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Population Health Metrics
Published in: Population Health Metrics 1/2015

Open Access 01-12-2015 | Research

Erosion of the healthy soldier effect in veterans of US military service in Iraq and Afghanistan

Authors: Mary J Bollinger, Susanne Schmidt, Jacqueline A Pugh, Helen M Parsons, Laurel A Copeland, Mary Jo Pugh

Published in: Population Health Metrics | Issue 1/2015

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Abstract

Background

This research explores the healthy soldier effect (HSE) – a lower mortality risk among veterans relative to the general population—in United States (US) veterans deployed in support of operations in Iraq and Afghanistan (OEF/OIF/OND). While a HSE has been affirmed in other OEF/OIF/OND populations, US veterans of OEF/OIF/OND have not been systematically studied.

Methods

Using US Department of Veterans Affairs (VA) administrative data, we identified veterans who (1) had been deployed in support of OEF/OIF/OND between 2002 and 2011 and (2) were enrolled in the VA health care system. We divided the VA population into VA health care utilizers and non-utilizers. We obtained Department of Defense (DOD) administrative data on the OEF/OIF/OND population and obtained VA and DOD mortality data excluding combat deaths from the analyses. Indirect standardization was used to compare VA and DOD cohorts to the US population using total population at risk to compute the Standardized Mortality Ratio (SMR). A directly standardized relative risk (DSRR) was calculated to enable comparisons between cohorts. To compare VA enrollee mortality on military specific characteristics, we used a DOD population standard.

Results

The overall VA SMR of 2.8 (95% Confidence Interval [CI] 2.8-2.9), VA utilizer SMR of 3.2 (95% CI 3.1-3.3), VA non-utilizer SMR of 0.9 (95% CI 0.8-1.1), and DOD SMR of 1.5 (95% CI 1.4-1.5) provide no evidence of a HSE in any cohort relative to the US standard population. Relative to DOD, both the total VA population SMR of 2.1 (95% CI 2.0-2.2) and the SMR for VA utilizers of 2.3 (95% CI 2.3-2.4) indicate mortality twice what would be expected given DOD mortality rates. In contrast, the VA enrollees who had not used clinical services had 40% lower than expected mortality relative to DOD.

