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

Abstract

BackgroundThis 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.MethodsUsing 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.ResultsThe 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.ConclusionsNo 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.

Veterans' Likelihood of Reporting Cardiovascular Disease

“…These findings support an emerging literature that questions whether the HSE is as relevant for the newest generation of veterans as it once was. 2,32,33 Researchers from the VA note that "the healthy solider/worker effect gradually subdued over time." 33 VA data estimate that male and female veterans have fewer expected life years (0.8 and 1.2 years, respectively) than nonveterans.…”

“…This is due to a lack of clearly designated front lines and clear demarcation between enemy combatants and the civilians populations in which the enemy tended to embed; the higher number of war-zone tours; and longer deployments than earlier wars. 39 In addition, the wars in Iraq and Afghanistan relied more heavily on service members from National Guard and Reserve units that, in general, have a lower state of military preparedness 32 and less access to military institutional support mechanisms such as Family Readiness Groups that provide crucial social, economic, and emotional support before, during, and after deployment. 40 Emerging evidence suggests increased risks to health for Iraq and Afghanistan veterans who seem to have higher rates of tobacco and alcohol use, 32,41,42 known risk factors for CVD, and to early onset mortality.…”

“…39 In addition, the wars in Iraq and Afghanistan relied more heavily on service members from National Guard and Reserve units that, in general, have a lower state of military preparedness 32 and less access to military institutional support mechanisms such as Family Readiness Groups that provide crucial social, economic, and emotional support before, during, and after deployment. 40 Emerging evidence suggests increased risks to health for Iraq and Afghanistan veterans who seem to have higher rates of tobacco and alcohol use, 32,41,42 known risk factors for CVD, and to early onset mortality. Interestingly, the effects of tobacco and alcohol use seem to marginally affect the likelihood of veterans reporting higher rates of CVD conditions than nonveterans when controlling for age; this has been documented elsewhere.…”

Top Ten Tips Palliative Care Providers Should Know About Caring for Veterans

“…25 On average, Veterans have had a lower mortality rate than the general public (referred to as the ''healthy soldier effect''), although this effect has, unfortunately, reversed for Veterans from recent conflicts. 26 Nearly half of Veterans are over age 65. Among Veterans in the labor force, unemployment rates are lower than for non-Veteran civilians, although Veterans covered by VA health care are unemployed at rates 50% higher than the general Veteran population and 20% higher than the civilian population.…”

Obstetric Outcomes in U.S. Veterans: Emerging Knowledge, Considerations, and Gaps

“…4 By comparison, active duty servicewomen may be healthier than the general population as a result of physical and educational requirements to enter military service. 26,27 What Is Known About Pregnant Veterans Using VA Maternity Care Benefits Veterans using VA coverage for their prenatal and delivery care have repeatedly been demonstrated to be a high-risk group (►Table 3). One of the earliest works looking at pregnancy and mental health among women Veterans returning from Iraq and Afghanistan compared 2,966 Veterans with any evidence of pregnancy-related diagnoses or care (e.g., positive pregnancy tests) in the VA to their nonpregnant peers, and found that Veterans with a pregnancy were twice as likely to have mental health diagnoses, including depression, anxiety, PTSD, or other serious mental illness.…”