was associated with significantly increased risk of all-cause mortality (hazard ratio [HR], 1.13; 95% CI, 1.03–1.23), but not with risk of CVD (HR, 1.00; 95% CI, 0.90–1.11), cancer (HR, 1.04; 95% CI, 0.95–1.14), hip fracture (HR, 1.16; 95% CI, 0.94–1.43), or diabetes (HR, 1.00; 95% CI, 0.89–1.1).

      Conclusions

      Women veterans' postmenopausal health, particularly risk for all-cause mortality, warrants further consideration. In particular, efforts to identify and address modifiable risk factors associated with all-cause mortality are needed.
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      Biography

      Julie C. Weitlauf, PhD, is Director of the Women's Mental Health and Aging Core of the VISN 21 MIRECC at the VA Palo Alto Health Care System, and Clinical Associate Professor (Affiliated) of Psychiatry and Behavioral Sciences at Stanford.

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      Andrea Z. LaCroix, PhD, is Professor and Chief of Epidemiology and Director of the Women's Health Center of Excellence within the Department of Family Medicine and Public Health at the University of California, San Diego.

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      Chloe E. Bird, PhD, is Senior Sociologist at RAND, with particular expertise in women's cardiovascular health. She also serves as Professor within the Pardee RAND Graduate School, and as Editor-in-Chief of Women's Health Issues.

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      Donna L. Washington, MD, MPH, is Director of the Office of Health Equity/QUERI Partnered Evaluation Center, Greater Los Angeles VA Health Care System, and Professor of Medicine, at the University of California, Los Angeles, David Geffen School of Medicine.

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      Jodie G. Katon, PhD, MS, is Health Sciences Research Specialist within the VA Puget Sound Health Care System and Senior Epidemiologic Consultant within the VA Office of Patient Care, Women's Health Services.

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      Michael J. LaMonte, PhD, MPH, is Research Associate Professor of Epidemiology within the Department of Epidemiology and Environmental Health of the School of Public Health and Health Professions of the State University of New York at Buffalo.

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      Mary K. Goldstein, MD, MS in Health Services Research, is Director of the Palo Alto Geriatrics Research Education and Clinical Center, VA Palo Alto Health Care System, and Professor of Medicine, Center for Primary Care and Outcomes Research at Stanford University School of Medicine.

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      Shari S. Bassuk, ScD, is an epidemiologist with the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School.

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      Gloria E. Sarto, MD, PhD, is Professor Emeritus of Obstetrics and Gynecology at the University of Wisconsin-Madison, has served on several boards/committees within the Institute of Medicine, and was involved in the development of NIH's Office of Women's Health.

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      Marcia L. Stefanick, PhD, is Professor of Medicine (Stanford Prevention Research Center), and of Obstetrics & Gynecology at Stanford University School of Medicine. She is also Director of the Stanford Women and Sex Differences in Medicine (WSDM) Center.