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. 2019 Nov-Dec;29(6):471-479.
doi: 10.1016/j.whi.2019.08.002. Epub 2019 Sep 10.

Four Decades after War: Incident Diabetes among Women Vietnam-Era Veterans in the HealthViEWS Study

Eric M Schmidt  1 , Kathryn Magruder  2 , Amy M Kilbourne  3 , Eileen M Stock  4 , Yasmin Cypel  5 , Suad El Burai Félix  4 , Tracey Serpi  4 , Rachel Kimerling  6 , Beth Cohen  7 , Avron Spiro  8 , Joan Furey  9 , Grant D Huang  10 , Susan M Frayne  11
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Four Decades after War: Incident Diabetes among Women Vietnam-Era Veterans in the HealthViEWS Study

Eric M Schmidt et al. Womens Health Issues. 2019 Nov-Dec.

Abstract

Objectives: We analyzed long-term differences in incident diabetes associated with military service in a warzone among women who served during the Vietnam War era.

Methods: For HealthViEWS, the largest later-life study of women Vietnam War-era U.S. veterans, a population-based retrospective cohort who served during 1965-1973 completed a health interview in 2011-2012. This cohort included women deployed to Vietnam, near Vietnam, or who served primarily in the United States. We hypothesized a warzone exposure gradient: Vietnam (highest exposure), near Vietnam, and the United States (lowest exposure). We used an extended Cox regression to test for differences in incident diabetes by location of wartime service.

Results: Of 4,503 women in the analysis, 17.7% developed diabetes. Adjusting for demographics and military service characteristics, hazard of incident diabetes was significantly lower initially in the Vietnam group compared with the U.S. group (hazard ratio, 0.33; 95% confidence interval, 0.15-0.69). However, lower diabetes hazard in the Vietnam group was not constant over time; rather, hazard accumulated faster over time in the Vietnam group compared with the U.S. group (hazard ratio, 1.38; 95% confidence interval, 1.11-1.72). No significant difference in diabetes hazard was found between the near Vietnam and U.S. groups. Older age during military service, minority race/ethnicity, and lower military rank were associated with a higher diabetes hazard.

Conclusions: Women deployed to a warzone might have protective health factors that lower risk for diabetes early in their military career, but delivery systems for long-term health should consider that a lower risk for chronic diseases like diabetes can wane quickly in the decades that follow warzone service.

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