Abstract
Objectives
We analyzed long-term differences in incident diabetes associated with military service
in a warzone among women who served during the Vietnam War era.
Methods
For HealthViEWS, the largest later-life study of women Vietnam War-era U.S. veterans,
a population-based retrospective cohort who served during 1965–1973 completed a health
interview in 2011–2012. This cohort included women deployed to Vietnam, near Vietnam,
or who served primarily in the United States. We hypothesized a warzone exposure gradient:
Vietnam (highest exposure), near Vietnam, and the United States (lowest exposure).
We used an extended Cox regression to test for differences in incident diabetes by
location of wartime service.
Results
Of 4,503 women in the analysis, 17.7% developed diabetes. Adjusting for demographics
and military service characteristics, hazard of incident diabetes was significantly
lower initially in the Vietnam group compared with the U.S. group (hazard ratio, 0.33;
95% confidence interval, 0.15–0.69). However, lower diabetes hazard in the Vietnam
group was not constant over time; rather, hazard accumulated faster over time in the
Vietnam group compared with the U.S. group (hazard ratio, 1.38; 95% confidence interval,
1.11–1.72). No significant difference in diabetes hazard was found between the near
Vietnam and U.S. groups. Older age during military service, minority race/ethnicity,
and lower military rank were associated with a higher diabetes hazard.
Conclusions
Women deployed to a warzone might have protective health factors that lower risk for
diabetes early in their military career, but delivery systems for long-term health
should consider that a lower risk for chronic diseases like diabetes can wane quickly
in the decades that follow warzone service.
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Biography
Eric M. Schmidt, PhD, is a Senior Evaluator and health services researcher with the Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Central Office.
Biography
Kathryn Magruder, PhD, MPH, is Professor, Department of Psychiatry and Behavioral Sciences, College of Medicine at the Medical University of South Carolina.
Biography
Amy M. Kilbourne, PhD, MPH, is Professor, Department of Psychiatry, University of Michigan, and Director of the Veterans Affairs Quality Enhancement Research Initiative.
Biography
Eileen M. Stock, PhD, is a Statistician with the Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, U.S. Department of Veterans Affairs.
Biography
Yasmin Cypel, PhD, MS, is a Statistician and Researcher with the Epidemiology Program, Post-Deployment Health Services, Office of Patient Care Services, U.S. Department of Veterans Affairs.
Biography
Suad El Burai Félix, MPH, is an Analyst with the Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, U.S. Department of Veterans Affairs.
Biography
Tracey Serpi, PhD, was a Statistician with the Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, U.S. Department of Veterans Affairs.
Biography
Rachel Kimerling, PhD, is a Research Psychologist and health services researcher for the National Center for Posttraumatic Stress Disorder and the Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System.
Biography
Beth Cohen, MD, MAS, is Associate Professor, Department of Medicine, University of California at San Francisco, and a General Internist at the San Francisco Veterans Affairs Health Care System.
Biography
Avron Spiro, PhD, is Professor, Department of Epidemiology, School of Public Health, and Department of Psychiatry, School of Medicine, Boston University, and a Research Scientist with the Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Health Care System.
Biography
Joan Furey, RN, MA, is a Registered Nurse and a veteran of the U.S. Military who served during the Vietnam War.
Biography
Grant D. Huang, MPH, PhD, is Director of the Cooperative Studies Program, Office of Research and Development, U.S. Department of Veterans Affairs.
Biography
Susan M. Frayne, MD, MPH, is a Professor, Division of General Medical Disciplines, Stanford University, and a Health Scientist at Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System.
Article info
Publication history
Published online: September 10, 2019
Accepted:
August 5,
2019
Received in revised form:
July 26,
2019
Received:
July 30,
2018
Footnotes
This study was supported by the Department of Veterans Affairs (VA), Veterans Health Administration, VA Office of Research and Development, Cooperative Studies Program (CSP #579, Long-term Health Outcomes of Women Veterans‘ Service During the Vietnam Era [Health of Vietnam Era Women Study, or HealthViEWS] NCT00958061). Dr. Schmidt was supported by the VA Office of Academic Affiliations Advanced Fellowship in Health Services Research and Development (HSR&D) and the VA HSR&D Service. Dr. Spiro was supported by a VA CSR&D Senior Research Career Scientist Award.
All aspects of the study, including the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication, were approved by the Department of Veterans Affairs.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the United States Government.
The authors have no conflicts of interest to disclose.
Identification
Copyright
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.
