Adjusting Suicide Rates in a Military Population: Methods to Determine the Appropriate Standard Population

Watkins, Eren Youmans; Spiess, Anita; I, Abdul-Rahman; Hill, Christopher; Gibson, Nkechinyere; Nichols, Jerrica; McLeod, Vanessa; Johnson, Latoya D; Mitchell, Trevor; Pecko, Joseph; Cox, Kenneth L.

doi:10.2105/ajph.2018.304410

Cited by 8 publications

(6 citation statements)

References 6 publications

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“…The study is also complemented by the use of an Army population standard as opposed to commonly used US population standards. This choice was based on the findings and recommendations of Watkins et al 16 in 2018. The authors compared reasonable US and Army population standards to identify the most appropriate for comparing health outcomes/events between these groups.…”

Section: Discussionmentioning

confidence: 99%

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A Comparative Analysis of Reported Chlamydia and Gonorrhea Cases Among US Army Soldiers, 2015 to 2019

2021

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Background: Chlamydia and gonorrhea have increased nationally and in the US Army. Rates reported in the Army are elevated relative to the general population, partly because of differing population demographics.Methods: Age-and sex-specific chlamydia and gonorrhea case rates among Army active component soldiers and the wider 18-to 64-year-old US adult population were computed from reports submitted through national and military surveillance systems in 2015 to 2019. Rates were standardized using the 2015 Army age and sex population distribution. Multivariable generalized linear models were generated to evaluate associated risk factors.Results: Army age-and sex-adjusted chlamydia rates (per 100,000 personyears) were nearly twice those of US adults (2019 rates, 2317 vs. 1241), whereas US age-and sex-adjusted gonorrhea rates surpassed Army rates (2019 rates, 536 vs. 396). Chlamydia and gonorrhea rates were significantly elevated in Army women younger than 25 years relative to US women aged 18 to 24 years (2015-2019 crude rates, 10,404 Army/4243 US for chlamydia and 1014 Army/694 US for gonorrhea). Gonorrhea rates were significantly elevated in US men aged 25 to 44 years (2015-2019 crude rates, 506 US/ 251 Army and 223 US/86 Army for men aged 25-34 and 35-44 years, respectively). Age, sex, and race-ethnicity were significantly associated with infection among soldiers.Conclusions: Observed increases in chlamydia and gonorrhea and identified risk factors are consistent with those reported nationally. Higher adjusted chlamydia rates among soldiers may reflect greater individual or sexual network risks, screening biases, or increased health care access. The Army's lower adjusted gonorrhea rates may reflect differences in high-risk subgroups (e.g., men who have sex with men), differing sexual networks, or other confounders.

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Section: Discussionmentioning

confidence: 99%

“…Direct standardization methods were used to adjust annual CT and NG rates by sex and age for both populations (Army AC soldiers and US demographic peers) 15 . The 2015 Army population distribution per the aforementioned age categories was used as the population standard and provides consistency when comparing annual trends 16 …”

Section: Methodsmentioning

confidence: 99%

A Comparative Analysis of Reported Chlamydia and Gonorrhea Cases Among US Army Soldiers, 2015 to 2019

2021

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“…Rates were standardized for all years using the 2004 active duty Army population. 15 Age-adjusted rates were calculated using the Statistical Analysis System standard rate procedure, which provides directly standardized rates and risk estimates. 16 If mortality rates are homogenous across age strata, this procedure also provides the Cochran-Mantel-Haenszel method to compute a pooled estimate of mortality that is based on stratum-specific mortality estimates.…”

Section: Discussionmentioning

confidence: 99%

Mortality Among Male U.S. Army Soldiers Within 18 Months of Separation

Abdur-Rahman

Watkins

Jarvis³

et al. 2021

Military Medicine

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Introduction Understanding how soldiers die after separation from military service, particularly those who die shortly after separating from service, may help to identify opportunities to ease transitions to civilian life. Materials and Methods Mortality data were analyzed for male U.S. Army soldiers who died within 18 months of their separation from service (from 1999 to 2011). Descriptive statistics were calculated for natural, accidental, suicidal, homicidal, undetermined, and legal/operation of war deaths and were stratified by age, component, time in service, and type of discharge. Crude and age-adjusted mortality rates, standardized for all years using the 2004 Regular Army population, were also calculated. The Public Health Review Board of the U.S. Army Public Health Center approved this study as Public Health Practice. Results Of the 1,884,653 male soldiers who separated from service during the study period, 3,819 died within 18 months of separation. A majority of all separations were Reserve or National Guard (58%), and 62% of decedents were in the Reserve or National Guard. Deaths from natural causes (38%) were the most common, followed by accident deaths (34%), suicides (20%), homicides (6%), undetermined deaths (2%), and legal/operation of war deaths (<1%). For overall mortality, age-adjusted rates were higher among the male U.S. population when compared to male soldiers who had separated from the Army. Conclusions The time period immediately following separation from the Army presents a unique challenge for many soldiers. Developing more effective pre-separation prevention programs that target specific risks requires knowing the causes of death for natural deaths, suicides, and accidents. Over half of all deaths occurring shortly after separation from service are preventable. Continued surveillance of specific causes of preventable deaths following separation can improve pre-separation prevention programs and transitions to post-service care.

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“…The Army suicide rate surpassed the civilian suicide rate in the United States for the first time in 2008 (Bachynski et al, 2012) and has continued to be higher ever since (Watkins et al, 2018). Because of this, the Army has invested heavily in research (Hoge et al, 2005;Kessler et al, 2005;Kessler et al, 2013;Nock et al, 2008;Nock et al, 2013;Nweke et al, 2015;Ribeiro et al, 2016;Schoenbaum et al, 2014;Ursano et al, 2014), including a $50 million project in 2009 (Jo, 2014;Kessler et al, 2013;Ursano et al, 2014), to better understand risk and protective factors associated with death by suicide.…”

Section: Introductionmentioning

confidence: 99%

Financial costs to the U.S. Army for suicides by newly enlisted Soldiers

Schaughency

Watkins

Barnes

et al. 2021

Suicide & Life Threat Behav

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Objective: To estimate the financial burden to the U.S. Army of suicide by enlisted Soldiers during their first year of service. Methods: This analysis included new Army enlisted Soldiers who started initial entry training from October 2012 through September 2016 and subsequently died by suicide within their first year of service. Outpatient and inpatient direct medical, direct nonmedical, recruiting, and training costs to the Army were calculated. Results: During the 48-month observational study period, 29 Soldiers died by suicide within their respective first year of service. The described financial costs accrued by the Army as a result of these deaths were $152,271-with an average of $6,091 per healthcare utilizer. Recruiting and training costs were $1,115,860 for all suicide cases. Conclusion: Average direct cost per healthcare utilizer increased during a Soldier's first year of service. This may be associated with the transition through different phases of training and to the first operational duty station. Public Health Implications: Results obtained through this cost-of-illness analysis may serve as baseline metrics to inform future cost-effectiveness studies.

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Adjusting Suicide Rates in a Military Population: Methods to Determine the Appropriate Standard Population

Cited by 8 publications

References 6 publications

A Comparative Analysis of Reported Chlamydia and Gonorrhea Cases Among US Army Soldiers, 2015 to 2019

A Comparative Analysis of Reported Chlamydia and Gonorrhea Cases Among US Army Soldiers, 2015 to 2019

Mortality Among Male U.S. Army Soldiers Within 18 Months of Separation

Financial costs to the U.S. Army for suicides by newly enlisted Soldiers

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