Military Generation and Its Relationship to Mortality in Women Veterans in the Women's Health Initiative

Published in: The Gerontologist, v. 56, no. 1, p. S126-S137

Posted on RAND.org on February 09, 2016

by Donna L. Washington, Chloe E. Bird, Michael J. Lamonte, Karen M. Goldstein, Eileen Rillamas-Sun, Marcia L. Stefanick, Nancy F. Woods, Lori A. Bastian, Margery Gass, Julie C. Weitlauf

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PURPOSE OF THE STUDY: Women's military roles, exposures, and associated health outcomes have changed over time. However, mortality risk--within military generations or compared with non-Veteran women--has not been assessed. Using data from the Women's Health Initiative (WHI), we examined all-cause and cause-specific mortality by Veteran status and military generation among older women. DESIGN AND METHODS: WHI participants (3,719 Veterans; 141,802 non-Veterans), followed for a mean of 15.2 years, were categorized into pre-Vietnam or Vietnam/after generations based on their birth cohort. We used cox proportional hazards models to examine the association between Veteran status and mortality by generation. RESULTS: After adjusting for sociodemographic characteristics and WHI study arm, all-cause mortality hazard rate ratios (HRs) for Veterans relative to non-Veterans were 1.16 (95% CI: 1.09–1.23) for pre-Vietnam and 1.16 (95% CI: 0.99–1.36) for Vietnam/after generations. With additional adjustment for health behaviors and risk factors, this excess mortality rate persisted for pre-Vietnam but attenuated for Vietnam/after generations. After further adjustment for medical morbidities, across both generations, Veterans and non-Veterans had similar all-cause mortality rates. Relative to non-Veterans, adjusting for sociodemographics and WHI study arm, pre-Vietnam generation Veterans had higher cancer, cardiovascular, and trauma-related morality rates; Vietnam/after generation Veterans had the highest trauma-related mortality rates (HR = 2.93, 1.64–5.23). IMPLICATIONS: Veterans' higher all-cause mortality rates were limited to the pre-Vietnam generation, consistent with diminution of the healthy soldier effect over the life course. Mechanisms underlying Vietnam/after generation Veteran trauma-related mortality should be elucidated. Efforts to modify salient health risk behaviors specific to each military generation are needed.

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