Erosion of the Healthy Soldier Effect in Veterans of U.S. Military Service in Iraq and Afghanistan

Mary Bollinger, U.S. Department of Veterans Affairs
Susanne Schmidt, University of Texas at San Antonio
Jacqueline Pugh, VHA, STVHCS
Helen Parsons, University of Texas at San Antonio
Laurel Copeland, VHA, CTVHSC
Mary Jo Pugh, VHA, STVHCS

Background: This research explores the healthy soldier effect (HSE) - a lower mortality risk among Veterans relative to the general population--in United States (U.S.) Veterans deployed in support of operations in Iraq and Afghanistan (OEF/OIF/OND). Methods: Using U.S. Department of Veterans Affairs (VA) and DOD administrative data, we identified Veterans deployed in support of OEF/OIF/OND during 2002 and 2011. Indirect standardization was used to compare VA and DOD cohorts to the U.S. population. 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 HSE in these cohorts relative to the U.S. standard population. Conclusions: No support was found for HSE among U.S. Veterans of OEF/OIF/OND. These findings may be attributable to post-deployment risk taking behavior as well as the nature of the OEF/OIF/OND conflict.