The DOI matches its Crossref record; 38 of the 39 references it cites were found in a registry or an index.
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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]
In the citing paper
“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]
Citations
Cites
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
Fox, A. J., & Collier, P. F. (1976) · Journal of Epidemiology & Community Health · doi:10.1136/jech.30.4.225 · Cited by 465
Mortality among U.S. Veterans of the Persian Gulf War
Kang, H. K., & Bullman, T. A. (1996) · New England Journal of Medicine · doi:10.1056/nejm199611143352006 · Cited by 319
Observations on the Healthy Worker Effect
Monson, R. R. (1986) · Journal of Occupational and Environmental Medicine · doi:10.1097/00043764-198606000-00009 · Cited by 233
Mack, T. M. (1995) · Cancer · doi:10.1002/1097-0142(19950101)75:1+ · Cited by 174
Choi, B. C. K. (1992) · PubMed · Cited by 151
Anatomy of the healthy worker effect: a critical review.
Wen, C. P., Tsai, S. P., & Gibson, R. L. (1983) · PubMed · Cited by 130
Observations on the Evaluation of Occupational Mortality Data
McMichael, A. J., Haynes, S., & Tyroler, H. A. (1975) · Journal of Occupational and Environmental Medicine · doi:10.1097/00043764-197502000-00019 · Cited by 123
EFFECTS OF SELECTION ON MORTALITY1
Seltzer, C. C., & Jablon, S. (1974) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a112047 · Cited by 109
The Registrar-General's Statistical Review of England and Wales for the Year 1945
(1946) · Public Health · doi:10.1016/s0033-3506(46)80291-9 · Cited by 105
Flagged first, then by citations
1 of the 39 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Items 101–153 of 153
Military Veterans’ Psychological Health and Physical Activity After Separation From Service
Waldhauser, K. J., Hives, B. A., Liu, Y., Puterman, E. M., Sharifian, N., Castañeda, S. F., Carey, F. R., Rull, R. P., & Beauchamp, M. R. (2025) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2025.04.012 · Cited by 4
Bullman, T. A., & Schneiderman, A. (2019) · Cancer Epidemiology · doi:10.1016/j.canep.2019.07.002 · Cited by 3
Military Service, Education, and Mortality Across Cohorts from World War II to the Post-Vietnam Era
Cassidy, S. P., MacLean, A., & Denney, J. T. (2023) · Population Research and Policy Review · doi:10.1007/s11113-023-09815-w · Cited by 4
“People have consistently been chosen to serve in the armed forces on the basis of characteristics that should lead them to have better average health (McLaughlin et al., 2008).”
BackgroundMethodInfluentialGender differences in mental health outcomes among Afghanistan veterans exposed to war zone trauma
Rønning, L., Nordstrand, A. E., Hjemdal, O., & Bøe, H. J. (2024) · Journal of Traumatic Stress · doi:10.1002/jts.23015 · Cited by 3
Kang, J., & Song, Y. (2016) · Vaccine · doi:10.1016/j.vaccine.2016.10.076 · Cited by 3
Wilson, N., Clement, C., Summers, J. A., Thomson, G., & Harper, G. (2021) · BMJ Military Health · doi:10.1136/bmjmilitary-2021-001991 · Cited by 3
Skopp, N. A., Smolenski, D. J., Boyd, C. C., Shank, L. M., Bellanti, D. M., Lara‐Ruiz, J., Evatt, D. P., & Kelber, M. S. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.07.020 · Cited by 2
Mortality Among Male U.S. Army Soldiers Within 18 Months of Separation
Abdur-Rahman, I., Watkins, E. Y., Jarvis, B. P., Beymer, M. R., Schoenbaum, M., Bossarte, R. M., Pecko, J. A., & Cox, K. L. (2020) · Military Medicine · doi:10.1093/milmed/usaa511 · Cited by 2
“Other diseases of the circulatory system f 11 Hypertension and hypertensive renal disease 6 Atherosclerosis 0 All other diseases 221 (15) Symptoms, signs, and lab findings 73 (5) Chronic liver disease and cirrhosis 39 (3) Diabetes mellitus 21 (1) Influenza and pneumonia 14 (1) Chronic lower respiratory diseases 10 (1)…”
BackgroundAngelis, R. D., Piciocchi, A., Bugani, M., Rossi, S., Lastilla, M., Vento, R., Autore, A., Sebastiani, N., Palomba, S., Manno, V., et al. (2022) · Environmental Research · doi:10.1016/j.envres.2022.113029 · Cited by 3
Military Service and Health Outcomes of the Elderly in China
Zhao, C., Guo, J., & Yan, J. (2023) · Armed Forces & Society · doi:10.1177/0095327x221149423 · Cited by 2
“On one hand, due to strict screening of physical conditions before joining the army, veterans may be healthier than civilians, which is called the “healthy soldier effect” (McLaughlin et al., 2008).”
