Examining the geographic distribution of six chronic disease risk factors for severe COVID-19: Veteran-nonveteran differences.

Michelle Mcdaniel,Justin T Mcdaniel

doi:10.1177/17423953211028280

Abstract

ObjectivesWe aimed to better understand where the prevalence of risk factors for severe COVID-19 occur, especially among veterans and nonveterans – populations that are given the opportunity to seek healthcare from separate entities.MethodsIn this cross-sectional study, we use data from the SMART Behavioral Risk Factor Surveillance System to estimate the prevalence (i.e., survey-weighted %) of six risk factors for severe COVID-19 (i.e., chronic obstructive pulmonary disorder [COPD], asthma, diabetes, obesity, cardiovascular disease, and kidney disease) for veterans and nonveterans at the national level, in 155 metropolitan/micropolitan statistical areas, and in Veteran Integrated Service Networks (veterans only). We examine differences in these outcomes among veterans and between geographic areas using chi-square analysis or multivariable logistic regression.ResultsIn the national aggregate, veterans exhibited higher prevalence rates of COPD, diabetes, cardiovascular disease, and kidney disease than nonveterans, but not asthma and obesity. However, we show significant variation in the prevalence of risk factors for severe COVID-19 among veterans by geographic location.DiscussionThis study provides a dataset that can be used by healthcare providers in order to prioritize prevention programming for veterans who may be at higher risk for COVID-19 due to their increased risk for certain chronic diseases.

Highlights

Severe acute respiratory syndrome virus 2 (SARS-CoV-2 or COVID-19) is a respiratory tract infection which presents mild symptoms for most
We obtained data from the 2015–2017 Selected Metropolitan/Micropolitan Area Risk Trends (SMART) Behavioral Risk Factor Surveillance System (BRFSS) datasets, which provides information on individual-level health behaviors and chronic diseases (e.g., COPD, asthma, diabetes, obesity, cardiovascular disease, and kidney disease) for participants in metropolitan or micropolitan areas (MMSAs) with BRFSS samples !500.18 Participants of the BRFSS are noninstitutionalized adults aged > 17 years
After adjusting for confounding variables – including age, race, sex, and geographic location – results of multivariable logistic regression models (Table 2), in which the six risk factors for severe COVID-19 served as dependent variables in separate models, showed that veterans were at greater risk for only COPD, diabetes, Cardiovascular disease (CVD), and kidney disease (p < 0.001)

Summary

Introduction

Severe acute respiratory syndrome virus 2 (SARS-CoV-2 or COVID-19) is a respiratory tract infection which presents mild symptoms for most. For about 14% of those infected, the disease is severe and may require breathing support and time spent in an intensive care unit.[1] A SARS-CoV-2 outbreak became pandemic on March 11, 2020.2 As of April 28, 2021, there were 3,19,24,610 confirmed cases and 569,771 confirmed deaths due to COVID19 in the United States.[3,4] The COVID-19 case fatality rate (i.e., deaths among persons with the virus) is 6.48% among military veterans[5] and 3.07% in the general public in the United States.[6] The COVID19 pandemic has placed significant stress on hospitals and clinics,[7] as well as created the need to better prioritize and implement prevention messaging to the public.[8]. Studies have shown that persons who have served in the United States military are more likely to report one of these underlying conditions than individuals without military experience.[11,12,13,14] Military veterans are more likely to exhibit one of these underlying conditions because combat experience causes severe mental distress, such as posttraumatic stress disorder (PTSD) and depression, leading to certain unhealthy behaviors that might explain increased prevalence of chronic disease.[11,12,14] For example, in a study by Albright et al, while 25% of veterans who did not smoke cigarettes felt depressed, 36% of veterans who did smoke cigarettes felt depressed.[15]

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