Prevalent Atherosclerotic Cardiovascular Disease Among Veterans by Sexual Orientation
Background Seven million lesbian, gay, and bisexual (LGB) adults will be aged >50 years by 2030; assessing and addressing their risk for cardiovascular disease is critical. Methods and Results We analyzed a nationwide cohort using the Veterans Health Administration data. Sexual orientation (SO) w...
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| Format: | Article |
| Language: | English |
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Wiley
2024-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.036898 |
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| author | Carl G. Streed Meredith S. Duncan Kory R. Heier T. Elizabeth Workman Lauren B. Beach Billy A. Caceres John R. O'Leary Melissa Skanderson Joseph L. Goulet |
| author_facet | Carl G. Streed Meredith S. Duncan Kory R. Heier T. Elizabeth Workman Lauren B. Beach Billy A. Caceres John R. O'Leary Melissa Skanderson Joseph L. Goulet |
| author_sort | Carl G. Streed |
| collection | DOAJ |
| description | Background Seven million lesbian, gay, and bisexual (LGB) adults will be aged >50 years by 2030; assessing and addressing their risk for cardiovascular disease is critical. Methods and Results We analyzed a nationwide cohort using the Veterans Health Administration data. Sexual orientation (SO) was classified via a validated natural language processing algorithm. Prevalent atherosclerotic cardiovascular disease (ASCVD) (history of acute myocardial infarction, ischemic stroke, or revascularization) was identified via International Classification of Diseases, Ninth and Tenth Revision (ICD‐9 and ICD‐10) codes. The index date was the date of the first primary care appointment on or after October 1, 2009. We ascertained covariates and prevalent ASCVD in the year following the index date; the baseline date was 1 year after the index date. We calculated sample statistics by sex and SO and used logistic regression analyses to assess associations between SO and prevalent ASCVD. Of 1 102 193 veterans with natural language processing‐defined SO data, 170 861 were classified as LGB. Prevalent ASCVD was present among 25 031 (4105 LGB). Adjusting for age, sex, race, and Hispanic ethnicity, LGB veterans had 1.24 [1.19–1.28] greater odds of prevalent ASCVD versus non‐LGB identified veterans. This association remained significant upon additional adjustment for the ASCVD risk factors substance use, anxiety, and depression (odds ratio [OR],1.17 [95% CI, 1.13–1.21]). Among a subset with self‐reported SO, findings were consistent (OR, 1.53 [95% CI, 1.20–1.95]). Conclusions This is one of the first studies to examine cardiovascular risk factors and disease of the veteran population stratified by natural language processing‐defined SO. Future research must explore psychological, behavioral, and physiological mechanisms that result in poorer cardiovascular health among LGB veterans. |
| format | Article |
| id | doaj-art-05ba33faa98b48dbb97d2c3a5f268d49 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-05ba33faa98b48dbb97d2c3a5f268d492024-11-19T12:31:39ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-11-01132210.1161/JAHA.124.036898Prevalent Atherosclerotic Cardiovascular Disease Among Veterans by Sexual OrientationCarl G. Streed0Meredith S. Duncan1Kory R. Heier2T. Elizabeth Workman3Lauren B. Beach4Billy A. Caceres5John R. O'Leary6Melissa Skanderson7Joseph L. Goulet8Department of Medicine, Section of General Internal Medicine Boston University Chobanian and Avedisian School of Medicine Boston MA USADepartment of Biostatistics University of Kentucky Lexington KY USADepartment of Biostatistics University of Kentucky Lexington KY USABiomedical Informatics Center George Washington University Washington DC USADepartment of Medical Social Sciences Feinberg School of Medicine, Northwestern University Chicago IL USASchool of Nursing Columbia University Irving Medical Center New York NY USADepartment of Internal Medicine Yale School of Medicine New Haven CT USADepartment of Internal Medicine Yale School of Medicine New Haven CT USAVeterans Affairs Connecticut Healthcare System West Haven CT USABackground Seven million lesbian, gay, and bisexual (LGB) adults will be aged >50 years by 2030; assessing and addressing their risk for cardiovascular disease is critical. Methods and Results We analyzed a nationwide cohort using the Veterans Health Administration data. Sexual orientation (SO) was classified via a validated natural language processing algorithm. Prevalent atherosclerotic cardiovascular disease (ASCVD) (history of acute myocardial infarction, ischemic stroke, or revascularization) was identified via International Classification of Diseases, Ninth and Tenth Revision (ICD‐9 and ICD‐10) codes. The index date was the date of the first primary care appointment on or after October 1, 2009. We ascertained covariates and prevalent ASCVD in the year following the index date; the baseline date was 1 year after the index date. We calculated sample statistics by sex and SO and used logistic regression analyses to assess associations between SO and prevalent ASCVD. Of 1 102 193 veterans with natural language processing‐defined SO data, 170 861 were classified as LGB. Prevalent ASCVD was present among 25 031 (4105 LGB). Adjusting for age, sex, race, and Hispanic ethnicity, LGB veterans had 1.24 [1.19–1.28] greater odds of prevalent ASCVD versus non‐LGB identified veterans. This association remained significant upon additional adjustment for the ASCVD risk factors substance use, anxiety, and depression (odds ratio [OR],1.17 [95% CI, 1.13–1.21]). Among a subset with self‐reported SO, findings were consistent (OR, 1.53 [95% CI, 1.20–1.95]). Conclusions This is one of the first studies to examine cardiovascular risk factors and disease of the veteran population stratified by natural language processing‐defined SO. Future research must explore psychological, behavioral, and physiological mechanisms that result in poorer cardiovascular health among LGB veterans.https://www.ahajournals.org/doi/10.1161/JAHA.124.036898bisexualcardiovasculargayheart attacklesbiansexual minority |
| spellingShingle | Carl G. Streed Meredith S. Duncan Kory R. Heier T. Elizabeth Workman Lauren B. Beach Billy A. Caceres John R. O'Leary Melissa Skanderson Joseph L. Goulet Prevalent Atherosclerotic Cardiovascular Disease Among Veterans by Sexual Orientation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease bisexual cardiovascular gay heart attack lesbian sexual minority |
| title | Prevalent Atherosclerotic Cardiovascular Disease Among Veterans by Sexual Orientation |
| title_full | Prevalent Atherosclerotic Cardiovascular Disease Among Veterans by Sexual Orientation |
| title_fullStr | Prevalent Atherosclerotic Cardiovascular Disease Among Veterans by Sexual Orientation |
| title_full_unstemmed | Prevalent Atherosclerotic Cardiovascular Disease Among Veterans by Sexual Orientation |
| title_short | Prevalent Atherosclerotic Cardiovascular Disease Among Veterans by Sexual Orientation |
| title_sort | prevalent atherosclerotic cardiovascular disease among veterans by sexual orientation |
| topic | bisexual cardiovascular gay heart attack lesbian sexual minority |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.036898 |
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