Vable Anusha M, Kiang Mathew V, Basu Sanjay, Rudolph Kara E, Kawachi Ichiro, Subramanian S V, Glymour M Maria
Center for Population Health Sciences, Department of Medicine, Stanford University, Palo Alto, CA.
Center for Primary Care and Outcomes Research, Department of Health Research and Policy, Stanford University, Stanford, CA.
Mil Med. 2018 Sep 1;183(9-10):e576-e582. doi: 10.1093/milmed/usx196.
Military service is associated with smoking initiation, but U.S. veterans are also eligible for special social, financial, and healthcare benefits, which are associated with smoking cessation. A key public health question is how these offsetting pathways affect health disparities; we assessed the net effects of military service on later life pulmonary function among Korean War era veterans by childhood socio-economic status (cSES).
Data came from U.S.-born male Korean War era veteran (service: 1950-1954) and non-veteran participants in the observational U.S. Health and Retirement Study who were alive in 2010 (average age = 78). Veterans (N = 203) and non-veterans (N = 195) were exactly matched using coarsened exact matching on birth year, race, coarsened height, birthplace, childhood health, and parental and childhood smoking. Results were evaluated by cSES (defined as maternal education <8 yr/unknown or ≥8 yr), in predicting lung function, as assessed by peak expiratory flow (PEF), measured in 2008 or 2010.
While there was little overall association between veterans and PEF [β = 12.8 L/min; 95% confidence interval (CI): (-12.1, 37.7); p = 0.314; average non-veteran PEF = 379 L/min], low-cSES veterans had higher PEF than similar non-veterans [β = 81.9 L/min; 95% CI: (25.2, 138.5); p = 0.005], resulting in smaller socio-economic disparities among veterans compared to non-veterans [difference in disparities: β = -85.0 L/min; 95% CI: (-147.9, -22.2); p = 0.008].
Korean War era military service appears to disproportionately benefit low-cSES veteran lung functioning, resulting in smaller socio-economic disparities among veterans compared with non-veterans.
服兵役与开始吸烟有关，但美国退伍军人也有资格获得特殊的社会、经济和医疗福利，而这些福利与戒烟有关。一个关键的公共卫生问题是这些相互抵消的途径如何影响健康差异；我们通过童年社会经济地位（cSES）评估了朝鲜战争时期退伍军人服兵役对其晚年肺功能的净影响。
数据来自于出生在美国的朝鲜战争时期男性退伍军人（服役时间：1950 - 1954年）以及参与美国健康与退休研究观察项目的非退伍军人，这些人在2010年时仍然在世（平均年龄 = 78岁）。退伍军人（N = 203）和非退伍军人（N = 195）通过在出生年份、种族、身高粗略值、出生地、童年健康状况以及父母和童年吸烟情况等方面进行精确匹配。结果通过cSES（定义为母亲教育年限<8年/未知或≥8年）进行评估，以预测肺功能，肺功能通过2008年或2010年测量的呼气峰值流量（PEF）来评估。
虽然退伍军人与PEF之间总体关联不大[β = 12.8升/分钟；95%置信区间（CI）：（-12.1，37.7）；p = 0.314；非退伍军人平均PEF = 379升/分钟]，但低cSES退伍军人的PEF高于类似的非退伍军人[β = 81.9升/分钟；95%CI：（25.2，138.5）；p = 0.005]，与非退伍军人相比，退伍军人之间的社会经济差异更小[差异差异：β = -85.0升/分钟；95%CI：（-147.9，-22.2）；p = 0.008]。
朝鲜战争时期的服兵役似乎对低cSES退伍军人的肺功能有不成比例的益处，与非退伍军人相比，退伍军人之间的社会经济差异更小。
