Citation

Knapik JJ, Marin RE, Grier TL, Jones BH. BMC Public Health 2009; 9(1): 231.

Copyright

(Copyright © 2009, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/1471-2458-9-231

PMID

19594931

PMCID

PMC2720964

Abstract

BACKGROUND: This paper reports on a systematic review of the literature on the post-conflict injury-related mortality of service members who deployed to conflict zones. METHODS: Literature databases, reference lists of articles, agencies, investigators, and other sources were examined to find studies comparing injury-related mortality of military veterans who had served in conflict zones with that of contemporary veterans who had not served in conflict zones. Injury-related mortality was defined as a cause of death indicated by International Classification of Diseases E-codes E800 to E999 (external causes) or subgroupings within this range of codes. RESULTS: Twenty studies met the review criteria; all involved veterans serving during either the Vietnam or Persian Gulf conflict. Meta-analysis indicated that, compared with non-conflict-zone veterans, injury-related mortality was elevated for veterans serving in Vietnam (summary mortality rate ratio (SMRR)=1.26, 95% confidence interval (95%CI)=1.08-1.46) during 9 to 18 years of follow-up. Similarly, injury-related mortality was elevated for veterans serving in the Persian Gulf War (SMRR=1.26, 95%CI=1.16-1.37) during 3 to 8 years of follow-up. Much of the excess mortality among conflict-zone veterans was associated with motor vehicle events. The excess mortality decreased over time. Hypotheses to account for the excess mortality in conflict-zone veterans included post-traumatic stress, coping behaviors such as substance abuse, ill-defined diseases and symptoms, lower survivability in injury events due to conflict-zone comorbidities, altered perceptions of risk, and/or selection processes leading to the deployment of individuals who were risk-takers. CONCLUSIONS: Further research on the etiology of the excess mortality in conflict-zone veterans is warranted to develop appropriate interventions.

Language: en