title: Vasomotor Symptoms and Quality of Life Among Veteran and Non-Veteran Postmenopausal Women.
abstract: BACKGROUND
  Vasomotor symptoms (VMS), including hot flashes and night sweats, are common among postmenopausal women and are associated with reduced health related quality of life (HRQOL).
  
  
  OBJECTIVE
  To determine whether Veterans are more likely to report VMS than non-Veterans, and whether the association of VMS with HRQOL varies by Veteran status.
  
  
  METHODS
  We used data from the Women's Health Initiative Observational Study, including self-reported baseline VMS presence and severity, and HRQOL at follow-up Year 3 (RAND Short Form 36-Item Health Survey). Employing generalized linear models we estimated whether Veteran status was associated with any VMS. We estimated the association between any VMS and HRQOL using linear regression, stratified by Veteran status. Interaction terms were added separately to determine whether the association varied by baseline depression, obesity, or smoking status.
  
  
  RESULTS
  The final analyses included 77,153 postmenopausal women (2,004 Veterans). After adjustment, Veterans were no more likely than non-Veterans to report any VMS at baseline (relative risk [RR] 0.97, 95% confidence interval [CI] 0.90-1.04) or moderate to severe VMS (RR 1.03, 95% CI 0.89-1.18). Any VMS was associated with decreased HRQOL at Year 3, particularly among Veterans (mean difference range: Veterans -2.7 to -4.6, p-values < .001; non-Veterans -2.2 to -2.6, 95% CI -0.13 to -0.09, p values < .001). Baseline depression and obesity, but not smoking, amplified the negative association between VMS and HRQOL.
  
  
  CONCLUSIONS
  Multicondition care models for postmenopausal Veteran and non-Veteran women are needed that incorporate management strategies for VMS, weight, and depression.
authors.affiliation: Health Services Research and Development (HSR&D), VA Puget Sound Health Care System, Seattle, Washington. Women's Health Services, VA Office of Patient Care, Washington, District of Columbia. jodie.katon@va.gov.
authors.forename: Jodie G
authors.initials: JG
authors.lastname: Katon
authors.affiliation: Health Services Research and Development (HSR&D), VA Puget Sound Health Care System, Seattle, Washington. Department of Health Services, University of Washington School of Public Health, Seattle.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Gray
authors.affiliation: VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Megan R
authors.initials: MR
authors.lastname: Gerber
authors.affiliation: Department of Epidemiology, University of Washington School of Public Health, Seattle.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Harrington
authors.affiliation: University of Washington School of Nursing, Seattle.
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Woods
authors.affiliation: VA Palo Alto Health Care System, California. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Weitlauf
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health Care System, California. Division of General Internal Medicine, VA Greater Los Angeles Health Care System, California.
authors.forename: Bevanne
authors.initials: B
authors.lastname: Bean-Mayberry
authors.affiliation: Durham VA Medical Center, North Carolina. Department of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Goldstein
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Julie R
authors.initials: JR
authors.lastname: Hunt
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
authors.affiliation: Women's Health Services, VA Office of Patient Care, Washington, District of Columbia. VA Connecticut Health Care System, New Haven.
authors.forename: Sally G
authors.initials: SG
authors.lastname: Haskell
authors.affiliation: Women's Health Services, VA Office of Patient Care, Washington, District of Columbia.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: McCutcheon
authors.affiliation: Cleveland Clinic Lerner College of Medicine Case Western Reserve University, Mayfield Heights, Ohio.
authors.forename: Margery L
authors.initials: ML
authors.lastname: Gass
authors.affiliation: Mental Illness Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Gibson
authors.affiliation: Women's Health Services, VA Office of Patient Care, Washington, District of Columbia. Department of Obstetrics and Gynecology, New York University Langone School of Medicine.
authors.forename: Laurie C
authors.initials: LC
authors.lastname: Zephyrin
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D019584:Hot Flashes / Q000453:epidemiology*; D006801:Humans; D016014:Linear Models; D008593:Menopause; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D017698:Postmenopause; D011788:Quality of Life; D057566:Self Report; D012907:Smoking / Q000453:epidemiology; D013546:Sweating; D014481:United States / Q000453:epidemiology; D014666:Vasomotor System; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Depression; Obesity; Quality of life; Vasomotor symptoms; Veterans