Erosion of the healthy soldier effect in veterans of US military service in Iraq and Afghanistan
Open accessAbstract
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.
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The physical and psychological stressors of military service erode the healthy soldier effect.
“However, the physical and psychological stressors of military service have been found to erode this effect.2”
From Factors associated with self-reported health among New Zealand military veterans: A cross-sectional study (2022) · cites this paper as [2]
The Conclusion (page not provided) reports that the healthy soldier effect had eroded in the studied Iraq and Afghanistan veteran cohorts. It suggests repeated deployments and survival from severe injuries as possible contributors, but does not establish that physical and psychological stressors caused the erosion; the Background mentions psychological conditions without linking them to that finding. (LLM, conf=0.86)
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- Authors
- Bollinger, M. J., Schmidt, S., Pugh, J. A., Parsons, H. M., Copeland, L. A., & Pugh, M. J.
- Affiliations
- The University of Texas at San Antonio Health Science Center (US)
- Central Texas Veterans Health Care System (US)
- Corresponding author
- Bollinger, Mary J
- ORCID
- Venue
- Population Health Metrics
- Published
- 2015-03-18
- Volume
- 13
- Issue
- 1
- Pages
- 8-8
- ISSN
- 1478-7954 (ISSN-L)
- PMC
- PMC4367975
- OpenAlex
- W2105697361
- Cited by
- 49
- References
- 33
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 5 · 2023: 8 · 2022: 7 · 2021: 3 · 2020: 4 · 2019: 6 · 2018: 4 · 2017: 5 · 2016: 3 · 2014: 1
- FWCI
- 12.66
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Population Health Metrics (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs (DHI-09-237)
- Office of Research and Development
- Health Services Research and Development (DHI 09-237)
- Topics
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
- Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- military veterans, mortality, Operation Enduring Freedom, Iraq War, Operation New Dawn, standardized mortality ratio, health care access, veterans' health, Iraq and Afghanistan deployment, Department of Veterans Affairs, indirect standardization, direct standardization, relative risk
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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.
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