Martindale Sarah L, Kolaja Claire A, Belding Jennifer N, Liu Lynne, Rull Rudolph P, Trone Daniel W, Rowland Jared A
Salisbury VA Healthcare System, Salisbury, NC, United States.
Veterans Integrated Service Network (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States.
Front Neurol. 2025 Jul 31;16:1599351. doi: 10.3389/fneur.2025.1599351. eCollection 2025.
The effects of blast overpressure (BOP) on brain health are increasingly recognized, yet longitudinal research into these effects after separation from military service remains limited. This study assessed the association between high-level blast (HLB) and low-level blast (LLB) exposure during military service using data from the Millennium Cohort Study (MCS) and diagnoses related to traumatic brain injury (TBI) diagnosed in the Veterans Health Administration (VHA).
MCS participants were included in the analytic sample if they responded to the 2013 survey, were separated from military service, and utilized VHA care for at least 2 years. HLB exposure was assessed using self-report of injury from a "blast/explosion/bullet" in the 2013 survey; LLB risk was determined using military occupational specialty as a proxy. Clinical diagnoses of five TBI severity levels (e.g., mild, penetrating), 22 TBI-related conditions (e.g., tinnitus, dementia/delirium, fatigue) and 10 mental health conditions (e.g., adjustment, bipolar, schizophrenia) were identified using ICD diagnosis codes. Modified Poisson regression with robust error variance was used to examine the relationships between HLB, LLB, and their interaction, adjusting for demographic and military characteristics for each diagnosis of interest.
Statistically significant associations were found between HLB and several TBI diagnoses, TBI-related conditions, and mental health conditions. LLB exposure was associated with only one TBI condition, eight TBI-related conditions, and two mental health conditions. In addition, significant interactions between HLB and LLB were observed for two TBI-related conditions and four mental health conditions.
This study contributes to the growing body of evidence on the long-term effects of BOP on brain health. These findings may inform policy development and educational resources, provide metrics to calculate the potential financial burden on the VHA and increase understanding of long-term health outcomes associated with blast exposure. By utilizing a prospective design and examining VHA diagnoses, the research highlights the potential enduring effects of blast exposure that may continue to require healthcare services after military separation.
爆炸超压（BOP）对大脑健康的影响日益受到认可，但对退伍后这些影响的纵向研究仍然有限。本研究利用千禧队列研究（MCS）的数据以及退伍军人健康管理局（VHA）诊断的与创伤性脑损伤（TBI）相关的诊断，评估了服役期间高水平爆炸（HLB）和低水平爆炸（LLB）暴露之间的关联。
如果MCS参与者对2013年调查做出了回应、已退伍且使用VHA医疗服务至少2年，则将其纳入分析样本。HLB暴露通过2013年调查中“爆炸/爆炸物/子弹”导致的伤害自我报告进行评估；LLB风险以军事职业专长作为替代指标来确定。使用国际疾病分类（ICD）诊断代码确定了五个TBI严重程度级别（如轻度、穿透性）、22种与TBI相关的病症（如耳鸣、痴呆/谵妄、疲劳）和10种心理健康状况（如适应障碍、双相情感障碍、精神分裂症）的临床诊断。采用具有稳健误差方差的修正泊松回归来检验HLB、LLB及其相互作用之间的关系，并针对每个感兴趣的诊断对人口统计学和军事特征进行调整。
在HLB与几种TBI诊断、与TBI相关的病症以及心理健康状况之间发现了具有统计学意义的关联。LLB暴露仅与一种TBI病症、八种与TBI相关的病症以及两种心理健康状况相关。此外，在两种与TBI相关的病症和四种心理健康状况中观察到HLB和LLB之间存在显著的相互作用。
本研究为关于BOP对大脑健康长期影响的越来越多的证据做出了贡献。这些发现可能为政策制定和教育资源提供信息，可以提供衡量指标以计算VHA的潜在财务负担，并增进对与爆炸暴露相关的长期健康结果的理解。通过采用前瞻性设计并检查VHA诊断，该研究突出了爆炸暴露可能产生的潜在持久影响，这些影响在退伍后可能继续需要医疗服务。
