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American Journal of Epidemiology Vol. 154, No. 2 : 128-137
Copyright © 2001 by The Johns Hopkins University School of Hygiene and Public Health

ORIGINAL CONTRIBUTIONS

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

Abla M. Sibai1, Astrid Fletcher2 and Haroutune K. Armenian3

1 Department of Epidemiology and Biostatistics, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
2 Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
3 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.

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.

cardiovascular diseases; mortality; sex; social class; socioeconomic factors; stress; war

Abbreviations: CI, confidence interval; CVD, cardiovascular disease; RR, rate ratio.


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