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退伍军人心血管健康的性别差异。

Sex Differences in Veterans' Cardiovascular Health.

机构信息

Department of Veterans Affairs, Central Office, Washington, District of Columbia.

Durham VA and Duke University School of Medicine, Durham, North Carolina.

出版信息

J Womens Health (Larchmt). 2019 Oct;28(10):1418-1427. doi: 10.1089/jwh.2018.7228. Epub 2019 Mar 6.

Abstract

In the U.S. civilian population, sex differences have been identified in cardiovascular health; these differences have been used to inform care. Our objective is to determine if the same sex differences are present in Veterans who use the Department of Veterans Affairs (VA) Health Care System given the additional stressors associated with military service. Cardiovascular disease (CVD) risk factors and conditions among women and men Veterans using VA in fiscal year (FY) 2014 were identified through the presence of International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes in VA administrative records. ICD-9-CM codes were grouped into conditions; prevalence was examined by gender overall, by age, and by race/ethnicity. Within the FY 2014 cohort of VA Veteran patients included in this analysis, 7.1% ( = 412,901) were women and 92.9% were men ( = 5,376,749). Compared with men, women in this cohort were younger and more ethnically diverse. Overall, women were less likely to have traditional CVD risk factors, but more likely to have a nontraditional CVD risk factor (depression) compared with men. Women had higher odds of chest pain/angina (adjusted odds ratio [AOR] 1.03, confidence interval [95% CI] 1.02-1.05), palpitations (AOR 2.04; 95% CI 1.98-2.10), and valvular disease (AOR 1.05; 95% CI 1.02-1.08), but lower odds of coronary artery disease (AOR 0.29; 95% CI 0.29-0.30), acute MI (AOR 0.46; 95% CI 0.43-0.49), and heart failure (AOR 0.55; 95% CI 0.53-0.56) compared with men, overall. In age-adjusted comparisons, sex differences in the prevalence of CVD risk factors and conditions among the VA Veteran patient population was similar in that seen in the civilian population with a few exceptions.

摘要

在美国的平民人口中,心血管健康存在性别差异;这些差异已被用于指导护理。我们的目标是确定在使用退伍军人事务部(VA)医疗保健系统的退伍军人中是否存在相同的性别差异,因为与兵役相关的额外压力。在 2014 财年(FY)中,通过 VA 行政记录中的国际疾病分类,第九修订版,临床修正(ICD-9-CM)代码,确定了使用 VA 的女性和男性退伍军人的心血管疾病(CVD)风险因素和状况。ICD-9-CM 代码分为疾病;按性别、年龄和种族/族裔总体检查患病率。在这项分析中包括的 FY 2014 年 VA 退伍军人患者队列中,7.1%( = 412,901)为女性,92.9%( = 5,376,749)为男性。与男性相比,该队列中的女性更年轻,种族更加多样化。总体而言,与男性相比,女性患传统 CVD 风险因素的可能性较小,但更有可能患有非传统 CVD 风险因素(抑郁)。与男性相比,女性胸痛/心绞痛(调整后的优势比[OR] 1.03,95%置信区间[95%CI] 1.02-1.05)、心悸(OR 2.04;95%CI 1.98-2.10)和瓣膜病(OR 1.05;95%CI 1.02-1.08)的几率更高,但患冠心病(OR 0.29;95%CI 0.29-0.30)、急性心肌梗死(OR 0.46;95%CI 0.43-0.49)和心力衰竭(OR 0.55;95%CI 0.53-0.56)的几率更低,总体而言。在年龄调整比较中,退伍军人事务部退伍军人患者人群中 CVD 风险因素和状况的性别差异与平民人群中的性别差异相似,但也存在一些例外。

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