BackgroundResultKoterov, A. N., Ushenkova, L. N., Kalinina, M. V., & Biryukov, A. P. (2023) · Medical Radiology and radiation safety · doi:10.33266/1024-6177-2023-68-4-43-50 · Cited by 2
Narratives of holistic mental health recovery in New Zealand Defence Force personnel
Grimm, C. J., de Terte, I., Hodgetts, D., & Kearney, S. (2023) · Military Psychology · doi:10.1080/08995605.2023.2250708 · Cited by 2
“While NZDF personnel exhibit healthy soldier effects (McBride et al., 2022; McLaughlin et al., 2008), NZDF has a high proportion of at-risk groups for mental distress and suicidal behavior, specifically young males and Māori (Stuart & Bennett, 2017).”
Houtkooper, A., Wingelaar, T. T., Endert, E. L., & van Ooij, P.-J. A. (2023) · Diving and Hyperbaric Medicine Journal · doi:10.28920/dhm53.3.218-223 · Cited by 2
DeBlois, J. P., London, A. S., & Heffernan, K. S. (2024) · PLoS ONE · doi:10.1371/journal.pone.0298366 · Cited by 2
“One mechanism that might be associated with lower risk of hypertension is the positive selection of the most physically and mentally fit at the time of induction or assignment to combat roles—the so-called “healthy soldier” and “healthy deployer” effects [21,22].”
BackgroundMilitary experience and mortgage stress
Hu, M., & Su, Y. (2025) · International Review of Financial Analysis · doi:10.1016/j.irfa.2025.104237 · Cited by 2
Klein, S., & Alexander, D. M. (2012) · Cited by 2
Carey, F. R., Jacobson, I. G., Roenfeldt, K. A., & Rull, R. P. (2021) · Obesity Science & Practice · doi:10.1002/osp4.556 · Cited by 2
“This fitness for service is analogous to the healthy warrior effect where service members are often healthier than their civilian counterparts.(10,11) Additional T A B L E 1 (Continued)”
BackgroundOpioid prescribing to US military members
Larson, M. J., Ritter, G. A., & Adams, R. S. (2023) · Regional Anesthesia & Pain Medicine · doi:10.1136/rapm-2023-105067 · Cited by 2
“Both studies suggest a poten - tial ‘healthy warrior’ effect, 3 where military members healthy enough to deploy and remain in service are less likely to receive opioids.”
BackgroundMortality Among Individuals Released From U.S. Prisons: Does Military History Matter?
McNeeley, S., Morgan, M. A., Logan, M. W., Hazelwood, A. R., & Clark, V. A. (2023) · Armed Forces & Society · doi:10.1177/0095327x231218893 · Cited by 1
“…have historically evinced lower all-cause mortality rates when compared with the general population—a phenomenon known as the “healthy soldier effect” (McLaughlin et al., 2008)— recent findings suggest that this effect is eroding among U.S. veterans who served in Iraq and Afghanistan (Bollinger et…”
Bäckström, P. (2024) · Scandinavian Journal of Military Studies · doi:10.31374/sjms.239 · Cited by 1
Comparing Veteran and Nonveteran Epigenetic Aging in a Representative Sample of United States Adults
Nwanaji‐Enwerem, J. C., Khodasevich, D., Gladish, N., Shen, H., Daredia, S., Needham, B. L., Rehkopf, D. H., & Cárdenas, A. (2025) · Military Medicine · doi:10.1093/milmed/usaf071 · Cited by 1
Zhu, Y., Hall, C. B., Sharifian, N., Boparai, S. K., Carey, F. R., Boyko, E. J., Dursa, E. K., & Rull, R. P. (2025) · BMC Public Health · doi:10.1186/s12889-025-25507-w · Cited by 1
“The reduced mortality risks of the healthy soldier effect may be stronger among cohorts with younger military populations and decrease as follow-up time (i.e., time since separating from the military) increases [26, 32, 35, 36].”
