Prior health care utilization as a potential determinant of enrollment in a 21-year prospective study, the Millennium Cohort Study

Wells, Timothy S.; Jacobson, Isabel G.; Smith, Tyler C.; Spooner, Christina N.; Smith, Besa; Reed, Robert J.; Amoroso, Paul J.; Ryan, Margaret A. K.

doi:10.1007/s10654-007-9216-0

Cited by 68 publications

(62 citation statements)

References 26 publications

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“…Previous studies have shown these cohort data to be reliable and survey response to be uninfluenced by poor health status. 15,17,[37][38][39][40][41][42][43] We believe that these results are generalizable to the entire US military because of the large sample size and population-based random sampling methods used. To some extent, results may also be generalizable to any population of healthy young adults.…”

Section: Limitations and Strengthsmentioning

confidence: 77%

Newly Reported Hypertension After Military Combat Deployment in a Large Population-Based Study

et al. 2009

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Abstract-High-stress situations, such as combat deployments, are a potential risk factor for hypertension. Although stress is postulated to increase blood pressure, the underlying role of stress on hypertension is not well established. We sought to determine the relations between combat deployment-induced stress and hypertension. The Millennium Cohort baseline questionnaire (2001)(2002)(2003) was completed by 77 047 US active-duty and Reserve/National Guard members. Follow-up was completed by 55 021 responders Ϸ3 years later (2004 -2006). Multivariable logistic regression was used to estimate the 3-year risk of newly reported hypertension, adjusting for general and mental health, demographics, and occupational and behavioral characteristics. After applying exclusion criteria, our analyses included 36 061 service members. Subanalyses of deployers included 8829 participants. Newly reported hypertension was identified in 6.9% of the cohort between baseline and follow-up, many of whom had deployed on military operations in support of the conflicts in Iraq and Afghanistan. After adjusting, deployers who experienced no combat exposures were less likely to report hypertension than nondeployers (odds ratio: 0.77; 95% CI: 0.67 to 0.89). Among deployers, those reporting multiple combat exposures were 1.33 times more likely to report hypertension compared with noncombat deployers (95% CI: 1.07 to 1.65). Although military deployers, in general, had a lower incidence of hypertension than nondeployers, deployment with multiple stressful combat exposures appeared to be a unique risk factor for newly reported hypertension. ilitary deployment may present profound psychological and physical stressors to deployers, such as exposure to life-threatening situations, dead or maimed bodies, and suboptimal living conditions. Although stress related to high-pressure work, natural disasters, and missile attacks has been associated with increased myocardial infarction and other cardiovascular risk, 1 the underlying role of deploymentinduced stress or combat-related violence on hypertension is not well established.Stress is postulated to increase blood pressure through the release of corticoids and inhibition of prostaglandin synthesis, which regulates blood pressure; the sudden rise in dopamine that increases coronary blood flow; or perhaps by altering electrolytes and increasing sodium, thereby aggravating hypertension. [2][3][4] Violence is thought to sustain nighttime blood pressure through mechanisms related to elevated sympathetic nervous system response. 5 Several studies have linked acute stress from life-threatening situations, such as earthquake shock and combat, with elevated blood pressure, although this effect was temporary, lasting only hours to weeks. 6 -8 However, acute stress responses reported after terrorist attacks were shown to increase physician-diagnosed hypertension by 115% at 1 year and 75% at 2 years. 9 Individuals with sustained nighttime blood pressure (Ͻ10% decrease from awake to sleep) were 3.5 times as likel...

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Section: Limitations and Strengthsmentioning

confidence: 77%

Newly Reported Hypertension After Military Combat Deployment in a Large Population-Based Study

et al. 2009

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“…The population-based design allowed for assessment among all service branches and components (active duty, Reserve, and National Guard), including those no longer serving in the military. Although limitations exist with self-reported data, previous analyses have shown that Millennium Cohort participants self-report data reliably, well represent the U.S. military, and were not influenced to participate on the basis of previous health (53)(54)(55)(56)(57)(58)(59)(60). Additional strengths of the study include the large sample size that provided statistical power and the ability to control for multiple confounders.…”

Section: Discussionmentioning

confidence: 98%

Bodybuilding, Energy, and Weight-Loss Supplements Are Associated With Deployment and Physical Activity in U.S. Military Personnel

Jacobson

Horton

Smith

et al. 2012

Annals of Epidemiology

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“…However, multiple investigations of possible reporting and selection biases in baseline Millennium Cohort data suggest reliable reporting, minimal response bias, and a representative sample of military personnel, including deployers. 14,15,[30][31][32][33][34][35]37,73,81 Use of the PHQ along with the DSM-IV criteria has shown to correlate well with a physician's assessment of depression symptoms, 32 and the PHQ is internally valid in Millennium Cohort members. 32 However, the use of a standardized instrument for self-reported data as a surrogate for depression diagnosis is imperfect.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study of Depression Following Combat Deployment in Support of the Wars in Iraq and Afghanistan

et al. 2010

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Objective. We investigated relations between deployment and new-onset depression among US service members recently deployed to the wars in Iraq and Afghanistan. Methods. We included 40 219 Millennium Cohort Study participants who completed baseline and follow-up questionnaires and met inclusion criteria. Participants were identified with depression if they met the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire criteria for depression at follow-up, but not at baseline. Results. Deployed men and women with combat exposures had the highest onset of depression, followed by those not deployed and those deployed without combat exposures. Combat-deployed men and women were at increased risk for new-onset depression compared with nondeployed men and women (men: adjusted odds ratio [AOR] = 1.32; 95% confidence interval [CI] = 1.13, 1.54; women: AOR = 2.13; 95% CI = 1.70, 2.65). Conversely, deployment without combat exposures led to decreased risk for new-onset depression compared with those who did not deploy (men: AOR = 0.66; 95% CI = 0.53, 0.83; women: AOR = 0.65; 95% CI = 0.47, 0.89). Conclusions. Deployment with combat exposures is a risk factor for new-onset depression among US service members. Post-deployment screening may be beneficial for US service members exposed to combat.

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Prior health care utilization as a potential determinant of enrollment in a 21-year prospective study, the Millennium Cohort Study

Cited by 68 publications

References 26 publications

Newly Reported Hypertension After Military Combat Deployment in a Large Population-Based Study

Newly Reported Hypertension After Military Combat Deployment in a Large Population-Based Study

Bodybuilding, Energy, and Weight-Loss Supplements Are Associated With Deployment and Physical Activity in U.S. Military Personnel

A Prospective Study of Depression Following Combat Deployment in Support of the Wars in Iraq and Afghanistan

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