Conclusions

No support was found for the HSE among US veterans of OEF/OIF/OND. These findings may be attributable to a number of factors including post-deployment risk-taking behavior, an abbreviated follow up period, and the nature of the OEF/OIF/OND conflict.
Literature
1.
Defense Manpower Data Center (DMDC) Reporting System (DRS). Active Duty and Reserve Component Service Members Data. In Book Active Duty and Reserve Component Service Members Data (Editor ed.^eds.). City; 2013.
2.
Seltzer CC, Jablon S. Effects of selection on mortality. Am J Epidemiol. 1974;100:367–72.PubMed
3.
Kang HK, Bullman TA. Mortality among U.S. veterans of the Persian Gulf War. N Engl J Med. 1996;335:1498–504.CrossRefPubMed
4.
Howe GR. Components and modifiers of a “Healthy Worker Effect”: Evidence from three occupational cohorts, and implications for industrial compensation. In: Book Components and modifiers of a “Healthy Worker Effect”: Evidence from three occupational cohorts, and implications for industrial compensation (Editor ed.^eds.). City: Ministry of Labour of the Government of Ontario; 1988. p. 40.
5.
McMichael AJ. Standardized mortality ratios and the “healthy worker effect”: Scratching beneath the surface. J Occup Med. 1976;18:165–8.CrossRefPubMed
6.
Li CY, Sung FC. A review of the healthy worker effect in occupational epidemiology. Occup Med (Lond). 1999;49:225–9.CrossRef
7.
8.
Knapik JJ, Marin RE, Grier TL, Jones BH. A systematic review of post-deployment injury-related mortality among military personnel deployed to conflict zones. BMC Public Health. 2009;9:231.CrossRefPubMedPubMedCentral
9.
10.
Strand LA, Martinsen JI, Koefoed VF, Sommerfelt-Pettersen J, Grimsrud TK. Cause-specific mortality and cancer incidence among 28,300 Royal Norwegian Navy servicemen followed for more than 50 years. Scand J Work Environ Health. 2011;37:307–15.CrossRefPubMed
11.
McBride D, Cox B, Broughton J, Tong D. The mortality and cancer experience of New Zealand Vietnam war veterans: a cohort study. BMJ Open. 2013;3:e003379.CrossRefPubMedPubMedCentral
12.
Sikorski C, Emerson MA, Cowan DN, Niebuhr DW. Risk factors for medical disability in U.S. enlisted Marines: fiscal years 2001 to 2009. Mil Med. 2012;177:128–34.CrossRefPubMed
13.
Niebuhr DW, Krampf RL, Mayo JA, Blandford CD, Levin LI, Cowan DN. Risk factors for disability retirement among healthy adults joining the U.S. Army. Mil Med. 2011;176:170–5.CrossRefPubMed
14.
Wilson J, Jones M, Fear NT, Hull L, Hotopf M, Wessely S, et al. Is previous psychological health associated with the likelihood of Iraq war Deployment? An investigation of the “Healthy Warrior Effect”. Am J Epidemiol. 2009;169:1362–9.CrossRefPubMed
15.
Larson GE, Highfill-McRoy RM, Booth-Kewley S. Psychiatric diagnoses in historic and contemporary military cohorts: combat deployment and the healthy warrior effect. Am J Epidemiol. 2008;167:1269–76.CrossRefPubMed
16.
Waller M, Kanesarajah J, Zheng W, Dobson A. The Middle East Area of Operations (MEAO) Mortality and Cancer Incidence Study. In: Book The Middle East Area of Operations (MEAO) Mortality and Cancer Incidence Study. (Editor ed.^eds.). City: The University of Queensland; 2013.
17.
Haus-Cheymol R, Boussaud M, Jougla E, Verret C, Decam C, Pommier De Santi V, et al. Mortality among active-duty male French Armed Forces, 2006-10. J Public Health (Oxf). 2012;34:454–61.CrossRef
18.
19.
VA Information Resource Center (VIREC). VIReC Data Investigation: Vital Status File Date of Birth (DOB) and Sex Quality Review. In Book VIReC Data Investigation: Vital Status File Date of Birth (DOB) and Sex Quality Review (Editor ed.^eds.). City; 2011.
20.
21.
Siegel J, Swanson D. The Methods and Materials of Demography. San Diego: Elsevier Academic Press; 2004.
22.
Boyle P, Parkin DM. Cancer Registration: Principles and Methods. In Book Cancer Registration: Principles and Methods (Editor ed.^eds.), vol. IARC Scientific Publication #95. City: World Health Organizaiton, International Agency for Research on Cancer; 1991.
23.
Miettinen OS. Standardization of risk ratios. Am J Epidemiol. 1972;96:383–8.PubMed
24.
Barnes SM, Walter KH, Chard KM. Does a history of mild traumatic brain injury increase suicide risk in veterans with PTSD? Rehabil Psychol. 2012;57:18–26.CrossRefPubMed
25.
Kaplan MS, Huguet N, McFarland BH, Newsom JT. Suicide among male veterans: a prospective population-based study. J Epidemiol Community Health. 2007;61:619–24.CrossRefPubMedPubMedCentral
26.
Belmont PJ, Schoenfeld AJ, Goodman G. Epidemiology of combat wounds in Operation Iraqi Freedom and Operation Enduring Freedom: orthopaedic burden of disease. J Surg Orthop Adv. 2010;19:2–7.PubMed
27.
Department of Veterans Affairs VHA, Assistant Deputy Under Secretary for health for Policy and Planning. 2013 VA Enrollee Health Care Projection Model, Base Year 2012. In Book 2013 VA Enrollee Health Care Projection Model, Base Year 2012 (Editor ed.^eds.). City; 2013.
28.
Burns CJ, Bodner KM, Jammer BL, Collins JJ, Swaen GM. The healthy worker effect in US chemical industry workers. Occup Med (Lond). 2011;61:40–4.CrossRef
29.
Belmont Jr PJ, Goodman GP, Zacchilli M, Posner M, Evans C, Owens BD. Incidence and epidemiology of combat injuries sustained during “the surge” portion of operation Iraqi Freedom by a U.S. Army brigade combat team. J Trauma. 2010;68:204–10.CrossRefPubMed
30.
Gifford B. Combat casualties and race: what can we learn from the 2003–2004 Iraq conflict? Armed Forces Soc. 2005;31:201–25.CrossRef
31.
Buzzell E, Preston S. Mortality of American Troops in the Iraq War. Popul Dev Rev. 2007;33:555–66.CrossRef
32.
Cawley J, Maclean JC. Unfit for service: the implications of rising obesity for US military recruitment. Health Econ. 2012;21:1348–66.CrossRefPubMed
33.
Inskeep S, Bowman T. Army Documents Show Lower Recruiting Standards. In: Book Army Documents Show Lower Recruiting Standards (Editor ed.^eds.). City: National Public Radio; 2008.
34.
Unknown. Lower standards help Army meet recruiting goal. In Book Lower standards help Army meet recruiting goal (Editor ed.^eds.). City: Gannett Co. Inc.; 2006.
35.
Singer M. Military Lowers Standards to Fill Ranks. In Book Military Lowers Standards to Fill Ranks (Editor ed.^eds.). City; 2007.
36.
Congressional Budget Office. The all-volunteer military: issues and performance. In: Book The all-volunteer military: issues and performance (Editor ed.^eds.). City: Congress of the United States; 2007.
37.
Montez JK, Hummer RA, Hayward MD. Educational attainment and adult mortality in the United States: a systematic analysis of functional form. Demography. 2012;49:315–36.CrossRefPubMedPubMedCentral
Metadata
Title
Erosion of the healthy soldier effect in veterans of US military service in Iraq and Afghanistan
Authors
Mary J Bollinger
Susanne Schmidt
Jacqueline A Pugh
Helen M Parsons
Laurel A Copeland
Mary Jo Pugh
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Population Health Metrics / Issue 1/2015
Electronic ISSN: 1478-7954
DOI
https://doi.org/10.1186/s12963-015-0040-6

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