偏头痛退伍军人的频率、人口统计学特征、合并症和医疗保健利用：一项退伍军人事务部全国队列研究。
Frequency, Demographics, Comorbidities, and Health Care Utilization by Veterans With Migraine: A VA Nationwide Cohort Study.
机构信息
From the VA Connecticut Healthcare System (B.T.F., K.W., A.S.G., M.S., J.J.S.), West Haven; Yeshiva University (A.S.G.), Bronx; Albert Einstein College of Medicine (R.B.L.), Bronx; Montefiore Medical Center (R.B.L.), Bronx, NY; Yale School of Medicine (B.T.F., K.W., M.S., J.J.S.), New Haven; Yale School of Public Health (K.W.), New Haven, CT; Bedford VA Medical Center (J.N.); Boston University School of Medicine (J.N.), MA; Richard L. Roudebush VA Medical Center (T.D.), Indianapolis; and Indiana University School of Medicine (T.D.), Indianapolis.
出版信息
Neurology. 2022 Oct 31;99(18):e1979-e1992. doi: 10.1212/WNL.0000000000200888.
BACKGROUND AND OBJECTIVE
To describe the relative frequency, demographics, comorbidities, and health care utilization of veterans who receive migraine care at the Veteran's Health Administration (VHA) and to evaluate differences by gender.
METHODS
This study extracted data from VHA administrative sources. Veterans diagnosed with migraine by a health care provider between fiscal year 2008 and 2019 were included. Demographics and military exposures were extracted at cohort entry. Comorbidities were extracted within 18 months of the first migraine diagnosis. Health care utilization and headache comorbidities were extracted across the study period. Differences between men and women were evaluated using χ tests and Student tests.
RESULTS
More than half a million (n = 567,121) veterans were diagnosed with migraine during the 12-year study period, accounting for 5.3% of the 10.8 million veterans served in the VHA; in the most recent year of the study period (2019), the annual incidence and 1-year period prevalence of medically diagnosed migraine was 2.7% and 13.0% for women and 0.7% and 2.5% for men. In the total cohort diagnosed with migraine, 27.8% were women and 72.2% men. Among those with diagnosed migraine, a higher proportion of men vs women also had a TBI diagnosis (3.9% vs 1.1%; < 0.001). A higher proportion of women vs men reported military sexual trauma (35.5% vs 3.5%; < 0.001). Participants with diagnosed migraine had an average of 1.44 (SD 1.73) annual encounters for headache. Primary care was the most common headache care setting (88.1%); almost one-fifth of veterans with diagnosed migraine sought care in the ED at least once during the study period. Common comorbidities were overweight/obesity (80.3%), nonheadache pain disorders (61.7%), and mental health disorders (48.8%).
DISCUSSION
Migraine is commonly treated in the VHA setting, but likely underascertained. Most people treated for migraine in the VHA are men. Pain comorbidities and psychiatric disorders are common. Future research should identify methods to improve diagnosis and treatment and to reduce use of the emergency department.
背景与目的
描述在退伍军人事务部（VHA）接受偏头痛治疗的退伍军人的相对频率、人口统计学特征、合并症和卫生保健利用情况，并按性别评估差异。
方法
本研究从 VHA 行政来源提取数据。纳入在 2008 财年至 2019 年期间由医疗保健提供者诊断为偏头痛的退伍军人。在队列入组时提取人口统计学和军事暴露情况。在首次偏头痛诊断后 18 个月内提取合并症。在整个研究期间提取卫生保健利用和头痛合并症情况。使用 χ 检验和学生 t 检验评估男女之间的差异。
结果
在 12 年的研究期间，超过 56.7121 万名（n=567121）退伍军人被诊断患有偏头痛，占在 VHA 服役的 1080 万名退伍军人的 5.3%；在研究期间的最近一年（2019 年），女性的年度发病率和 1 年期间患病率为 2.7%和 13.0%，男性为 0.7%和 2.5%。在被诊断患有偏头痛的总队列中，女性占 27.8%，男性占 72.2%。在患有偏头痛诊断的人群中，与女性相比，更多的男性也被诊断为创伤性脑损伤（3.9%比 1.1%；<0.001）。与男性相比，更多的女性报告了军事性创伤（35.5%比 3.5%；<0.001）。被诊断患有偏头痛的参与者平均每年有 1.44 次（SD 1.73）头痛就诊。初级保健是最常见的头痛保健场所（88.1%）；在研究期间，近五分之一的被诊断患有偏头痛的退伍军人至少有一次在急诊室就诊。常见的合并症包括超重/肥胖（80.3%）、非头痛疼痛障碍（61.7%）和精神健康障碍（48.8%）。
讨论
偏头痛在 VHA 环境中常被治疗，但可能被低估了。在 VHA 接受偏头痛治疗的大多数人是男性。疼痛合并症和精神疾病很常见。未来的研究应该确定改善诊断和治疗以及减少急诊使用的方法。
Zotero 插件