Exposure to Holocaust is associated with chronic morbidity in older adults–Results from national health and nutrition surveys

Background: Although studies have suggested that Holocaust survivors are more likely than their non-Holocaust-exposed counterparts to suffer from mental and chronic morbidity, methodology differences and potential confounders often compromise result replicability and external validity. We examined associations between Holocaust exposure and chronic morbidity, as well as overall risk of mortality. Methods: Sociodemographic, health-related behavior and nutritional-intake data from two representative National Health and Nutrition Survey Ages 65 and Over—the 2005–2006 MABAT ZAHAV 1 (MZ1) and the 2014–2015 MZ2, including face-to-face interviews and anthropometric measurements—were analyzed. Demographic, health, nutritional and lifestyle characteristics, and exposure to the Holocaust were self-reported. Longitudinal data on overall mortality were obtained by linking the MZ1 population to the population registry dataset. Associations between Holocaust exposure and prevalence of chronic morbidity and risk factors were estimated by multivariable logistic regression analyses, and to risk of overall mortality by Cox regression analysis, both adjusted to significant covariates. Results: Among 2096 study participants aged 75.7 ± 6.1 years, 47.0% male, 518 were Holocaust survivors. In the fully adjusted model, Holocaust exposure was associated with increased prevalence of heart disease (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.07–1.83), metabolic syndrome (OR 2.28, CI 1.23–4.21), and stroke (OR 1.77, CI 1.17–2.69), but not cancer or osteoporosis. Holocaust exposure did not substantially affect the overall risk of mortality (hazard ratio 1.10, CI 0.92–1.32). Conclusions: Further research is needed to understand the mechanisms governing long-term outcomes of exposure to acute physical or mental trauma.