Objectives associated with aging-related health PTSD affects 1 in - PDF document

9/24/18 Increased Risk for Cardiovascular The views expressed in this presentation are those of Disease Among Postmenopausal the authors and do not necessarily reflect the position Women with Diabetes and Comorbid or policy of the Department of Veterans Affairs or the United States government. Posttraumatic Stress Disorder Carolyn Gibson, PhD, MPH San Francisco VA Health Care System No conflicts of interest to report. and University of California, San Francisco NAMS Annual Meeting, October 5, 2018 PTSD is common, often chronic, and Objectives associated with aging-related health • PTSD affects 1 in 10 women 1) Examine independent associations between PTSD, diabetes, and incident CVD. • PTSD associated with aging-related health, including diabetes, cardiovascular disease 2) Examine additive associations between comorbid PTSD and diabetes and incident CVD. • Diabetes comorbid with depression is more strongly linked to CVD morbidity, mortality than either alone. Similar pattern with PTSD? 1

9/24/18 Study design Statistical Analyses • Retrospective cohort study PTSD Incident • National VA medical record data for women CVD Veterans aged 55 and older diabetes • 1+ VA encounter during baseline (2008-2011) 2008-2011 2012-2015 and follow-up (2012-2015) Fine-Gray proportional hazards models adjusted for age, education, income, hypertension, hyperlipidemia, obesity Statistical Analyses Statistical Analyses PTSD PTSD Incident Incident CVD CVD diabetes diabetes 2008-2011 2012-2015 2008-2011 2012-2015 Fine-Gray proportional hazards models adjusted for age, Fine-Gray proportional hazards models adjusted for age, education, income, hypertension, hyperlipidemia, obesity education, income, hypertension, hyperlipidemia, obesity 2

9/24/18 Sample characteristics Sample characteristics 20 N=150,791 17% 18 Age (mean, SD) 62.64 (8.0) 16 >25% college-educated 42% 14 12% Median income tertile 12 9% Low 31% 10 Middle 31% 8 High 33% 6 Hypertension 44% 4 2% Hyperlipidemia 44% 2 0 Obesity 24% PTS D Diabetes PTS D + Di abetes CVD PTSD Diabetes PTSD + Diabetes Incident CVD 2008-2011 2012-2015 PTSD and diabetes are associated Two-fold risk for incident CVD with with incident CVD comorbid PTSD and diabetes PTSD PTSD 1.47 (1.38-1.57) 1.47 (1.38-1.57) Diabetes Diabetes 1.49 (1.44-1.55) 1.49 (1.44-1.55) PTSD + Diabetes 1.96 (1.80-2.12) 1 1.5 2.0 2.5 1 1.5 2.0 2.5 HR (95% CI) HR (95% CI) Risk for incident CVD, adjusted for age, education, income, Risk for incident CVD, adjusted for age, education, income, hypertension, hyperlipidemia, obesity hypertension, hyperlipidemia, obesity 3

9/24/18 Strengths and Limitations Conclusions • Veteran VA users may not be generalizable to • PTSD is an underrecognized risk factor for CVD non-VA users, civilians and aging-related health in older women • ICD-9 codes: Diagnoses may be • PTSD may augment diabetes-related CVD risk underrepresented; validity, chronicity, severity, and some temporal relationships unknown • Clinicians need to recognize prevalence and impact of PTSD among older women in chronic • Information about PTSD treatment unknown disease prevention and management Thank you! Yixia Li, MPH Sabra Inslicht, PhD Karen Seal, MD, MPH Amy Byers, PhD, MPH Research supported in part by the VA Advanced Fellowship Program in Women's Health at the San Francisco VA Health Care System and VA HSR&D CDA 17-018 (CJG). 4