Multimorbidity and quality of life after blast-related injury among US military personnel: a cluster analysis of retrospective data

Abstract

Background: Blast injury emerged as a primary source of morbidity among US military personnel during the recent conflicts in Iraq and Afghanistan, and led to an array of adverse health outcomes. Multimorbidity, or the presence of two or more medical conditions in an individual, can complicate treatment strategies. To date, there is minimal research on the impact of multimorbidity on long-term patient-reported outcomes. We aimed to define multimorbidity patterns in a population of blast-injured military personnel, and to examine these patterns in relation to long-term quality of life (QOL). Methods: A total of 1972 US military personnel who sustained a blast-related injury during military operations in Iraq and Afghanistan were identified from clinical records. Electronic health databases were used to identify medical diagnoses within the first year postinjury, and QOL was measured with a web-based assessment. Hierarchical cluster analysis methods using Ward's minimum variance were employed to identify clusters with related medical diagnosis categories. Duncan's multiple range test was used to group clusters into domains by QOL. Results: Five distinct clusters were identified and grouped into three QOL domains. The lowest QOL domain contained one cluster with a clinical triad reflecting musculoskeletal pain, concussion, and mental health morbidity. The middle QOL domain had two clusters, one with concussion/anxiety predominating and the other with polytrauma. The highest QOL domain had two clusters with little multimorbidity aside from musculoskeletal pain. Conclusions: The present study described blast-related injury profiles with varying QOL levels that may indicate the need for integrated health services. Implications exist for current multidisciplinary care of wounded active duty and veteran service members, and future research should determine whether multimorbidity denotes distinct post-blast injury syndromes.

Military Injuries—Understanding Posttraumatic Epilepsy, Health, and Quality-of-Life Effects of Caregiving: Protocol for a Longitudinal Mixed Methods Observational Study (Preprint)

“…We follow the RAND Corporation's blueprint for MVC research [94] as we develop our strategy. Specifically, of the 10 research objectives identified by their stakeholder panels, we will directly address the following 5 objectives: (1) describe caregivers (and unique characteristics of caregivers of PTE or epilepsy); (2) assess how the needs of care recipients change over time; (3) document the effects of caregiving on care recipient outcomes; (4) document the effects of caregiving on caregiver outcomes; and (5) examine factors associated with caregiver and care recipient harm.…”

“…Among post-9/11 veterans, prior studies have found a prevalence of epilepsy of approximating 10.6/1000 [1]. In particular, posttraumatic epilepsy (PTE), which occurs following a traumatic brain injury (TBI), is more common among veterans who served during Operation Enduring Freedom or Operation Iraqi Freedom (post-9/11) because of the higher incidence of TBI and blast injuries compared with earlier conflicts [1][2][3]. The annual cost of epilepsy care in the United States has been estimated at US $12.5 billion [4], with higher costs for those newly diagnosed, those with seizures refractory to anticonvulsant medication treatment, and those with comorbid health conditions [5,6].…”

Combat injury profiles among U.S. military personnel who survived serious wounds in Iraq and Afghanistan: A latent class analysis

“…Although measures such as the Injury Severity Score (ISS) have proven useful in predicting mortality [ 23 – 25 ], their utility in the assessment of long-term outcomes is unclear. One recent study found a pattern of postinjury multimorbidity (i.e., co-occurrence of two or more long-term health conditions) and poorer quality of life among military personnel with combat injury that was not associated with the highest levels of ISS [ 26 ]. This suggests that other factors, such as protracted impairments resulting from TBI or extremity trauma, may play a role beyond injury severity [ 11 , 19 ].…”

Military Injuries—Understanding Posttraumatic Epilepsy, Health, and Quality-of-Life Effects of Caregiving: Protocol for a Longitudinal Mixed Methods Observational Study

“…Among post-9/11 veterans, prior studies have found a prevalence of epilepsy of approximating 10.6/1000 [ 1 ]. In particular, posttraumatic epilepsy (PTE), which occurs following a traumatic brain injury (TBI), is more common among veterans who served during Operation Enduring Freedom or Operation Iraqi Freedom (post-9/11) because of the higher incidence of TBI and blast injuries compared with earlier conflicts [ 1 - 3 ]. The annual cost of epilepsy care in the United States has been estimated at US $12.5 billion [ 4 ], with higher costs for those newly diagnosed, those with seizures refractory to anticonvulsant medication treatment, and those with comorbid health conditions [ 5 , 6 ].…”