Understanding Chronic Health Outcomes and COVID-19 Risk Among OEF/OIF/OND Veterans
Stress (both physical and mental) can adversely impact physical and mental health outcomes, which are estimated to cost the United States upwards of $500 billion per year. Critically, Veterans experience disproportionate rates of stress exposure as compared to civilians, highlighting the importance of understanding stress-related mechanisms of dysfunction for this patient population. Blast exposure (via detonation of high-impact explosives) represents a major potential source of stress for Servicemembers, often resulting in mild traumatic brain injury (mTBI, the “signature injury” of the Iraq and Afghanistan wars) that is highly comorbid with post-traumatic stress disorder (PTSD) and chronic pain (e.g. polytrauma). Chronic stress and PTSD can significantly contribute to adverse long-term health outcomes (e.g. diabetes, hypertension, obesity), but the potential for blast exposure as a contributor to poor physical health has not been previously investigated. Recent results from our battlefield-relevant mouse model of blast exposure highlight the possibility that blast exposure contributes to chronic health outcomes; in addition to behavioral and cognitive dysfunction, blast-exposed mice exhibit chronic increases in body fat and metabolic, intestinal, and vascular dysfunction. This study proposes to use Veterans Affairs (VA) Electronic Health Records (EHR) as a research tool to bridge understanding and translational relevance between recent animal model findings and chronic health outcomes in Veterans with and without a history of blast exposure. Given the potential for blast-related adverse health outcomes to serve as underlying risk factors for SARS-CoV-2 infection and COVID-19 disease severity, as well as evidence of the blast overpressure waves (i.e., the initial shock wave that brings a sudden increase in atmospheric pressure) to physically injure the organs most susceptible to SARS-CoV-2 infection (e.g. lungs, intestines), we will also examine whether a history of blast exposure contributes to COVID-19-related prevalence, morbidity, and mortality. In summary, we propose a study focused on overall health outcomes in Veterans with and without a history of blast exposure, including COVID-19 diagnosis/disease progression. The proposed investigation has the potential to inform clinical care and will lay the necessary groundwork for future clinical grant proposals aimed at addressing adverse health outcomes in Veterans.
