Variations in the impact of long-term wartime stressors on mortality among the middle-aged and older population in Beirut, Lebanon, 1983--1993.
Author: Sibai AM, Fletcher A, Armenian HK.
Source:
American journal of epidemiology, 154(2), 128-137.
The authors investigated the relation between exposure to wartime events and
cardiovascular disease (CVD) and all-cause mortality in Lebanon, which recently
underwent a 16-year civil war. The study population comprised a representative
cohort (n = 1,786) of middle-aged and older men and women who, in 1983,
participated in a community-based health interview survey. In 1993, the authors
traced 87.7 % of the original cohort (n = 1,567) and assessed their vital status,
exposure to war-related events, and, in case they had died, cause of death. War
experiences were aggregated into different clusters according to type of
exposure, realm affected (human vs. property losses), and person central to the
event. Women, but not men, had a significantly elevated CVD mortality risk for
exposures to human traumas that occurred to them (rate ratio = 3.37, 95%
confidence interval: 1.41, 8.05) or their families (rate ratio = 1.45, 95%
confidence interval: 1.20, 1.74). Exposure to property losses and work-related
problems carried a greater mortality risk for men, particularly those with lower
levels of education, than for women. Subjects displaced during the war had a
significantly higher risk for CVD and total mortality. These results suggest
that, during prolonged wars, different elements of exposures have a long-term
impact on mortality, with effects varying by gender and socioeconomic resources.