Abstract Objective The aim of this study was to examine health, demographic, and service utilization characteristics of veterans with multimorbid tobacco use disorder (TUD) and morbid obesity compared to those with either condition alone. Methods: Health record data were extracted from the computerized patient record system of the Veterans Health Administration (VHA; October 1, 2011 to September 30, 2012). Bivariate and multivariate logistic regression models were used to compare veterans with both TUD and morbid obesity (body mass index [BMI] ≥ 40 kg/m2) to veterans with each condition alone on a range of demographic, health, and service utilization outcome variables that also were extracted from the VHA administrative record. Results: Veterans with both morbid obesity and TUD showed higher rates of medical and psychiatric comorbidity than did veterans with either condition alone. However, while veterans with TUD and morbid obesity showed higher rates of comorbid substance use disorders than veterans with morbid obesity alone, veterans with both conditions showed substantially lower rates of substance use disorders than those with TUD alone. Conclusions: Veterans with co-occurring morbid obesity and TUD appear to be at greater risk for medical disease and psychiatric conditions. The unexpected finding that veterans with TUD alone had more concurrent substance use disorders than veterans with both TUD and morbid obesity suggest the possibility that overeating may be a substitute for substance use in the context of TUD. The multimorbidity profile described here may suggest unique treatment needs for individuals with both TUD and morbid obesity. Highlights Medical multimorbidities predict additional health conditions and poorer outcomes. Obesity and tobacco use may share common underlying vulnerabilities. Veterans with both conditions showed higher rates of certain multimorbidities. Obesity may protect against substance use in tobacco users.

中文翻译：

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退伍军人健康管理局在全国范围内并发病态肥胖和烟草使用障碍的相关性

摘要 目的本研究的目的是检查与单独患有任何一种疾病的退伍军人相比，患有多种病态烟草使用障碍 (TUD) 和病态肥胖症的退伍军人的健康、人口统计学和服务利用特征。方法：从退伍军人健康管理局（VHA；2011年10月1日至2012年9月30日）的计算机化患者记录系统中提取健康记录数据。使用双变量和多变量逻辑回归模型将同时患有 TUD 和病态肥胖（体重指数 [BMI] ≥ 40 kg/m2）的退伍军人与单独患有每种疾病的退伍军人在一系列人口统计学、健康和服务利用结果变量上进行比较也从 VHA 管理记录中提取。结果：患有病态肥胖和 TUD 的退伍军人比单独患有这两种疾病的退伍军人表现出更高的医疗和精神共病率。然而，虽然患有 TUD 和病态肥胖的退伍军人表现出比单独患有病态肥胖的退伍军人更高的共病物质使用障碍发生率，但同时患有这两种疾病的退伍军人的物质使用障碍发生率明显低于单独患有 TUD 的退伍军人。结论：同时发生病态肥胖和 TUD 的退伍军人似乎面临更大的医学疾病和精神疾病风险。与同时患有 TUD 和病态肥胖症的退伍军人相比，单独患有 TUD 的退伍军人同时患有更多的物质使用障碍这一意外发现表明，在 TUD 的背景下，暴饮暴食可能会替代物质使用。这里描述的多发病情况可能表明对 TUD 和病态肥胖的个体有独特的治疗需求。亮点 医学多发病预测额外的健康状况和较差的结果。肥胖和烟草使用可能具有共同的潜在脆弱性。患有这两种疾病的退伍军人表现出更高的某些多重疾病发生率。肥胖可以防止烟草使用者使用物质。