InfluentialClark, A. L., Asimakopoulos, G., Valocchi, E., Coffinier, C., McGill, M. B., Thomas, K. R., Jester, D. J., Logue, M. W., & Merritt, V. C. (2026) · Neurology · doi:10.1212/wnl.0000000000214748 · Cited by 1
Borowski, S. C., Kumar, S. A., Caine, E. D., Karras, E., Gamble, S. A., & Vogt, D. S. (2026) · Journal of Behavioral Medicine · doi:10.1007/s10865-026-00657-3 · Cited by 1
“It is also possible that this finding is partially due to the “healthy worker effect,” with some veterans completing service after a shorter time because of health or other personal challenges that contribute to poorer transition outcomes (McLaughlin et al., 2008).”
Benakovic, R., Wilson, M. J., Kealy, D., Rice, S., Oliffe, J. L., Sharp, P., & Seidler, Z. E. (2023) · Counselling Psychology Quarterly · doi:10.1080/09515070.2023.2276219 · Cited by 1
“…for successful military team environments, with military service acting as a protective factor for health, especially in relation to physical health and lower mortality risk (McLaughlin, Nielsen, & Waller, 2008; Sullivan-Baca, Rehman, & Haneef, 2023; Wilson, Horsley, & van der Hoek, 2005).”
Veteran Single Parents: Surviving but Not Thriving
Smucker, S., Ruder, T., Yi, S., & Farris, C. A. (2024) · Rand health quarterly · doi:10.7249/rhq-11-03-09 · Cited by 1
Differential lifespan impacts on veterans by war exposure in the First World War
Wilson, N., Clement, C., Summers, J. A., Thomson, G., & Harper, G. (2022) · BMJ Military Health · doi:10.1136/military-2022-002278 · Cited by 1
“It was able to utilise a “natural experiment” involving relatively comparable cohorts (war-exposed vs non-war) which had been through a similar selection process into the military as so avoid the “healthy solider effect”.(8) This study is therefore probably one of the most detailed to date of lifespan of military pers…”
MethodCANCER INCIDENCE AND CAUSE-SPECIFIC MORTALITY FOLLOWING BALKAN DEPLOYMENT
Schram-Bijkerk, D., Bogers, R. P., Schouten, L. J., Kiemeney, B. L. A. L. M., & van Leeuwen, F. E. (2011) · ISEE Conference Abstracts · doi:10.1289/isee.2011.00519 · Cited by 1
“These decreased mortality rates are generally attributed to a better health and fitness of military personnel, which is known as the ‘healthy soldier effect’ (33).”
