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

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2020 Sep 22

PMID 32959346

Citations 9

Authors

Ian J Stewart

Eduard Poltavskiy

Jeffrey T Howard

Jud C Janak

Warren Pettey

Lee Ann Zarzabal

Lauren E Walker

Carl A Beyer

Alan Sim

Ying Suo

Andrew Redd

Kevin K Chung

Adi Gundlapalli

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Major trauma and comorbidity: a scoping review.

Glynn R, Edwards F, Wullschleger M, Gardiner B, Laupland K Eur J Trauma Emerg Surg. 2025; 51(1):133.

PMID: 40074872 PMC: 11903538. DOI: 10.1007/s00068-025-02805-x.

Comparison of Racial and Ethnic Mortality Disparities among Post-9/11 Veterans with and without Traumatic Brain Injury to the Total U.S. Adult Population.

Howard J, Stewart I, Walker L, Amuan M, Rayha K, Janak J J Racial Ethn Health Disparities. 2024; .

PMID: 38622427 DOI: 10.1007/s40615-024-02004-1.

Hypertension at the nexus of veteran status, psychiatric disorders, and traumatic brain injury: Insights from the 2011 Behavioral Risk Factor Surveillance System.

DeBlois J, London A, Heffernan K PLoS One. 2024; 19(3):e0298366.

PMID: 38498456 PMC: 10947695. DOI: 10.1371/journal.pone.0298366.

Relationship between combat-related traumatic injury and its severity to predicted cardiovascular disease risk: ADVANCE cohort study.

Boos C, Haling U, Schofield S, Cullinan P, Bull A, Fear N BMC Cardiovasc Disord. 2023; 23(1):581.

PMID: 38012542 PMC: 10680223. DOI: 10.1186/s12872-023-03605-0.

The Influence of Physical and Mental Health Mediators on the Relationship Between Combat-Related Traumatic Injury and Ultra-Short-Term Heart Rate Variability in a U.K. Military Cohort: A Structural Equation Modeling Approach.

Maqsood R, Schofield S, Bennett A, Khattab A, Clark C, Bull A Mil Med. 2023; 189(3-4):e758-e765.

PMID: 37656495 PMC: 10898941. DOI: 10.1093/milmed/usad341.

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