Veterans Aging Cohort Study (VACS)

Justice, Amy C.; Dombrowski, Elizabeth; Conigliaro, Joseph; Fultz, Shawn L.; Gibson, Deborah; Madenwald, Tamra; Goulet, Joseph L.; Simberkoff, Michael S.; Butt, Adeel A.; Rimland, David; Rodriguez‐Barradas, Maria C.; Gibert, Cynthia L.; Oursler, Kris Ann; Brown, Sheldon T.; Leaf, David A.; Goetz, Matthew Bidwell; Bryant, Kendall

doi:10.1097/01.mlr.0000223741.02074.66

Cited by 299 publications

(318 citation statements)

References 37 publications

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“…We did not account for medications received outside the VHA system, though this effect would likely be small, as most VHA patients get their medications from the VHA system. 15,41 In addition, our measurement of primary care engagement was limited and may not completely describe the interaction between primary care engagement and BP control.…”

Section: Discussionmentioning

confidence: 99%

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Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort

et al. 2016

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BACKGROUND: Incarceration is associated with increased risk of hypertension and cardiovascular disease mortality. We used data from the Veterans Aging Cohort Study (VACS) to explore the impact of incarceration on blood pressure (BP) control. METHODS: Among hypertensive VACS participants, we measured the association between self-reported recent incarceration or past (not recent) history of incarceration and BP control in the year following the survey. To analyze the association between incarceration and BP control, we u s e d l o g i s t i c r e g r e s s io n m od e l s a dj u s t e d f o r sociodemographic characteristics, clinical factors (HIV status and body mass index), and behavioral factors (history of smoking, unhealthy alcohol use, illicit drug use). We explored potential mediators including post-traumatic stress disorder (PTSD), depression, primary care engagement, and adherence to antihypertensive medications. RESULTS: Among the 3515 eligible VACS participants, 2304 participants met the inclusion criteria. Of these, 163 (7 %) reported recent incarceration, and 904 (39 %) reported a past history of incarceration. Participants with recent or past history of incarceration were more likely to have uncontrolled BP than those without a history of incarceration (67 % vs. 56 % vs. 51 %, p < 0.001). In multivariable analysis, recent incarceration (adjusted odds ratio [AOR] = 1.57 95 % confidence interval [CI]: 1.09-2.26), but not a past history of incarceration (AOR = 1.08 95 % CI: 0.90-1.30), was associated with uncontrolled BP compared with those who were never incarcerated. CONCLUSIONS: Among patients with a history of hypertension, recent incarceration is associated with having uncontrolled BP following release. Interventions are needed for recently released individuals to improve hypertension outcomes.

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Section: Discussionmentioning

confidence: 99%

“…matched uninfected veterans who receive healthcare services in the Veterans Health Administration (VHA). 15 Briefly, VACS assesses a combination of self-reported, administrative, and clinical data from eight VHA clinical sites. Data collected include measures of patients' sociodemographic characteristics, comorbidities, and health behaviors.…”

Section: Samplementioning

confidence: 99%

Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort

et al. 2016

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“…VACS is a prospective longitudinal cohort of HIV‐positive veterans matched 1:2 with uninfected veterans on age, sex, race/ethnicity, and clinical site; they were enrolled in the same calendar year 20, 21. We included all VACS participants enrolled on or after April 1, 2003, in whom the baseline was the first clinic visit on or after this date.…”

Section: Methodsmentioning

confidence: 99%

Bilirubin Is Inversely Associated With Cardiovascular Disease Among HIV‐Positive and HIV‐Negative Individuals in VACS (Veterans Aging Cohort Study)

