Health Outcomes Among Veterans in Relation to Service and Combat Exposure in Vietnam

Persistent Link:
http://hdl.handle.net/10150/194970
Title:
Health Outcomes Among Veterans in Relation to Service and Combat Exposure in Vietnam
Author:
Tomasallo, Carrie
Issue Date:
2007
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
Introduction. The relationships among military service, combat intensity and long-term health effects were investigated in a cohort of 6,355 Vietnam-era American Legionnaires who were recruited in 1984 and followed through 1998. First, the effect of Vietnam service on coronary heart disease (CHD) risk was assessed among 3,781 veterans who responded to both questionnaires. Next, the effect of serving in Vietnam and combat exposure was investigated as risk factors for the mortality of the cohort. Finally, potential threats to the validity of this study were evaluated.Methods. Military service and lifestyle factors were assessed by questionnaires in 1984 and 1998. Vital status in 1998 was determined and causes of death were ascertained through the National Death Index. Cox proportional hazards modeling was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for CHD incidence and mortality in relation to service location and combat exposure, adjusting for age, smoking, alcohol consumption, body mass, and hypertension. Response bias and reliability of self-reported data were examined.Results. Serving in Vietnam was associated with an increased hazard of developing heart disease (HR=1.37, 95% CI: 1.09, 1.73), after controlling for independent risk factors. Vietnam veterans experienced a 50% higher mortality than non-Vietnam veterans during 14-year follow-up (HR=1.48, 95% CI= 1.13 - 1.93), which increased with combat intensity after adjustment for other risk factors, (low combat: HR 1.17, 95% CI 0.79 - 1.73; medium combat HR=1.51, 95% CI 1.05 - 2.17; high combat HR=1.82, 95% CI 1.20 - 2.76). A stronger relationship was observed by level of combat for CHD mortality (low combat: HR =1.48, 95% CI 0.75 - 2.95; medium combat HR= 2.01, 95% CI 1.06 - 3.79; high combat HR= 2.27, 95% CI 1.08 - 4.79). Results showed that non-respondents differed only slightly from respondents for important variables potentially related to exposures and chronic disease outcomes. Furthermore, veteran self-report was moderately to highly reliable when measured over a 14 year period.Conclusions. Vietnam veterans are still experiencing higher rates of adverse health effects, even more than thirty years after their military service. These data support a long term and independent adverse effect of military service in Vietnam on cardiovascular health.
Type:
text; Electronic Dissertation
Keywords:
heart disease; mortality; Vietnam veterans; combat exposure; stress; longitudinal studies
Degree Name:
PhD
Degree Level:
doctoral
Degree Program:
Epidemiology; Graduate College
Degree Grantor:
University of Arizona
Advisor:
Harris, Robin
Committee Chair:
Harris, Robin

Full metadata record

DC FieldValue Language
dc.language.isoENen_US
dc.titleHealth Outcomes Among Veterans in Relation to Service and Combat Exposure in Vietnamen_US
dc.creatorTomasallo, Carrieen_US
dc.contributor.authorTomasallo, Carrieen_US
dc.date.issued2007en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractIntroduction. The relationships among military service, combat intensity and long-term health effects were investigated in a cohort of 6,355 Vietnam-era American Legionnaires who were recruited in 1984 and followed through 1998. First, the effect of Vietnam service on coronary heart disease (CHD) risk was assessed among 3,781 veterans who responded to both questionnaires. Next, the effect of serving in Vietnam and combat exposure was investigated as risk factors for the mortality of the cohort. Finally, potential threats to the validity of this study were evaluated.Methods. Military service and lifestyle factors were assessed by questionnaires in 1984 and 1998. Vital status in 1998 was determined and causes of death were ascertained through the National Death Index. Cox proportional hazards modeling was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for CHD incidence and mortality in relation to service location and combat exposure, adjusting for age, smoking, alcohol consumption, body mass, and hypertension. Response bias and reliability of self-reported data were examined.Results. Serving in Vietnam was associated with an increased hazard of developing heart disease (HR=1.37, 95% CI: 1.09, 1.73), after controlling for independent risk factors. Vietnam veterans experienced a 50% higher mortality than non-Vietnam veterans during 14-year follow-up (HR=1.48, 95% CI= 1.13 - 1.93), which increased with combat intensity after adjustment for other risk factors, (low combat: HR 1.17, 95% CI 0.79 - 1.73; medium combat HR=1.51, 95% CI 1.05 - 2.17; high combat HR=1.82, 95% CI 1.20 - 2.76). A stronger relationship was observed by level of combat for CHD mortality (low combat: HR =1.48, 95% CI 0.75 - 2.95; medium combat HR= 2.01, 95% CI 1.06 - 3.79; high combat HR= 2.27, 95% CI 1.08 - 4.79). Results showed that non-respondents differed only slightly from respondents for important variables potentially related to exposures and chronic disease outcomes. Furthermore, veteran self-report was moderately to highly reliable when measured over a 14 year period.Conclusions. Vietnam veterans are still experiencing higher rates of adverse health effects, even more than thirty years after their military service. These data support a long term and independent adverse effect of military service in Vietnam on cardiovascular health.en_US
dc.typetexten_US
dc.typeElectronic Dissertationen_US
dc.subjectheart diseaseen_US
dc.subjectmortalityen_US
dc.subjectVietnam veteransen_US
dc.subjectcombat exposureen_US
dc.subjectstressen_US
dc.subjectlongitudinal studiesen_US
thesis.degree.namePhDen_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineEpidemiologyen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorHarris, Robinen_US
dc.contributor.chairHarris, Robinen_US
dc.contributor.committeememberRoe, Deniseen_US
dc.contributor.committeememberSwanson, Marieen_US
dc.contributor.committeememberMartinez, Elenaen_US
dc.contributor.committeememberThompson, Patriciaen_US
dc.contributor.committeememberStellman, Stevenen_US
dc.identifier.proquest2498en_US
dc.identifier.oclc659748409en_US
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