American journal of epidemiology
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Expert opinion is divided about whether US military veterans, the vast majority of whom are middle-aged or older, are at increased risk of suicide. To assess the risk of suicide associated with veteran status, the authors conducted a prospective cohort study of 499,356 male participants in the Cancer Prevention Study II. Participants reported their veteran status and other characteristics in 1982 and were followed for mortality through 2004. ⋯ In age-adjusted analyses, the risk of suicide did not differ by veteran status. Additional adjustment for several sociodemographic, behavioral, and clinical factors had little effect on hazard ratios. The authors concluded that the risk of death from suicide among middle-aged and older US males is independent of veteran status and suggest that policies to prevent veteran suicide should focus on factors that may heighten suicide risk rather than on veteran status per se.
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Comment
Invited commentary: defining incident chronic kidney disease in epidemiologic study settings.
Chronic kidney disease affects an estimated 31 million Americans and potentially poses a significant global health and socioeconomic crisis. Chronic kidney disease can be treated if patients are identified early enough in the evolution of their kidney disease. However, in order for this to occur, suitable definitions of what is meant by "chronic kidney disease" need to be identified. ⋯ However, it is unclear how to best define an incident of chronic kidney disease when the definition relies on the need for a patient to be seen multiple times over an extended period of time. In this issue of the Journal, Bash et al. (Am J Epidemiol. 2009;170(4):414-424) have compared 4 different definitions of incident chronic kidney disease and their agreement, incident rates, and association with known risk factors. This study explores an extremely important topic for longitudinal epidemiology studies of chronic kidney disease.
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The long-term health consequences of war service remain unclear, despite burgeoning scientific interest. A longitudinal cohort study of a random sample of Australian Vietnam veterans was designed to assess veterans' postwar physical and mental health 36 years after the war (2005-2006) and to examine its relation to Army service, combat, and post-traumatic stress disorder (PTSD) assessed 14 years previously (1990-1993). Prevalences in veterans (n = 450) were compared with those in the Australian general population. ⋯ Military and war service characteristics and age were the most frequent predictors of physical health endpoints, while PTSD was most strongly associated with psychiatric diagnoses. Draftees had better physical health than regular enlistees but no better mental health. Army service and war-related PTSD are associated with risk of illness in later life among Australian Vietnam veterans.
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Several observational studies have found a higher risk of recurrence/relapse of depression for patients who discontinue antidepressant use compared with those who continue. This study demonstrated that measurement of follow-up time can be subject to immortal and neglected time bias. Data were obtained from the 2001 Second Dutch National Survey of General Practice. ⋯ In method 2, a statistically nonsignificant risk ratio of 0.77 (95% confidence interval: 0.49, 1.21) was produced, indicating no difference in risk of relapse/recurrence. The authors found the method used in previous studies subject to bias. Applying a different method, accounting for immortal and neglected time bias, eliminated the protective effects of longer treatments.