Postservice Mortality in Vietnam Veterans

National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 10/2004; 164(17):1908-16. DOI: 10.1001/archinte.164.17.1908
Source: PubMed


During the 1980s, the postservice mortality component of the Vietnam Experience Study was conducted to examine the health effects of the Vietnam experience. This study was limited by the relatively short follow-up and the young age of the veterans. Thus, a follow-up mortality investigation on this cohort was undertaken to further assess the impact of the Vietnam experience on chronic conditions.
Vital status and underlying cause-of-death data on the Vietnam Experience Study cohort (18 313 male US Army veterans) were retrospectively ascertained from the end of the original study through 2000. Cox proportional hazards regression was used to calculate crude and adjusted rate ratios (RRs) for all-cause and cause-specific mortality, comparing Vietnam and non-Vietnam veterans.
All-cause mortality was 7% higher in Vietnam vs non-Vietnam veterans during 30-year follow-up (95% confidence interval [CI], 0.97-1.18). The excess mortality among Vietnam veterans was isolated to the first 5 years after discharge from active duty and resulted from an increase in external causes of death (RR, 1.62; 95% CI, 1.16-2.26). Cause-specific analyses revealed no difference in disease-related mortality. Vietnam veterans, however, experienced excess unintentional poisoning (RR, 2.26; 95% CI, 1.12-4.57) and drug-related (RR, 1.70; 95% CI, 1.01-2.86) deaths throughout follow-up.
Vietnam veterans continued to experience higher mortality than non-Vietnam veterans from unintentional poisonings and drug-related causes. Death rates from disease-related chronic conditions, including cancers and circulatory system diseases, did not differ between Vietnam veterans and their peers, despite the increasing age of the cohort (mean age, 53 years) and the longer follow-up (average, 30 years).

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Available from: Tegan Boehmer, Jul 22, 2014
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    • "• Adjusted Suicide Relative Risk 0.90, CI 0.44-1.85. Boehmer et al., 2004 • 18,313 Army Vietnam Veterans; • Discharge (1965-1977)-2000 Retrospective Cohort Study Completed Suicide • 0-5 years from discharge, 34.5% Veterans and 20.1% non-Veterans committed suicide for a Crude Rate Ratio (CRR)=1.72, CI 0.76-3.88; "
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    ABSTRACT: The number of female veterans is increasing. Veterans Administration (VA) enrollment increased over 40% from past eras. However, little research has focused on their mental health. We reviewed literature to examine associations of substance use with suicide in female veterans, identify research gaps, and inform future studies. Google Scholar, Pub Med, and PsychINFO were searched using: substance use, female veteran, and suicide. Exclusion criteria (e.g., not discussing U.S. veterans) left 17 articles. Nine studies examined completed suicide among veterans. In most recent years, rates of deaths were greater for veterans than nonveterans, including females. Completed suicide was associated with past trauma, young age, and a mental disorder. Studies have often not addressed substance use. Three studies examined completed suicide among VA treated veterans without examining substance use as an associated factor. Rates of completed suicides were also higher among veterans than nonveterans, including females. A large proportion of females also had a mental diagnosis. Five studies examined substance use and attempted or completed suicide among VA treated veterans. Veterans in poor mental health had increased odds of suicide mortality; women with a substance use disorder (SUD) had a higher hazard ratio for completed suicide than men with a SUD. Engagement in substance abuse treatment decreased odds of suicide attempt among veterans. Available data suggest that suicide rates are higher among female veterans than women in the general population. Substance use may increase the likelihood of suicidal behaviors among female veterans, particularly those with a mental diagnosis.
    Full-text · Article · Nov 2013 · Drug and alcohol dependence
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    • "Past research has demonstrated that all-cancer incidences in US Ranch Hand veterans (SIR, 1.08) and Australian veterans (SIR, 1.15) were not lower than in the general population [8,10], whereas the incidence in occupationally TCDD-exposed workers was lower than in the general population [15,16]. In mortality studies, Vietnam veterans have usually been found to have a lower death rate than the general population [5,8,17-19]. A "healthy soldier effect" can explain why the all-cancer incidence in the veterans was lower than in the general population. "
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    ABSTRACT: The aim of this study was to investigate the association between Vietnam experience including exposure to military herbicides and cancer incidence in Korean Vietnam War veterans. The cancer cases of 185 265 Vietnam veterans from January 1, 1992 to December 31, 2003 were confirmed from the Korea National Cancer Incidence Database. The age-adjusted incidence and standardized incidence ratios (SIRs) were calculated using the male population during 1992 to 2003 as a standard population. The age-adjusted overall cancer incidence per 100 000 person-years was 455.3 in Vietnam veterans. The overall cancer incidence was slightly yet significantly lower in veterans (SIR, 0.97; 95% confidence interval, 0.95 to 0.99) than in the general population. The overall cancer incidence in enlisted soldiers was not lower (SIR, 1.00), whereas that in officers was significantly lower (SIR, 0.87) than in the general population. The incidences of prostate cancer and T-cell lymphoma in all veterans, and lung cancer and bladder cancer in enlisted soldiers, and colon cancer and kidney cancer in non-commissioned officers, and colon cancer, kidney cancer, and prostate cancer in officers, were higher than in the general population. The SIR for overall cancer among Vietnam veterans rose from 0.92 for 1992-1997 to 0.99 for 1998-2003. The overall cancer incidence in Vietnam veterans was not higher than in the general male population. Vietnam veterans and military rank subcohorts experienced a higher incidence of several cancers, including prostate cancer, T-cell lymphoma, lung cancer, bladder cancer, kidney cancer, and colon cancer than the general population. The SIR for overall cancer increased over time in Vietnam veterans.
    Full-text · Article · Nov 2013
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    • "Furthermore, death rates from circulatory system diseases did not differ between Vietnam veterans and their peers [11] and female Vietnam veterans had significant lower-than-expected deaths from circulatory diseases [12]. On the other hand, results from the studies by Modan, et al [7] and Boscarino [8] are not necessarily conflicting with the studies by Johnson et al [9,10], Boehmer et al [11] and Thomas et al [12], as the former studies looked only at the subset of veterans with physical injury or PTSD, while the latter studies assessed all veterans exposed to combat. "
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    ABSTRACT: Wartime stress has been associated with increased late-life mortality of all causes of death. We evaluated whether wounded Finnish World War II veterans who were alive at the age of 55 have increased long-term coronary heart disease (CHD) mortality. Health survey data were recorded in 1980 from 667 men, aged 55 years. Of them 102 had been wounded or injured in action during 1939-1945. The remaining participants served as the comparison group. The death certificates during a 28-year follow-up were obtained from the national statistics centre. Statistical comparisons were done by Cox proportional hazard regression model. There were altogether 140 deaths from CHD. In men who had been wounded or injured in action the crude CHD mortality rate per 10,000 population was 2843, while in the comparison group the corresponding figure was 1961. Men who had been wounded or injured in action were 1.7 times (95% CI 1.1-2.5; p = 0.01) more likely to die from CHD than the comparison group. Physical trauma at young adulthood may extend to lifelong effects on health. This study suggests that being physically wounded or injured in war may lead to increased CHD mortality in late adulthood in a Finnish population.
    Full-text · Article · Feb 2011 · BMC Public Health
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