Department of Sociology, University of Utah, Salt Lake City, UT, USA.
Department of Sociology, University of Utah, Salt Lake City, UT, USA.
Soc Sci Med. 2020 Nov;265:113380. doi: 10.1016/j.socscimed.2020.113380. Epub 2020 Sep 19.
Populations in the global south are disproportionately exposed to the stressors of development, disaster and armed conflict, all of which heighten cardiovascular disease (CVD) risk. We consider how war-related stressors exert a lasting influence upon population health, in particular the cardiovascular health of war survivors now entering older adulthood. Data come from the 2018 Vietnam Health and Aging Study conducted among 2447 northern Vietnamese adults age 60 and older. We conduct survey-adjusted logistic regression analyses to examine the associations among respondents' wartime exposure to combat and physical threat, malevolent environment conditions, and four CVD conditions (hypertension, dyslipidemia, heart disease, and stroke). We examine posttraumatic stress disorder (PTSD) as it mediates the association between wartime stress exposures and late life CVD, and gender as it moderates the relationship between wartime stressors and CVD. We find that exposure to wartime combat and violence, as well as malevolent living conditions, exhibit significant, positive associations with cardiovascular conditions. These associations are mediated by the severity of recent PTSD symptoms. For certain CVD conditions, particularly hypertension, the associations between wartime stressors and late life cardiovascular conditions diverge across gender with women experiencing a greater penalty for their exposure to war-related stressors than their male counterparts. We conclude that the stressors of war and resultant PTSD, widespread in this cohort of Vietnamese older adults who endured myriad forms of war exposure during their young adulthood, exhibit modest, yet significant associations with late-life cardiovascular conditions. Women, especially those exposed to wartime violence and combat, bear this CVD burden alongside men.
全球南方的人口不成比例地面临发展、灾害和武装冲突的压力，所有这些都增加了心血管疾病（CVD）的风险。我们考虑了与战争相关的压力源如何对人口健康产生持久影响，特别是对现在进入老年的战争幸存者的心血管健康产生影响。数据来自于 2018 年在 2447 名 60 岁及以上的越南北部成年人中进行的越南健康与老龄化研究。我们进行了经过调查调整的逻辑回归分析，以研究受访者在战争期间接触战斗和身体威胁、恶劣环境条件以及四种 CVD 状况（高血压、血脂异常、心脏病和中风）之间的关联。我们研究了创伤后应激障碍（PTSD），因为它在战争压力暴露与晚年 CVD 之间的关联中起中介作用，性别在战争压力源与 CVD 之间的关系中起调节作用。我们发现，接触战争中的战斗和暴力，以及恶劣的生活条件，与心血管状况呈显著正相关。这些关联是由近期 PTSD 症状的严重程度介导的。对于某些 CVD 状况，特别是高血压，战争压力源与晚年心血管状况之间的关联因性别而异，与男性相比，女性因接触与战争相关的压力源而受到更大的惩罚。我们得出结论，战争压力源和由此产生的 PTSD，在这群越南老年人中普遍存在，他们在年轻时期经历了多种形式的战争暴露，与晚年心血管状况存在适度但显著的关联。女性，特别是那些接触过战争暴力和战斗的女性，与男性一样承受着这种 CVD 负担。
