Chronic obstructive pulmonary disease in Scottish military veterans

Bergman, Beverly P; Mackay, Daniel; Pell, Jill P.

doi:10.1136/jramc-2016-000729

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…Later non-ESL birth cohorts show reduced mortality risk, reflecting better health outcomes in this group as reported elsewhere [6][7][8]…”

Section: Resultssupporting

confidence: 68%

“…Smoking-related diseases were the commonest antecedent diagnoses in veterans who died (Table 2), affecting 46% of veterans compared with 39% of nonveterans, demonstrating the importance of lifestyle factors. Even among non-ESL, the negative gradient of risk with length of service which we have demonstrated elsewhere, [8] combined with the greater proportion of non-ESL (two-thirds) who served for less than 12 years, results in these conditions having a major impact. Nonetheless, there were few differences in the proportion of pre-existing physical conditions between ESL and non-ESL veterans who died, apart from hepatitis C, which was less common in non-ESL.…”

Section: Resultsmentioning

confidence: 62%

“…Early conflict specific studies such as those which followed up veterans of the Vietnam War tended to reinforce that belief, [1][2][3] although more recent work on UK veterans by the King's Centre for Military Health Research, and our analysis of the Scottish Veterans Health Study dataset, suggest that there may be important subgroup differences within the veteran population. The excess risk of post-traumatic stress disorder has been shown to affect predominantly combat troops [4], while the increased risk of smoking-related disease may be a legacy of historically high smoking prevalence among the armed forces [5] and disproportionately affects those with the shortest service [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Healthy workers or less healthy leavers? Mortality in military veterans

Bergman

Macdonald

Mackay

et al. 2019

Occupational Medicine

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Background: The 'healthy worker effect' predicts that longer employment is positively associated with reduced mortality, but few studies have examined mortality in military veterans irrespective of exposure to conflict. Aims: To examine mortality in a large national cohort of Scottish veterans by length of service. Methods: Retrospective cohort study comparing survival in up to 30 years follow-up among 57,000 veterans and 173,000 people with no record of service, matched for age, sex and area of residence, who were born between 1945 and 1985. We compared antecedent diagnoses in the two groups to provide information on probable risk factors. Results: By the end of follow-up, 3,520 (6%) veterans had died, compared with 10,947 (6%) non-veterans. Cox proportional hazard analysis confirmed no significant difference overall unadjusted or after adjusting for deprivation. On subgroup analysis, those who left prematurely (early service leavers) were at significantly increased risk of death, hazard ratio 1.16, 95% confidence intervals 1.09-1.24, P<0.001, although the increase became nonsignificant after adjusting for socioeconomic status, hazard ratio 1.05, 95% confidence intervals 0.99-1.12. Longer-serving veterans were at significantly lower risk of death than non-veterans; the risk decreased both with length of service and in more recent birth cohorts. Smoking-related disease was the greatest contributor to increased mortality in early leavers. Conclusion: Among longer-serving veterans, there was evidence of a 'healthy worker effect' partly attributable to selective attrition of early service leavers, but birth cohort analysis suggests improvements over time which may also reflect a causal effect of improved inservice health promotion.

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“…Later non-ESL birth cohorts show reduced mortality risk, reflecting better health outcomes in this group as reported elsewhere [6][7][8]…”

Section: Resultssupporting

confidence: 68%

Section: Resultsmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Healthy workers or less healthy leavers? Mortality in military veterans

Bergman

Macdonald

Mackay

et al. 2019

Occupational Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Tobacco smoking is the most important risk factor for PAD, and these findings are therefore consistent with the well-documented higher rates of smoking in serving personnel in the period when the veterans who demonstrated the highest risk in this study were serving, [11,12] with the increase in prevalence of both never-smoking and ex-smoking in longer-serving senior ranks, [21] and with our earlier findings of increased risk of lung cancer, COPD, and AMI in veterans, in which the greatest increase in risk was in those born prior to 1960 and in those with the shortest service. [14,15,22] The study therefore adds further weight to our earlier hypothesis that increased rates of military smoking, especially among earlier-and shorter-serving military personnel, have resulted in a substantial burden of cardiovascular disease in veterans. Military smoking prevalence is also significantly positively correlated with low educational attainment and with deprivation, [23] both of which are linked to premature termination of service.…”

Section: Main Finding Of This Studymentioning

confidence: 64%

“…We used NRT prescription as a proxy measure for smoking; although a novel measure, this has found utility in our earlier studies. [15,22] Veterans with Reserve service only could not be identified from NHS records and were therefore included amongst the non-veterans; this would have had the effect of reducing any observed differences between veterans and nonveterans.…”

Section: Limitations Of This Studymentioning

confidence: 99%