Peripheral arterial disease in Scottish military veterans: a retrospective cohort study of 57 000 veterans and 173 000 matched non-veterans

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

doi:10.1093/pubmed/fdy046

Cited by 6 publications

(7 citation statements)

References 35 publications

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“…both in earlier study 6 and confirmed in this up, but that paradoxically fewer amputations take place in veterans with PAD than non-veterans. We suggest that this may be due to earlier presentation, and hence greater likelihood of limb-saving treatment, as veterans may be less likely to ignore the symptoms of claudication than non-veterans.…”

Section: Original Researchsupporting

confidence: 77%

“…3 A study of US veterans showed that 63% of amputations between 1989 and 1998 were for diabetes and 24% for peripheral vascular disease, with overall age-specific rates for veterans exceeding those in the general US population. 4 5 We have shown that Scottish veterans are at increased risk of PAD compared with the wider population, 6 but we had no information on whether this was associated with an increased incidence of limb loss.…”

Section: Introductionmentioning

confidence: 99%

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Postservice lower limb amputation in Scottish military veterans

2021

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IntroductionRecent attention has focused on veterans who have lost limbs in conflict, but the number of UK veterans who lose limbs to disease is unknown. We used data from the Trends in Scottish Veterans’ Health study to explore postservice lower limb amputation.MethodsWe carried out a retrospective cohort study of 78 000 veterans and 253 000 non-veterans born between 1945 and 1995, matched for age, sex and area of residence. We used survival analysis to examine the risk of amputation in veterans compared with non-veterans, and explored associations with antecedent disease.ResultsWe found no difference between veterans and non-veterans in the risk of lower limb amputation, which was recorded in 145 (0.19%) veterans and 464 (0.18%) non-veterans (Cox proportional hazard ratio (HR) 1.00, 95% CIs 0.82 to 1.20, p=0.961). Peripheral arterial disease was recorded in two-thirds of both veteran and non-veteran amputees, and type 2 diabetes in 41% of veterans and 33% of non-veterans, with a dual diagnosis in 32% of veterans and 26% of non-veterans. Trauma was an infrequent cause of amputation.ConclusionsAlthough in later life veterans are no more likely to lose a limb to disease than non-veterans, the number so affected greatly outweighs those who have lost limbs in conflict. The high public profile of conflict-related limb loss risks eclipsing the needs of veterans with disease-related loss. Support for ageing veterans who have lost limbs due to disease will require planning with the same care as that afforded to the victims of conflict if inequalities are to be avoided.

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Section: Original Researchsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Postservice lower limb amputation in Scottish military veterans

2021

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“…Despite the theoretical increased risk of dementia in veterans based on their known increased risks of cardiovascular disease (Bergman et al, 2014(Bergman et al, , 2018, PTSD (Iversen et al, 2009) and traumatic/mild traumatic brain injury (Shively & Perl, 2012), reassuringly we find no evidence to support the hypothesis that veterans are at an increased risk of dementia overall in comparison with people who have never served. The veterans in our study were aged up to 73 years at the end of data collection, and therefore emerging differences might have been expected to become apparent.…”

Section: Main Findingscontrasting

confidence: 77%

Dementia in Scottish military veterans: early evidence from a retrospective cohort study

Bergman

Mackay²,

Pell³

2021

Psychol. Med.

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Background Few studies have examined whether UK military veterans are at an increased risk of dementia. We explored the risk of dementia in Scottish military veterans aged up to 73 years in comparison with people who have never served. Methods Retrospective cohort study of 78 000 veterans and 253 000 people with no record of service, matched for age, sex and area of residence, with up to 37 years follow-up, using Cox proportional hazard analysis to compare risk of dementia in veterans and non-veterans, overall and by subgroup. Results Dementia was recorded in 0.2% of both veterans and non-veterans overall, Cox proportional hazard ratio 0.98, 95% confidence interval (CI) 0.82–1.19, p = 0.879 (landmark age: 50 years), with no difference for men but increased risk in veteran women and Early Service Leavers. Post-traumatic stress disorder (PTSD) was associated with a higher risk of dementia in both veterans and non-veterans, although possibly to a lesser degree in veterans. A history of mood disorder was strongly associated with developing dementia, greater in veterans than in non-veterans, odds ratio 1.54, 95% CI 1.01–2.35, p = 0.045. Conclusions There was no evidence to suggest that military service increased the risk of dementia, although this may change as the cohort ages. The well-documented association with PTSD shows no evidence of being stronger in veterans; by contrast, the association of mood disorder with dementia is much stronger in veterans. Healthcare providers should carefully assess the cognitive status of older veterans presenting with depressive illness in order to identify early dementia and ensure optimum management.

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“…2 We have previously reported that a cohort of 57 000 veterans in Scotland who were born between 1945 and 1985, followed up for over 30 years to 2012, were at increased risk of acute myocardial infarction in comparison with 173 000 age-matched, sex-matched and geographically matched non-veterans. 3 We also found that the same cohort was at increased risk of peripheral arterial disease, 4 smoking-related cancers 5 and chronic obstructive pulmonary disease. 6 We suggested that this was likely to be due to the well-documented higher rates of smoking which have been reported in serving military personnel over many years.…”

Section: Introductionmentioning

confidence: 59%

Trends in cardiovascular disease in Scottish military veterans: a retrospective cohort study

2021

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ObjectivesTo examine the risk of cardiovascular disease (CVD) in Scottish military veterans in comparison with people who had never served in long-term follow-up to 2017, and to compare the findings with our earlier study to 2012 to assess trends.DesignRetrospective cohort study with up to 37 years follow-up.SettingPseudo-anonymised extract of computerised Scottish National Health Service records and national vital records.Participants78 000 veterans and 253 000 people with no record of service matched for age, sex and area of residence.Outcome measuresRisk of first occurrence of acute myocardial infarction, peripheral arterial disease and stroke in veterans compared with non-veterans, overall and by sex and birth cohort.ResultsA first episode of CVD was recorded in 5.7% of veterans and 4.8% of non-veterans overall, Cox proportional HR 1.16, 95% CIs 1.12 to 1.20, p=0.001. The difference was only significant for men, and for veterans born before 1960, and was highest in veterans with the shortest service. In all categories, the difference in risk was less than at the end of 2012.ConclusionsThe excess burden of CVD in veterans which was evident at the end of 2012 has reduced in the following 5 years from 23% to 16% overall. The increased risk continues to affect only those veterans born prior to 1960, suggesting that improvements in military health promotion since 1978, when veterans born from 1960 joined the armed forces, have had an important and ongoing beneficial effect on the long-term health of veterans.

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Peripheral arterial disease in Scottish military veterans: a retrospective cohort study of 57 000 veterans and 173 000 matched non-veterans

Abstract: The findings provide evidence for a hidden burden of life- and limb-threatening PAD in older veterans and are consistent with the higher rates of military smoking which have been reported previously. The study emphasizes the need for vascular preventive measures in this group.

Cited by 6 publications

References 35 publications

Postservice lower limb amputation in Scottish military veterans

Postservice lower limb amputation in Scottish military veterans

Dementia in Scottish military veterans: early evidence from a retrospective cohort study

Trends in cardiovascular disease in Scottish military veterans: a retrospective cohort study

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