Marconi

Duncan

So‐Armah

et al. 2018

JAHA

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BackgroundBilirubin may protect against cardiovascular disease (CVD) by reducing oxidative stress. Whether elevated bilirubin reduces the risk of CVD events among HIV + individuals and if this differs from uninfected individuals remain unclear. We assessed whether bilirubin independently predicted the risk of CVD events among HIV + and uninfected participants in VACS (Veterans Aging Cohort Study).Methods and ResultsWe conducted a prospective cohort study using VACS participants free of baseline CVD. Total bilirubin was categorized by quartiles. CVD as well as acute myocardial infarction, heart failure, and ischemic stroke events were assessed. Cox regression was used to evaluate hazard ratios of outcomes associated with quartiles of total bilirubin in HIV + and uninfected people after adjusting for multiple risk factors. There were 96 381 participants (30 427 HIV +); mean age was 48 years, 48% were black, and 97% were men. There were 6603 total incident CVD events over a mean of 5.7 years. In adjusted models, increasing quartiles of baseline total bilirubin were associated with decreased hazards of all outcomes (hazard ratio, 0.86; 95% confidence interval, 0.80–0.91). Among HIV + participants, results persisted for heart failure, ischemic stroke, and total CVD, but nonsignificant associations were observed for acute myocardial infarction.Conclusions VACS participants (regardless of HIV status) with elevated bilirubin levels had a lower risk of incident total CVD, acute myocardial infarction, heart failure, and ischemic stroke events after adjusting for known risk factors. Future studies should investigate how this apparently protective effect of elevated bilirubin could be harnessed to reduce CVD risk or improve risk estimation among HIV + individuals.

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“…The VHA, however, offers generous pharmacy benefits 28 and almost all HIV-infected patients receive their antiretroviral agents through the VHA. 50 We did not assess provider types that prescribed the opioid medications. Finally, these findings may not be generalizable to female patients or to patients receiving healthcare in rural settings or outside the VHA.…”

Section: Discussionmentioning

confidence: 99%

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

et al. 2012

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BACKGROUND: Opioids are increasingly prescribed, but there are limited data on opioid receipt by HIV status. OBJECTIVES: To describe patterns of opioid receipt by HIV status and the relationship between HIV status and receiving any, high-dose, and long-term opioids. DESIGN: Cross-sectional analysis of the Veterans Aging Cohort Study. PARTICIPANTS: HIV-infected (HIV+) patients receiving Veterans Health Administration care, and uninfected matched controls. MAIN MEASURES: Pain-related diagnoses were determined using ICD-9 codes. Any opioid receipt was defined as at least one opioid prescription; high-dose was defined as an average daily dose ≥120 mg of morphine equivalents; long-term opioids was defined as ≥90 consecutive days, allowing a 30 day refill gap. Multivariable models were used to assess the relationship between HIV infection and the three outcomes. KEY RESULTS: Among the HIV+ (n = 23,651) and uninfected (n=55,097) patients, 31 % of HIV+ and 28 % of uninfected (p<0.001) received opioids. Among patients receiving opioids, HIV+ patients were more likely to have an acute pain diagnosis (7 % vs. 4 %), but less likely to have a chronic pain diagnosis (53 % vs. 69 %). HIV+ patients received a higher mean daily morphine equivalent dose than uninfected patients (41 mg vs. 37 mg, p=0.001) and were more likely to receive high-dose opioids (6 % vs. 5 %, p<0.001). HIV+ patients received fewer days of opioids than uninfected patients (median 44 vs. 60, p<0.001), and were less likely to receive long-term opioids (31 % vs. 34 %, p< 0.001). In multivariable analysis, HIV+ status was associated with receipt of any opioids (AOR 1.40, 95 % CI 1.35, 1.46) and high-dose opioids (AOR 1.22, 95 % CI 1.07, 1.39), but not long-term opioids (AOR 0.94, 95 % CI 0.88, 1.01). CONCLUSIONS:Patients with HIV infection are more likely to be prescribed opioids than uninfected individuals, and there is a variable association with pain diagnoses. Efforts to standardize approaches to pain management may be warranted in this highly complex and vulnerable patient population.

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Veterans Aging Cohort Study (VACS)

Cited by 299 publications

References 37 publications

Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort

Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort

Bilirubin Is Inversely Associated With Cardiovascular Disease Among HIV‐Positive and HIV‐Negative Individuals in VACS (Veterans Aging Cohort Study)

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

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