Comparison of Racial and Ethnic Mortality Disparities among Post-9/11 Veterans with and without Traumatic Brain Injury to the Total U.S. Adult Population.

Howard, Jeffrey T; Stewart, Ian J; Walker, Lauren E; Amuan, Megan; Rayha, Kara; Janak, Jud C; Pugh, Mary Jo

Howard, Jeffrey T; Stewart, Ian J; Walker, Lauren E; Amuan, Megan; Rayha, Kara; Janak, Jud C; Pugh, Mary Jo.

Afiliação

Howard JT; Department of Public Health, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA. jeffrey.howard@utsa.edu.
Stewart IJ; Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA.
Walker LE; Military Cardiovascular Outcomes Research Program, Bethesda, MD, USA.
Amuan M; Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA.
Rayha K; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
Janak JC; University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, Utah, USA.
Pugh MJ; United States Department of Veterans Affairs, 550 Foothill Dr, Salt Lake City, Utah, USA.

J Racial Ethn Health Disparities ; 2024 Apr 15.

Article em En | MEDLINE | ID: mdl-38622427

ABSTRACT

ABSTRACT

INTRODUCTION:

The extent of racial/ethnic disparities and whether they are attenuated in the Veteran population compared to the total US population is not well understood. We aimed to assess racial/ethnic mortality disparities from all-cause, cardiovascular (CVD) and cancer among post-9/11 military Veterans with and without exposure to TBI, compared to the total US population.

METHODS:

This cohort study included 2,502,101 US military Veterans (18,932,083 person-years) who served after 09/11/2001 with 3 or more years of care in the Military Health System (MHS); or had 3 or more years of care in the MHS and 2 or more years of care in the Veterans Health Administration. Mortality follow-up occurred from 01/01/2002 to 12/31/2020. Mortality rate ratios (MRR) from negative binomial regression models were reported for racial/ethnic groups compared to White non-Hispanic Veterans for all-cause, CVD and cancer mortality. Veteran MRR were compared to the total US population.

RESULTS:

Mortality rates for Black Non-Hispanic Veterans were higher for all-cause (MRR = 1.21;95%CI 1.13-1.29; p < 0.001), CVD (MRR = 1.78;95%CI 1.62-1.96; p < 0.001) and cancer (MRR = 1.17;95%CI 1.10-1.25; p < 0.001) than in White Non-Hispanic Veterans. Among Veterans with TBI, only Black Non-Hispanics had higher mortality than White Non-Hispanics and only for CVD (MRR = 1.32;95%CI 1.12-1.54; p < 0.001), while CVD mortality was higher among Veterans without TBI (MRR = 1.77;95%CI 1.63-1.93;p < 0.001). MRR for Black Non-Hispanics in the total US population, were consistently higher than those in the Veteran population for all-cause (MRR = 1.52;95%CI 1.46-1.58; p < 0.001), CVD (MRR = 2.03;95%CI 1.95-2.13; p < 0.001) and cancer (MRR = 1.26;95%CI 1.22-1.30; p < 0.001).