Retrospective Analysis of Long-Term Outcomes after Combat Injury

A Hidden Cost of War

Ian J. Stewart, Jonathan A. Sosnov, Jeffrey T. Howard, Jean A. Orman, Raymond Fang, Benjamin D. Morrow, David H. Zonies, Mary Bollinger, Caroline Tuman, Brett A. Freedman, Kevin K. Chung

Research output: Contribution to journalArticle

Abstract

Background - During the conflicts in Iraq and Afghanistan, 52 087 service members have been wounded in combat. The long-term sequelae of these injuries have not been carefully examined. We sought to determine the relation between markers of injury severity and the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease. Methods and Results - Retrospective cohort study of critically injured US military personnel wounded in Iraq or Afghanistan from February 1, 2002 to February 1, 2011. Patients were then followed until January 18, 2013. Chronic disease outcomes were assessed by International Classification of Diseases, 9th edition codes and causes of death were confirmed by autopsy. From 6011 admissions, records were excluded because of missing data or if they were for an individual's second admission. Patients with a disease diagnosis of interest before the injury date were also excluded, yielding a cohort of 3846 subjects for analysis. After adjustment for other factors, each 5-point increment in the injury severity score was associated with a 6%, 13%, 13%, and 15% increase in incidence rates of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease, respectively. Acute kidney injury was associated with a 66% increase in rates of hypertension and nearly 5-fold increase in rates of chronic kidney disease. Conclusions - In Iraq and Afghanistan veterans, the severity of combat injury was associated with the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease.

Original languageEnglish (US)
Pages (from-to)2126-2133
Number of pages8
JournalCirculation
Volume132
Issue number22
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

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Chronic Renal Insufficiency
Afghanistan
Iraq
Hypertension
Costs and Cost Analysis
Coronary Artery Disease
Diabetes Mellitus
Wounds and Injuries
Injury Severity Score
Military Personnel
International Classification of Diseases
Veterans
Acute Kidney Injury
Cause of Death
Autopsy
Chronic Disease
Cohort Studies
Retrospective Studies
Warfare
Incidence

Keywords

  • coronary disease
  • diabetes mellitus
  • hypertension
  • kidney
  • mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Stewart, I. J., Sosnov, J. A., Howard, J. T., Orman, J. A., Fang, R., Morrow, B. D., ... Chung, K. K. (2015). Retrospective Analysis of Long-Term Outcomes after Combat Injury: A Hidden Cost of War. Circulation, 132(22), 2126-2133. https://doi.org/10.1161/CIRCULATIONAHA.115.016950

Retrospective Analysis of Long-Term Outcomes after Combat Injury : A Hidden Cost of War. / Stewart, Ian J.; Sosnov, Jonathan A.; Howard, Jeffrey T.; Orman, Jean A.; Fang, Raymond; Morrow, Benjamin D.; Zonies, David H.; Bollinger, Mary; Tuman, Caroline; Freedman, Brett A.; Chung, Kevin K.

In: Circulation, Vol. 132, No. 22, 01.12.2015, p. 2126-2133.

Research output: Contribution to journalArticle

Stewart, IJ, Sosnov, JA, Howard, JT, Orman, JA, Fang, R, Morrow, BD, Zonies, DH, Bollinger, M, Tuman, C, Freedman, BA & Chung, KK 2015, 'Retrospective Analysis of Long-Term Outcomes after Combat Injury: A Hidden Cost of War', Circulation, vol. 132, no. 22, pp. 2126-2133. https://doi.org/10.1161/CIRCULATIONAHA.115.016950
Stewart, Ian J. ; Sosnov, Jonathan A. ; Howard, Jeffrey T. ; Orman, Jean A. ; Fang, Raymond ; Morrow, Benjamin D. ; Zonies, David H. ; Bollinger, Mary ; Tuman, Caroline ; Freedman, Brett A. ; Chung, Kevin K. / Retrospective Analysis of Long-Term Outcomes after Combat Injury : A Hidden Cost of War. In: Circulation. 2015 ; Vol. 132, No. 22. pp. 2126-2133.
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