Cardiovascular disease, bone fracture, and all-cause mortality risks among postmenopausal women by arthritis and veteran status: A multistate Markov transition analysis

作     者：Beydoun, Hind A. Beydoun, May A. Weiss, Jordan Brunner, Robert Mishra, Nishant K. Ding, Ming Wactawski-Wende, Jean Gradidge, Philippe Jean-Luc Liu, Simin Tsai, Jack 

作者机构：VA Natl Ctr Homelessness Vet US Dept Vet Affairs Washington DC USA Univ Texas Hlth Sci Ctr Houston Sch Publ Hlth Dept Management Policy & Community Hlth Houston TX USA Natl Inst Aging Intramural Res Program Lab Epidemiol & Populat Sci Baltimore MD USA NYU Optimal Aging Inst Grossman Sch Med New York NY USA NYU Dept Med Div Precis Med Grossman Sch Med New York NY USA Univ Nevada Reno Sch Med Dept Family & Community Med Emeritus Reno NV USA Yale Univ Sch Med Dept Neurol New Haven CT USA West Haven VA Med Ctr Dept Neurol West Haven CT USA Univ North Carolina Chapel Hill Sch Med Dept Emergency Med Chapel Hill NC USA Univ Buffalo Dept Epidemiol & Environm Hlth Buffalo NY USA Univ Witwatersrand Fac Hlth Sci Sch Therapeut Sci Dept Exercise Sci & Sports Med Johannesburg South Africa Univ Calif Irvine Joe Wen Sch Populat & Publ Hlth Dept Epidemiol & Biostat Irvine CA USA Yale Sch Med Dept Psychiat New Haven CT USA 

出 版 物：《GEROSCIENCE》 (GeroScience)

年 卷 期：2025年第47卷第3期

页      面：4169-4186页

核心收录：

基　　金：Intramural Research Program of the National Institute on Aging in Baltimore  Maryland 

主　　题：Arthritis Bone fracture Cardiovascular disease Menopause Multistate Veteran 

摘      要：Arthritis, a chronic inflammatory condition linked to cardiovascular disease (CVD) and bone fracture, is more frequent among military veterans and postmenopausal women. This study examined correlates of arthritis and relationships of arthritis with risks of developing CVD, bone fractures, and mortality among postmenopausal veteran and non-veteran women. We analyzed longitudinal data on 135,790 (3,436 veteran and 132,354 non-veteran) postmenopausal women from the Women s Health Initiative who were followed-up for an average of 16 years between enrollment (1993-1998) and February 17, 2024. Regression and multistate Markov modeling were applied to meet study objectives. The prevalence of arthritis at enrollment (1993-1998) did not differ by veteran status in a fully adjusted logistic model. Variable selection yielded 5 key predictors of prevalent arthritis among veterans and 15 key predictors among non-veterans. In fully-adjusted Cox models, prevalent arthritis was associated with CVD (hazard ratio [HR] = 1.08, 95% confidence interval [CI]: 1.05, 1.10) and all-cause mortality (HR = 1.03, 95% CI: 1.01, 1.05) risks among non-veterans only, but was not associated with bone fracture risk irrespective of veteran status. Transition probabilities between health and CVD and between bone fracture and death were higher among women with vs. without arthritis. The latter transition was more strongly related to arthritis among non-veteran vs. veteran women. In conclusion, among postmenopausal women, prevalent arthritis was associated with greater probabilities of transitioning from a healthy state to CVD and from bone fracture to death, with worse prognosis after bone fracture among those who did not serve in the military.