The operational definition of chronic pain used in this study may have research implications for examining predictors of incident and chronic pain. These data have important clinical implications in that addressing comorbid conditions of persistent pain may improve adaptive coping and functioning in these patients.

SUMMARY Purpose The absence of validated methods to identify hepatic decompensation in cohort studies has prevented a full understanding of the natural history of chronic liver diseases and impact of medications on this outcome. We determined the ability of diagnostic codes and liver-related laboratory abnormalities to identify hepatic decompensation events within the Veterans Aging Cohort Study (VACS). Methods Medical records of patients with hepatic decompensation codes and/or laboratory abnormalities of liver dysfunction (total bilirubin ≥5.0 gm/dL, albumin ≤2.0 gm/dL, international normalized ratio ≥1.7) recorded one year before through six months after VACS entry were reviewed to identify decompensation events (i.e., ascites, spontaneous bacterial peritonitis, variceal hemorrhage, hepatic encephalopathy, hepatocellular carcinoma) at VACS enrollment. Positive predictive values (PPVs) of diagnostic codes, laboratory abnormalities, and their combinations for confirmed outcomes were determined. Results Among 137 patients with a hepatic decompensation code and 197 with a laboratory abnormality, the diagnosis was confirmed in 57 (PPV, 42%; 95% CI, 33% – 50%) and 56 (PPV, 28%; 95% CI, 22% – 35%), respectively. The combination of any code plus laboratory abnormality increased PPV (64%; 95% CI, 47% - 79%). One inpatient or ≥2 outpatient diagnostic codes for ascites, spontaneous bacterial peritonitis, or variceal hemorrhage had high PPV (91%; 95% CI, 77% – 98%) for confirmed hepatic decompensation events. Conclusion An algorithm of 1 inpatient or ≥2 outpatient codes for ascites, peritonitis, or variceal hemorrhage has sufficiently high PPV for hepatic decompensation to enable its use for epidemiologic research in VACS. This algorithm may be applicable to other cohorts.

Objective PTSD increases cardiovascular disease and cardiovascular mortality risk. Neither the prospective relationship of PTSD to incident hypertension risk, nor the effect of PTSD treatment on hypertension risk has been established. Methods Data from a nationally representative sample of 194,319 veterans were drawn from the Veterans Administration roster of United States service men and women. This included veterans whose end of last deployment was from September 2001 – July 2010, and whose first VA medical visit was from October 1, 2001 – January 1, 2009. Incident hypertension was modeled as 3 events: 1) a new diagnosis of hypertension; and/or 2) a new prescription for anti-hypertensive medication; and/or 3) a clinic BP reading in the hypertensive range (≥140mmHg/90mmHg, systolic/diastolic). PTSD diagnosis was the main predictor. PTSD treatment was defined as, 1) at least 8 individual psychotherapy sessions of ≥ 50min during any consecutive 6 months and/or 2) a prescription for SSRI medication. Results Over a median 2.4 year follow-up, the incident hypertension risk independently associated with PTSD ranged from HR=1.12 (95% CI 1.08 – 1.17, p<0.0001) to HR=1.30 (95% CI 1.26 – 1.34, p<0.0001). The interaction of PTSD and treatment revealed that treatment reduced the PTSD associated hypertension risk (e.g., from HR=1.44 [95% CI 1.38 – 1.50, p<0.0001] for those untreated, to HR=1.20 [95% CI 1.15 – 1.25, p<0.0001] for those treated). Conclusions These results indicate that reducing the long term health impact of PTSD and the associated costs, may require very early surveillance and treatment.

Background. Medication classes, polypharmacy, hazardous alcohol and illicit substance abuse may exhibit stronger associations with serious falls among persons living with HIV (PLWH) than with uninfected comparators. We investigated whether these associations differed by HIV status. Setting. Veterans Aging Cohort Study Methods. We employed a nested case-control design. Cases (N=13,530) were those who fell. Falls were identified by external cause of injury codes and a machine learning algorithm applied to radiology reports. These were matched to controls (N=67,060) by age, race, sex, HIV status, duration of observation, and baseline date. Risk factors included medication classes, count of unique non-antiretroviral (non-ART) medications, and hazardous alcohol and illicit substance use. We used unconditional logistic regression to evaluate associations. Results. Among PLWH, benzodiazepines (odds ratio (OR) 1.24; 95% confidence interval (CI) 1.08, 1.40) and muscle relaxants (OR 1.29; 95% CI 1.08, 1.46) were associated with serious falls but not among uninfected (p>0.05). In both groups, key risk factors included non-ART medications (per five medications) (