The impact of Purple Heart commendation and PTSD on mortality rates in older veterans

✍ Scribed by Tim Kimbrell; Jeffrey M. Pyne; Mark E. Kunik; Kathy M. Magruder; Nancy J. Petersen; Hong-Jen Yu; Teresa J. Hudson; Paul E. Schulz; Salah U. Qureshi

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: English
• Weight: 105 KB
• Volume: 28
• Category: Article
• ISSN: 1091-4269
• DOI: 10.1002/da.20850

✦ Synopsis

Background:

To determine whether having received a purple heart (ph) or having been diagnosed with posttraumatic stress disorder (ptsd) affected mortality in older veterans.

Methods:

We compared mortality rates of older veterans with a ph but without ptsd (ph+/ptsd-) to veterans with a ph and ptsd (ph+/ptsd+), veterans without a ph but with ptsd (ph-/ptsd+), and a comparison group without a ph or ptsd (ph-/ptsd-). administrative data from the veterans integrated service network 16 were collected between 10/01/97 and 09/30/99 for veterans who were 65 years or older. proportional hazards regression was used to compare the survival times for the four groups (n = 10,255) from entry into the study until death or study termination (9/30/2008). the charleson co-morbidity index was used to control for potential co-morbid illness burden differences between the groups.

Results:

Older veterans with a ph (ph+/ptsd- and ph+/ptsd+) had significantly lower mortality rates than ph-/ptsd- veterans (hazard ratio [hr] = 0.6, 95% confidence interval [ci] 0.5 to 0.6, p<.0001; and hr = 0.5, 95% ci 0.4 to 0.7, p<.0001). the ph-/ptsd+ group had a higher mortality rate than the ph-/ptsd- group (hr = 1.1, 95% ci 1.0 to 1.2, p<.01).

Conclusions:

Veterans who had ph citations and survived into their seventh decade had half the mortality rate of veterans without ph citations with or without ptsd. veterans with ptsd but without a ph had a significantly higher mortality rate compared to (ph-/ptsd-). veterans who suffer combat injury without developing ptsd may provide a useful study population for determining the factors that confer resilience.