Retrospective Analysis of Long Term Outcomes After Combat Injury: A Hidden Cost of War
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 1 Feb 2002 to 1 Feb 2011. Patients were then followed until 18 Jan 2013. Chronic disease outcomes were assessed by ICD-9 codes and causes of death were confirmed by autopsy. From 6,011 admissions, records were excluded due to missing data or if they were for an individual's second admission. Patients with a disease diagnosis of interest prior to the injury date were also excluded, yielding a cohort of 3,846 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, chronic kidney disease.
- Received April 10, 2015.
- Revision received August 25, 2015.
- Accepted August 28, 2015.