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Measuring how military service affects women’s longevity and overall health

Despite the large numbers of women who serve in the military, there is a dearth of information about their postmenopausal health risks and how military service might impact their longevity. Now comes a study of more than 3,700 female veterans, led by a Stanford-affiliated psychologist, which is the first to examine the postmenopausal health of women veterans who participated in the Women’s Health Initiative (WHI) and who, given their ages, likely served in World War II or the Korean War.

The study, which appears online in the journal Women’s Health Issues, shows these women have higher all-cause mortality rates than non-veterans, even though their risks for heart disease, cancer, diabetes and hip fractures were found to be the same.

“The findings underscore the salience of previous military service as a critical factor in understanding women's postmenopausal health and mortality risk, and the value of comparing women veterans to appropriately selected groups of non-veteran women, rather than benchmarking their health against that of the general public. It also reminds us of the importance of including women veterans in research,” said Julie Weitlauf, PhD, the study’s lead author and a clinical associate professor (affiliated) of psychiatry and behavioral sciences at the School of Medicine.

The Women’s Health Initiative is one of the most comprehensive research initiatives undertaken on the post-menopausal health of women, involving more than 160,000 women, including nearly 4,000 veterans.

Women can only serve in the military if they are deemed to be in good health, and military service stresses physical activity and many other elements of a healthy lifestyle, thus contributing to the concept of a “healthy soldier effect,” Weitlauf said. That explains why research typically shows that veterans, including women, have better health and lower mortality risk than non-veterans from the general public, she said. While the women in the study, most of whom who were likely military nurses, were probably very fit and healthy during their time of service, this effect may not be sustained throughout their lifetimes.

Veterans, particularly nurses who served during the earlier wars of this century, could have been exposed to many military occupational hazards, including infectious diseases; environmental exposures, such as second-hand smoke and other toxins; military sexual trauma; and forms of secondary trauma exposure that may result from treating wounded soldiers, as well as exposure to other trauma-related incidents, she said.

“The possibility of a cumulative effect of military and civilian health risk exposures may mean that we might expect to see a different pattern of health decline among older women veterans relative to their non-veteran peers. If so, it’s important to recognize that and factor that into their health care. This study is an important first step in deepening our understanding of postmenopausal health and mortality risk in the oldest groups of women veterans living today. It is our hope that this work will encourage more research attention on this important group of women,” Weitlauf said.

Weitlauf is a clinical psychologist and director of the Women’s Mental Health and Aging Core at the Veterans Affairs Palo Alto Health Care System. The senior author on the paper is Marcia Stefanick, PhD, a professor of medicine at the School of Medicine and a principal investigator in the Women’s Health Initiative.

Previously: Female veterans report poorer health despite access to care

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