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Higher Than Expected Mortality Rates in Post-9/11 Veterans With Moderate to Severe TBI
Post-9/11 US military veterans, especially those exposed to traumatic brain injury (TBI), have a higher mortality burden across multiple causes of death compared with the total US population, according to a study published in JAMA Network Open.
“In our cohort, excess deaths were observed from accident, suicide, cancer, and homicide, although suicide and accidental deaths were by far the biggest contributors,” wrote lead author Jeffrey T. Howard, PhD, University of Texas at San Antonio, and coauthors. “In fact, these 2 causes of death were associated with an estimated 6849 excess deaths, 1393 more deaths than the total number of combat deaths experienced over 20 years of war.”
The cohort study included data for 2.5 million military veterans who served during the Global War on Terrorism after the 9/11 terrorist attacks. Researchers investigated all-cause and cause-specific mortality that occurred between January 1, 2002, and December 31, 2018, stratified by the presence and severity of TBI, compared with the general population.
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Among veterans in the study, 17.5% had mild TBI and 3.0% had moderate to severe TBI. A total 30,564 deaths occurred during the study period.
Post-9/11 military veterans had higher adjusted, age-specific mortality rates, which increased with TBI severity, than the general population, the study showed.
US veterans had excess deaths caused by accident (2631), suicide (4218), cancer (378), and homicide (415). Deaths were lower among veterans in the categories of cardiovascular disease (-1202) and “all other causes” (-2583) compared with the general population, resulting in a reported 3858 excess deaths overall among veterans.
Among the excess deaths, 275 of the veterans were not exposed to TBI, 2285 had mild TBI, and 1298 had moderate to severe TBI. Although just 3.0% of the total cohort, veterans exposed to moderate to severe TBI accounted for 33.6% of the total excess deaths, “11-fold higher than would otherwise be expected,” researchers noted.
“After 20 years of war, it is vital to focus attention on what puts veterans at risk for accelerated aging and increased mortality, as well as how it can be mitigated,” the authors advised.
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