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An Evaluation of the Effect of Military Service on Mortality: Quantifying the Healthy Soldier Effect
Abstract
Purpose The healthy soldier effect denotes the proposition that military populations are likely to be healthier than other populations. A systematic review was conducted which aimed to quantify the magnitude of the healthy soldier effect.Methods Studies containing mortality rates of military personnel were identified from multiple electronic databases. Studies were included in the meta-analyses if they reported all-cause, cancer, or external-cause mortality in a military population and compared the rates to the general population. Fifty-nine studies were initially identified and 12 were included in the meta-analyses.Results The overall meta-standardized mortality ratios (SMRs) for all-cause mortality for deployed veterans was 0.76 (95% confidence interval [CI]: 0.65-0.89) and 0.73 (95% CI: 0.56-1.97) for non-deployed veterans based on a mean follow-up of 7.0 and 2.4 years, respectively; for cancer mortality, the SMRs were 0.78 (95% CI: 0.63-0.98) for deployed veterans and 0.75 (95% CI: 0.50-1.14) for non-deployed veterans based on 6.7 and 3.1 years follow-up, respectively; for external-cause mortality, the SMRs were 0.90 (95% CI: 0.72-1.13) for deployed veterans and 0.80 (95% CI: 0.63-1.01) for non-deployed veterans based on 4.8 and 2.0 years follow-up, respectively.Conclusion Military personnel do display a healthy soldier effect that decreases their risk of mortality compared to the general population. The overall healthy soldier effect estimated ranges from 10% to 25%, depending on the cause of death studied and the period of follow-up.
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“The healthy soldier effect is well known, service having a positive effect on well-being, with serving NZ Veterans having good access to primary healthcare through the military system, but the public healthcare system is the primary pathway to care for all Veterans, who are also covered by the ‘no fault’ accident compensation scheme for accidental injuries and occupational diseases.29”
From Factors associated with self-reported health among New Zealand military veterans: A cross-sectional study (2022) · cites this paper as [1]
In the citing paper
“Age had a negative association, length of service being positive, most likely due to the ‘healthy soldier’ effect.1”
From Factors associated with self-reported health among New Zealand military veterans: A cross-sectional study (2022) · cites this paper as [1]
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“On entry, soldiers, sailors and air personnel are subject to a selection process to ensure, as far as possible, good physical and mental health, giving rise to the ‘healthy soldier effect,’ with service personnel being, on average, healthier than the general population.1”
From Factors associated with self-reported health among New Zealand military veterans: A cross-sectional study (2022) · cites this paper as [1]
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“Military personnel are known to be healthier on average than members of the general population (the healthy soldier effect((40))), but our findings indicate that regardless of their better health, use of dietary supplements is very common among Australian military personnel.”
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“Also, by using nationwide registers from the National Board of Health and Welfare, the Military Archives, the Swedish Defense Recruitment Agency and Statistics Sweden, containing objective and standardized data on an individual level, it was possible to create a closely matched comparison group of non-deployed individ…”
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BackgroundBullman, T. A., Schneiderman, A., & Dursa, E. K. (2021) · Annals of Epidemiology · doi:10.1016/j.annepidem.2021.01.005 · Cited by 7
Kolaja, C. A., Castañeda, S. F., Woodruff, S. I., Rull, R. P., Armenta, R. F., & for the Millennium Cohort Study Team (2022) · PLoS ONE · doi:10.1371/journal.pone.0274973 · Cited by 7
“These results corroborate previous research on the Healthy Warrior 352 Effect that suggest deployed personnel have optimal health that protects them from later adverse 353 mental and physical outcomes.(44-46) Our results suggest that any advantage deployers had 354 prior to deployment may be attenuated if injured whil…”
ResultNissen, L. R., Stoltenberg, C., Nielsen, A. B. S., Vedtofte, M. S., Marott, J. L., Gyntelberg, F., & Guldager, B. (2016) · Military Medicine · doi:10.7205/milmed-d-15-00534 · Cited by 7
Sleep health among US Navy afloat versus ashore personnel in the Millennium Cohort Study
Jacobson, I. G., Harbertson, J., Sharifian, N., Rull, R. P., Steele, C. T., & Russell, D. W. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14207 · Cited by 5
The new study of UK nuclear test veterans
Kendall, G. M., & Little, M. P. (2022) · Journal of Radiological Protection · doi:10.1088/1361-6498/ac6a23 · Cited by 6
Maier, T., Rappel, M., Rhee, D.-S., Brill, S., Maderner, J., Pijahn, F., Gündel, H., Radermacher, P., Friemert, B., Becker, H.-P., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1011181 · Cited by 6
“Nevertheless these findings depend on the type and area of deployment as well as the follow-up time (64).”
