Variations in the Impact of Long-term Wartime Stressors on Mortality among the Middle-aged and Older Population in Beirut, Lebanon, 1983–1993

• Published in: American journal of epidemiology Vol. 154; no. 2; pp. 128 - 137
• Main Authors: Sibai, Abla M., Fletcher, Astrid, Armenian, Haroutune K.
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 15.07.2001; Oxford Publishing Limited (England)
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; cardiovascular disease; cardiovascular diseases; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cause of Death; confidence interval; CVD; Educational Status; Female; Follow-Up Studies; Health Status; Health Surveys; Humans; Lebanon - epidemiology; Male; Medical sciences; Middle Aged; Miscellaneous; mortality; Population Surveillance; rate ratio; Retrospective Studies; Risk Factors; sex; Sex Distribution; social class; Socioeconomic Factors; stress; Stress, Psychological - complications; Surveys and Questionnaires; Tropical medicine; Urban Health - statistics & numerical data; war; Warfare; Lebanon; Asia; Human; Socioeconomic status; Conflict; Heart disease; Cohort study; Mortality; Risk factor; Sex; Cardiovascular disease; Social class; Epidemiology; Stress
• ISSN: 0002-9262; 1476-6256; 0002-9262
• DOI: 10.1093/aje/154.2.128

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.