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2023 HSR&D/QUERI National Conference Abstract

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4059 — Post-traumatic stress disorder (PTSD) and Parkinson's Disease (PD) risk in a Veteran cohort

Lead/Presenter: Frances Weaver,  COIN - Hines
All Authors: Weaver FM ((Center of Innovation on Complex Chronic Healthcare (CINCCH), Edward Hines Jr VA Hospital & Loyola University, Chicago), Goldman S (San Francisco VAMC & University of California, San Francisco) Cao L (CINCCH, Hines VA Hospital) Brown E (UCSF) Gonzalez B (CINCCH, Hines VA Hospital) Kartje R (CINCCH, Hines VA Hospital) Stroupe KT (CINCCH, Hines VA Hospital & Loyola University Chicago) Tanner C (UCSF and San Francisco VAMC)

Objectives:
Stress has been proposed as a possible risk factor for PD, but limited supportive data are available. PTSD is an increasingly-recognized condition occurring in military veterans, with an estimated prevalence up to 15% in those previously deployed. The Veterans Health Administration (VHA) electronic medical record (EMR) provides a powerful resource to investigate this relationship. Our objective was to examine the relationship between PTSD and PD diagnosis in a large US Veteran cohort.

Methods:
We studied 340,489 US Marine Corps Veterans based at Camp Lejeune, NC or Camp Pendleton, CA between 1975 and 1985. We identified Veterans who utilized any VHA health care services (10/1/99- 2/28/2021) and/or Medicare (1/1/2000- 12/31/2018), and reviewed medical records of all with >1 diagnostic codes for PD (ICD9 332.0 or ICD10 G20) to validate and determine incident date of diagnosis. We defined PTSD as having at least one ICD9 (309.81) or ICD10 (F43.10, F43.11, F43.12) code in the VHA EMR or in Medicare. We tested associations of PTSD and PD risk using a nested case-control design, matching 10 controls to each veteran with PD on age at diagnosis (“index date”), gender, race, and rank. We adjusted for Camp in conditional logistic regression models, and conducted a sensitivity analysis restricted to cases and controls with any VHA usage prior to index date.

Results:
158,122 veterans (46% of initial cohort) had any healthcare utilization in VHA or Medicare. The majority were male (96%) and white (85%). After validation, we identified 437 veterans with PD. PTSD was diagnosed in 86 (19.7%) veterans with PD and 714 (16.4%) matched controls. Risk of PD was significantly higher in veterans with a PTSD diagnosis: OR 1.28, 95%CI 1.14-1.43, p < 0.001. Risk was greater among those who had used VHA services prior to their index date: OR 1.57, 95%CI 1.34-1.83, p < 0.0001.

Implications:
PTSD is associated with increased risk of PD in this large, well-validated cohort of US Marine Veterans.

Impacts:
Early identification and management of PTSD with evidence-based treatments could potentially affect the frequency and severity of PD in Veterans who may predisposed to developing PD.