BackgroundDid exposure to a severe outbreak of pandemic influenza in 1918 impact on long-term survival?
Wilson, N., BOYD, M., Nisa, S., CLEMENT, C., & Baker, M. G. (2016) · Epidemiology and Infection · doi:10.1017/s0950268816001606 · Cited by 6
“healthy soldier effect [12] (a selection effect analogous to the healthy worker effect).”
BackgroundPreconception Health Risk Factors in Women with and without a History of Military Service
McCabe, J. E., Katon, J. G., Ma, E., Fortney, J. C., Grote, N. K., Zephyrin, L., & Callegari, L. S. (2018) · Women s Health Issues · doi:10.1016/j.whi.2018.08.002 · Cited by 6
The Well-Being of Australian Service Mothers
Davy, C. P., Lorimer, M. F., McFARLANE, A. C., Hodson, S., Crompvoets, S., Lawrence‐Wood, E., & Neuhaus, S. J. (2015) · Women & Health · doi:10.1080/03630242.2015.1050541 · Cited by 5
Wilson, N., Clement, C., Boyd, M., Teng, A. M., Woodward, A. J., & Blakely, T. A. (2018) · Australian and New Zealand Journal of Public Health · doi:10.1111/1753-6405.12765 · Cited by 5
Who Are the Women Veterans in the Women’s Health Initiative?
Weitlauf, J. C., Washington, D. L., & Stefanick, M. L. (2016) · The Gerontologist · doi:10.1093/geront/gnv674 · Cited by 5
Kumar, R. G., Klyce, D. W., Nakase‐Richardson, R., Pugh, M. J., Walker, W. C., & Dams-O’Connor, K. (2022) · Journal of Neurotrauma · doi:10.1089/neu.2022.0340 · Cited by 4
“35,36 As our current-era troops approach older adulthood, there is strong motivation to understand the implications of past military and combat exposure among individuals with TBI.”
Cyr, K. S., Kurdyak, P. A., Smith, P. M., & Mahar, A. L. (2023) · Occupational and Environmental Medicine · doi:10.1136/oemed-2022-108772 · Cited by 4
“26 Further, not all members of the general population are well enough to be employed, and including these individuals in a comparator cohort could therefore exacerbate the HSE.”
Perceived Health Status and Medical Conditions Among US Active-Duty Service Members
Olapeju, B., Ahmed, A. E., Chu, K., Yoon, J., & Mancuso, J. D. (2023) · Psychology Research and Behavior Management · doi:10.2147/prbm.s429341 · Cited by 4
The prevalence and long-term effects of PTSD and moral injury in Swedish military veterans
Nilsson, S., Ohlsson, A., Svensén, S., & Larsson, G. (2025) · Frontiers in Sociology · doi:10.3389/fsoc.2025.1499411 · Cited by 5
“We suggest that a major reason for this finding is the Swedish Armed Forces’ selection requirements, which ensure that those eligible for international military missions are physically and mentally healthier than the general population (McLaughlin and Waller, 2008).”
