Beydoun Hind A, Beydoun May A, Weiss Jordan, Brunner Robert, Mishra Nishant K, Ding Ming, Wactawski-Wende Jean, Gradidge Philippe Jean-Luc, Liu Simin, Tsai Jack
U.S. Department of Veterans Affairs, VA National Center On Homelessness Among Veterans, Washington, DC, USA.
Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
Geroscience. 2025 Jan 29. doi: 10.1007/s11357-025-01527-7.
Arthritis, a chronic inflammatory condition linked to cardiovascular disease (CVD) and bone fracture, is more frequent among military veterans and postmenopausal women. This study examined correlates of arthritis and relationships of arthritis with risks of developing CVD, bone fractures, and mortality among postmenopausal veteran and non-veteran women. We analyzed longitudinal data on 135,790 (3,436 veteran and 132,354 non-veteran) postmenopausal women from the Women's Health Initiative who were followed-up for an average of 16 years between enrollment (1993-1998) and February 17, 2024. Regression and multistate Markov modeling were applied to meet study objectives. The prevalence of arthritis at enrollment (1993-1998) did not differ by veteran status in a fully adjusted logistic model. Variable selection yielded 5 key predictors of prevalent arthritis among veterans and 15 key predictors among non-veterans. In fully-adjusted Cox models, prevalent arthritis was associated with CVD (hazard ratio [HR] = 1.08, 95% confidence interval [CI]: 1.05, 1.10) and all-cause mortality (HR = 1.03, 95% CI: 1.01, 1.05) risks among non-veterans only, but was not associated with bone fracture risk irrespective of veteran status. Transition probabilities between health and CVD and between bone fracture and death were higher among women with vs. without arthritis. The latter transition was more strongly related to arthritis among non-veteran vs. veteran women. In conclusion, among postmenopausal women, prevalent arthritis was associated with greater probabilities of transitioning from a healthy state to CVD and from bone fracture to death, with worse prognosis after bone fracture among those who did not serve in the military.
关节炎是一种与心血管疾病（CVD）和骨折相关的慢性炎症性疾病，在退伍军人和绝经后女性中更为常见。本研究调查了绝经后退伍军人和非退伍军人女性中关节炎的相关因素，以及关节炎与发生CVD、骨折和死亡风险之间的关系。我们分析了来自女性健康倡议组织的135790名绝经后女性（3436名退伍军人和132354名非退伍军人）的纵向数据，这些女性在入组（1993 - 1998年）至2024年2月17日期间平均随访了16年。应用回归分析和多状态马尔可夫模型来实现研究目标。在完全调整的逻辑模型中，入组时（1993 - 1998年）关节炎的患病率在退伍军人和非退伍军人之间没有差异。变量选择得出了退伍军人中5个常见关节炎的关键预测因素和非退伍军人中15个关键预测因素。在完全调整的Cox模型中，仅在非退伍军人中，现患关节炎与CVD风险（风险比[HR] = 1.08，95%置信区间[CI]：1.05，1.10）和全因死亡率（HR = 1.03，95% CI：1.01，1.05）相关，但无论退伍军人身份如何，均与骨折风险无关。患有关节炎的女性从健康状态转变为CVD以及从骨折转变为死亡的概率高于未患关节炎的女性。后一种转变在非退伍军人女性中比在退伍军人女性中与关节炎的关系更强。总之，在绝经后女性中，现患关节炎与从健康状态转变为CVD以及从骨折转变为死亡的更高概率相关，在未服过兵役的女性中骨折后的预后更差。
