Background: African Americans (AA) in the general population have double the odds for developing diabetes (DM). In addition, older age and a score of 4+ on the Adverse Childhood Experiences (ACE) inventory has been associated with increased risk for DM; education has been found to moderate risk. In addition, military service disproportionately attracts those with high ACE; however, educational opportunity is more readily available. We explored the effect of military service on the risk for developing diabetes in AA with high ACE.
Methods: We analyzed 2009-2012 BRFSS data from U.S. states opting to include an ACE module (n=117,084). AA (n=8715) comprise about 9.3% of this sample after weighted for representativeness.
Results: In the overall sample, age (OR= 1.04, 95% CI = 1.05-1.05), high ACE (4+; OR = 1.38, 95% CI =1.24-1.53), and being AA (OR = 2.1, 95% CI = 1.88-2.34) all significantly (p < .001) increase likelihood of developing DM, and education reduces it (OR = 0.80, 95% CI = 0.77-0.83; p < .001). Controlling for age, males are more likely to have a history of military service (OR = 23.7, 95% CI = 20.9-26.9, p < .001). Those with high ACE are more likely to enlist (OR = 1.66, 95% CI = 1.45-1.90, p < .001) and AAs are more likely to enlist (OR = 1.27, 95% CI =1.09-1.47, p < .01) compared to other races. Furthermore, when examining just AAs, those with military service have an increased likelihood of developing DM (OR = 1.24, 95% CI = 1.12-1.38). However, 2009-10 data show current active duty and those who served within one year may experience some protective effects; when controlling for age, they have the same or decreased DM compared to other veterans or civilians.
Discussion: Military service does not buffer the risk for DM in AAs with high ACE, regardless of education. This may be partially due to an increase in ACE among those with a history of military service and the inclusion of the Veteran Administration population, which tend to have increase co-morbidities.
J.L. Wardian: None. E. Stone: None.