Increased Postdeployment Use of Medication for Common Mental Disorders in Danish Gulf War Veterans
Nissen, L. R., Stoltenberg, C., Vedtofte, M. S., Nielsen, A. B. S., Marott, J. L., Gyntelberg, F., & Guldager, B. (2017) · Military Medicine · doi:10.7205/milmed-d-16-00114 · Cited by 4
Strand, L. Å., Rudvin, I., Martinsen, J. I., Fadum, E. A., & Grimsrud, T. K. (2023) · Occupational and Environmental Medicine · doi:10.1136/oemed-2023-108877 · Cited by 4
Nursing Care of Women Veterans of the Iraq and Afghanistan Wars
Conard, P. L., & Armstrong, M. L. (2018) · Nursing for Women s Health · doi:10.1016/j.nwh.2018.02.007 · Cited by 4
Mental Health Among Children Living with Veterans: A Literature Mapping
Rayce, S. B., Andersen, S. B., Jørgensen, A. K., & Nielsen, A. B. S. (2019) · Scandinavian Journal of Military Studies · doi:10.31374/sjms.8 · Cited by 4
Four Decades after War: Incident Diabetes among Women Vietnam-Era Veterans in the HealthViEWS Study
Schmidt, E. M., Magruder, K. M., Kilbourne, A. M., Stock, E. M., Cypel, Y., Félix, S. E. B., Serpi, T., Kimerling, R. E., Cohen, B. E., Spiro, A., et al. (2019) · Women s Health Issues · doi:10.1016/j.whi.2019.08.002 · Cited by 4
Jones, A. M., Cousineau-Short, Y. D., Galanakis, C., Weiss, D., & Hall, A. L. (2025) · Occupational and Environmental Medicine · doi:10.1136/oemed-2024-109924 · Cited by 3
“5 In contrast, other international studies have observed higher risk of overall cancer in specific Veteran subgroups compared with general populations 6 ; or of specific cancer types in active duty populations, such as melanoma, prostate and breast cancer.”
Cause-Specific Mortality Among Norwegian Veterans Deployed to Afghanistan Between 2001 and 2019
Strand, L. Å., Rudvin, I., Borud, E. K., Bøe, H. J., Nordstrand, A. E., & Fadum, E. A. (2022) · Military Medicine · doi:10.1093/milmed/usac075 · Cited by 3
Lee, S., Lee, H. K., Yoon, C., Jeon, H., & Saunders, J. B. (2022) · Psychiatry Investigation · doi:10.30773/pi.2021.0187 · Cited by 3
Caldwell, J. A., Knapik, J. J., Kusumpa, S., Roy, T. C., Taylor, K. M., & Lieberman, H. R. (2024) · Sleep Health · doi:10.1016/j.sleh.2024.09.004 · Cited by 3
Metadata
- Authors
- McLaughlin, R., Nielsen, L., & Waller, M.
- Affiliations
- The University of Queensland (AU)
- Corresponding author
- McLaughlin, Ruth
- Venue
- Annals of Epidemiology
- Publisher
- Elsevier BV
- Published
- 2008-12
- Volume
- 18
- Issue
- 12
- Pages
- 928-936
- ISSN
- 1047-2797 (ISSN-L)
- OpenAlex
- W1999317474
- Cited by
- 153
- References
- 39
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 14 · 2023: 14 · 2022: 15 · 2021: 8 · 2020: 9 · 2019: 10 · 2018: 9 · 2017: 11 · 2016: 9 · 2015: 10 · 2014: 4 · 2013: 1 · 2012: 7
- FWCI
- 11.09
- Type
- journal article
- Language
- en
- Update notices
- erratum (2015-02-01)
- Open access
- closed
- Locations
- Annals of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Performance
- Social Sciences › Education › Education and Military Integration
- Social Sciences › Political Science and International Relations › Military and Defense Studies
- Keywords
- military personnel, mortality, cancer mortality, external causes of death, all-cause mortality, standardized mortality ratio, military health
- MeSH terms
- Australia, Female, United Kingdom, Humans, Male, Military Personnel, Mortality, Neoplasms, Regression Analysis, United States, Veterans, Models, Statistical, Cohort Studies, Epidemiologic Studies
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