Brooke Army Medical Center, JBSA Ft. Sam Houston, TX 78219, USA.
Army Medical Center of Excellence, JBSA-Fort Sam Houston, TX 78234, USA.
Mil Med. 2024 May 18;189(5-6):1210-1215. doi: 10.1093/milmed/usad300.
Preeclampsia (PE), a hypertensive-inflammatory disorder of pregnancy, poses acute risks of seizures, stroke, and heart attack during pregnancy and up to 6 weeks post-delivery. Recent data suggest that residual increased risks for cardiovascular disease (CVD) linger for much longer, possibly decades, after PE pregnancies. In civilian studies, PE and the major vascular events resulting from it disproportionately affect women from minority groups, especially African American women. The Military Health System (MHS) provides equal access to care for all active-duty servicewomen (ADSW), thus theoretically mitigating disparities. Racial/ethnic breakdown for PE and post PE CVD has not been studied in the MHS.
We identified healthy pregnancies in the MHS electronic health records of ADSW in the years 2009/2010 and those with a PE diagnosis. Patients with preexisting conditions of PE or CVD based on a look-back period of two calendar years were excluded. Cases were matched to controls based on age at pregnancy within 5 years and race/ethnicity. Cohort was assessed for diagnosed CVDs, race, age, and service during 2011-2017. Time to first CVD event was assessed with Cox proportional hazards model, results reported as relative risks (95% CI). All variables were summarized using mean (SD) for normally distributed continuous variables; non-normal continuous variables were characterized by median [IQR] and categorical variables were summarized by counts and frequencies. All statistical testings were two-sided with a significance level of 5% and were completed using SAS-EG version 9.2 or R version 3.5.2.
From an analysis of 106,808 inpatient ADSW records, PE incidence by race is 11.8% for White, 12% for African American, 11.4% for Asian/Pacific Islander, 11.2% for Native American, 9.5% for Other, and 7.6% for unknown (not documented) race. Thus, in the US Military, African American women have comparable (0.2% higher) PE rate than White women in contrast with civilian studies that often report much higher incidence in the African American population. Using Asians as referent group, PE increases the risk of CVD. White women have a hazard ratio (HR) of 1.47 95%CI (1.15-1.88), African Americans a HR of 1.51 95% CI (1.18-1.93), and Other a HR of 1.39 95% CI (1.01-1.91).
In this study, we report overall higher incidence of PE in military women than what is published for civilian women in all races and across all services. Importantly, we do not find significantly higher numbers of PE and post-PE CVD for African American, compared to White women in the military. Our study is not designed to address differences between military and civilian PE epidemiology, but these results deserve further exploration. This study shines light on a health risk unique to women, which we found to be more prevalent in the US Military than published civilian population. Further study to determine the details of long-term morbidity, disability, and death attributable to PE (CVD, stroke, and kidney diseases) are needed to design optimal medical management protocols, ensure readiness for duty, and protect our Women Warfighters.
子痫前期（PE）是一种妊娠高血压炎症性疾病，在怀孕期间以及产后 6 周内存在癫痫发作、中风和心脏病发作的急性风险。最近的数据表明，心血管疾病（CVD）的残余风险可能会持续更长时间，甚至可能在 PE 妊娠后数十年。在平民研究中，PE 以及由此产生的主要血管事件不成比例地影响少数族裔群体的女性，尤其是非裔美国女性。军事医疗系统（MHS）为所有现役女兵（ADSW）提供平等的医疗服务，因此理论上可以减轻差异。MHS 中尚未对 PE 和产后 CVD 的种族/族裔进行研究。
我们在 2009/2010 年 MHS ADSW 的电子健康记录中确定了健康妊娠，并在该记录中确定了患有 PE 的患者。排除了基于前两年回顾期患有 PE 或 CVD 预先存在疾病的患者。基于年龄在 5 年内相匹配的病例与对照，并根据种族/族裔进行匹配。队列在 2011-2017 年期间评估了诊断为 CVD、种族、年龄和服务情况。使用 Cox 比例风险模型评估首次 CVD 事件的时间，结果以相对风险（95%CI）报告。所有变量均采用正态分布连续变量的平均值（SD）进行总结；非正态连续变量采用中位数[IQR]表示，分类变量采用计数和频率进行总结。所有统计检验均为双侧，显著性水平为 5%，使用 SAS-EG 版本 9.2 或 R 版本 3.5.2 完成。
从对 106808 名住院 ADSW 记录的分析中，白人的 PE 发病率为 11.8%，非裔美国人的发病率为 12%，亚洲/太平洋岛民的发病率为 11.4%，美洲原住民的发病率为 11.2%，其他族裔的发病率为 9.5%，未知（未记录）的发病率为 7.6%。因此，在美国军队中，非裔美国女性的 PE 发生率比白人女性高（高 0.2%），这与平民研究中经常报告的非裔美国人发病率高形成鲜明对比。以亚洲人为参考组，PE 会增加 CVD 的风险。白人女性的危险比（HR）为 1.47（95%CI，1.15-1.88），非裔美国人的 HR 为 1.51（95%CI，1.18-1.93），其他种族的 HR 为 1.39（95%CI，1.01-1.91）。
在这项研究中，我们报告了在所有种族和所有军种中，军事女性的 PE 发病率总体高于平民女性。重要的是，我们没有发现军事中非裔美国女性的 PE 和产后 CVD 比白人女性明显更高。我们的研究并非旨在解决军事和民用 PE 流行病学之间的差异，但这些结果值得进一步探讨。这项研究揭示了一个独特的女性健康风险，我们发现该风险在美军中比已发表的平民人群更为普遍。需要进一步研究以确定 PE（CVD、中风和肾脏疾病）的长期发病率、残疾和死亡率的详细信息，以便设计最佳的医疗管理方案，确保履行职责，并保护我们的女兵。
