Prospective Analysis of Health and Mortality Risk in Veteran and Non-Veteran Participants in the Women's Health Initiative
Published in: Women's Health Issues, v. 25, no. 6, Nov.-Dec. 2015, p. 649-657
Posted on RAND.org on April 28, 2016
- Are risks of mortality and postmenopausal health condition different among veteran and non-veteran Women's Health Initiative participants?
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.
- Mortality risk among veteran women was significantly higher than non-veteran women.
- Veteran women were not more likely than their peers to develop cardiovascular disease, cancer, or diabetes.
- Hip fracture risk was slightly elevated among veterans, but the association did not hold when factors specific to bone health or fracture were considered.
- Results underscore the need to identify and address health and mortality risk factors that can be modified among women veterans.