Military Combat and Risk of Coronary Heart Disease and Ischemic Stroke in Aging Men: The Atherosclerosis Risk in Communities (ARIC) Study
Abstract: Purpose: To assess the long-term association of military combat stress with coronary heart disease (CHD) and ischemic stroke (IS). Methods: The association between exposure to military combat and the occurrence of CHD and IS was assessed among 5,347 men in the Atherosclerosis Risk in Communities (ARIC) study. Outcomes were assessed an average of 36 years after entry into military service during the eras of World War II, the Korean War and the Vietnam conflict. Results: Veterans were more likely to be older, white and of higher socioeconomic status than non-veterans. No differences in CHD period prevalence rates were noted among the three exposure groups, overall or by era of service. Associations between combat and ischemic stroke period prevalence may be modified by father’s education, although confidence intervals were wide and event rates small. Conclusions: Overall, middle-aged veterans with distant combat exposure are not at increased cardiovascular risk compared to those without combat exposure.
Abstract: IMPORTANCE: Veterans with occupational performance (e.g., activities of daily living [ADL]) limitations who are receiving inpatient psychiatric care may benefit from outpatient occupational therapy upon discharge, but access disparities have not been investigated. OBJECTIVE: To investigate whether ADL limitations, an indicator of need, are associated with outpatient occupational therapy utilization after inpatient psychiatric hospitalization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics. DESIGN: Secondary analysis of VHA medical record data. Modified Poisson regression was used to model outpatient occupational therapy utilization (yes or no) as a function of ADL limitations, facility characteristics, and sociodemographic and clinical characteristics. Interactions were used to estimate whether the relationship between ADL limitations and outpatient occupational therapy utilization differs across facility characteristics. SETTING: VHA outpatient setting. PARTICIPANTS: Veterans who received VHA inpatient psychiatric care from 2015 to 2020 and lived