Prospective Analysis of Health and Mortality Risk in Veteran and non-Veteran Participants in the Women’s Health Initiative

Abstract: The health of post-menopausal women Veterans is a neglected area of study. A stronger empirical evidence base is needed, and would inform the provision of health care for the nearly 1 million U.S. women Veterans currently 50 years of age or older. To this end, the present work compares salient health outcomes and risk of all-cause mortality among Veteran and non-Veteran participants of the Women’s Health Initiative (WHI). This study features prospective analysis of long-term health outcomes and mortality risk (average follow-up 8 years) among the 3,706 women Veterans and 141,009 non-Veterans who participated in the WHI Observational Study or Clinical Trials. Outcome measurements included confirmed incident cases of cardiovascular disease (CVD), cancer, diabetes, hip fractures, and all-cause mortality. We identified 17,968 cases of CVD; 19,152 cases of cancer; 18,718 cases of diabetes; 2,817 cases of hip fracture; and 13,747 deaths. In Cox regression models adjusted for age, sociodemographic, and health risk factors, Veteran status was associated with significantly increased risk of all-cause mortality (HR: 1.13; 95% CI: 1.03 – 1.23), but not with risk of CVD (HR: 1.00; CI 95%: 0.90 – 1.11); cancer (HR: 1.04; 95% CI: 0.95 – 1.14); hip fracture (HR: 1.16; 95% CI: 0.94 – 1.43); or diabetes (HR: 1.00; 95% CI: 0.89 – 1.1). Women Veterans’ post-menopausal health, particularly risk for all-cause mortality, warrants further consideration. In particular, efforts to identify and address modifiable risk factors associated with all-cause mortality are needed.