BackgroundInfluentialFrazier, E. (2022) · doi:10.18297/etd/3885 · Cited by 1
Bove, F. (2024) · Research Square · doi:10.21203/rs.3.rs-4171975/v1 · Cited by 1
Gaffey, A. E., Chang, T. E., Brandt, C., Haskell, S. G., Dhruva, S. S., Bastian, L. A., Levine, A., Melissa, S., & Burg, M. M. (2024) · medRxiv · doi:10.1101/2024.04.22.24306203 · Cited by 1
“…to a lingering healthy soldier effect in the initial years following service, 32 which has been estimated to lower health-related risk by 10%-25%, 33 to underdiagnosis of hypertension among this complex patient population, and to slightly different inclusion criteria as NHANES participants can…”
BackgroundEvaluation of Autopsied Military Deaths in Elazığ
Tokdemır, M., Türkoğlu, A., Tunçez, F. T., & Börk, T. (2015) · Turkiye Klinikleri Journal of Forensic Medicine · doi:10.5336/forensic.2015-44969
“Turkiye Klinikleri J Foren Med 2015;12(1)”
Baby Boomers and the Vietnam War: A life Course Approach to Aging Vietnam Veterans
Marsala, M. S. (2015) · ScholarsArchive (Brigham Young University) · doi:10.13140/rg.2.2.34582.80961
Oxlade, D. (2016) · The University of Queensland · doi:10.14264/uql.2016.1089
Willis, E. A. (2019) · Journal of International Crisis and Risk Communication Research
Bossarte, R. M., & Riggs-Donovan, C. A. (2020) · Psychiatry · doi:10.1080/00332747.2020.1804787
Johnston, D. W., Shields, M. A., & Siminski, P. (2015) · SSRN Electronic Journal · doi:10.2139/ssrn.2568048
Professional driver mortality in 9 countries: a systematic review and meta-analysis
Koterov, A. N., & Ushenkova, L. N. (2023) · Russian Journal of Occupational Health and Industrial Ecology · doi:10.31089/1026-9428-2023-63-5-315-326
Lin, P., Lee, Y., Wang, R.-S., Chen, T.-Y., Li, Y., Wu, Y., Hsu, T., & Chang, Y. (2023) · Military Medicine · doi:10.1093/milmed/usad198
Australian veteran sexual health: ‘…you are the first person I’ve spoken to about it.’
Douvos, K., Bourchier, L., Temple-Smith, M. J., & Malta, S. (2025) · Sexual Health · doi:10.1071/sh24152
Mortality Among Norwegian Military Veterans From Peacekeeping Service in Kosovo During 1999-2020
Strand, L. Å., Rudvin, I., Vejrup, K., & Fadum, E. A. (2025) · Military Medicine · doi:10.1093/milmed/usaf123
Dodge, J., Sullivan, K. S., Merrill, J. C., Clarke-Walper, K. M., Riviere, L. A., Wortham, W. K., & Castro, C. A. (2025) · Armed Forces & Society · doi:10.1177/0095327x251333077
“…including spouses and children, do not have to meet specific health requirements, eliminating the “healthy soldier effect” which is often invoked to explain better health outcomes among service members (Borah & Fina, 2017; Military Spouse and Family Benefits [MSFB], 2020; McLaughlin et al., 2008).”
Strand, L. Å., Rudvin, I., Vejrup, K., & Fadum, E. A. (2025) · Military Medicine · doi:10.1093/milmed/usaf262
Choi, H. J., Fadum, E. A., Ekhaugen, L., Haaland, T. L., Strand, L. Å., & Vejrup, K. (2025) · Military Medicine · doi:10.1093/milmed/usaf387
Angelis, R. D., Rossi, S., Bugani, M., Autore, A., Lastilla, M., Vento, R., Rocchetti, A., Guzzinati, S., Vicentini, M., Manno, V., et al. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1605457 · Cited by 1
Knowing is half the battle: veteran status and cardiovascular disease risk among women
Goldstein, K. M., & Bean‐Mayberry, B. (2025) · Baylor University Medical Center Proceedings · doi:10.1080/08998280.2025.2581478
“4 This effect is often invoked to describe the pattern of good health among current and recent active-duty members relative to civilian counterparts due to strict physical eligibility criteria at enlist-ment and health and weight restrictions while serving.”
Wilson, S. E. (2025) · American Journal of Men s Health · doi:10.1177/15579883251397903
Smith, A. C., McKenzie, A. R., Godier-McBard, L. R., Fear, N. T., & Stevelink, S. A. M. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-108672
Potter, A. W., Tharion, W. J., Looney, D. P., Murphy, C. E., & Friedl, K. E. (2026) · Research Square · doi:10.21203/rs.3.rs-9654631/v1
Prevalence of voice disorders in military personnel: a systematic review and meta-analysis
Morawska, J., Politański, P., Nowak, W., Przegalińska, K., Mędrala, K., & Pietruszewska, W. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1942500
Jones, A. M., Cousineau-Short, Y. D., Galanakis, C., & Hall, A. L. (2026) · Journal of Military Veteran and Family Health · doi:10.3138/jmvfh-2025-0110
Goh, M. S., Shudee, W., Junge, J. M., & McGee, M. R. (2026) · Military Medicine · doi:10.1093/milmed/usag463
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
