Higher death rates for post-9/11 US military personnel with TBI

February 17, 2022

2 minute read


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According to the study results, US military veterans with traumatic brain injury who served after the September 11, 2001, terrorist attacks had higher death rates than other veterans and the general US population.

“There is emerging evidence that TBI is associated with a significantly increased risk of mental health diagnoses, including PTSD, depression, anxiety, and dementia, as well as cardiovascular disease and premature death, Jeffrey T. Howard, PhD, from the University of Texas at San Antonio, and his colleagues wrote in Open JAMA Network. “However, the extent of all-cause and cause-specific mortality associated with TBI exposure among post-9/11 veterans remains unclear.”

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The researchers sought to assess mortality rates and estimate the number of excess deaths among US veterans, with and without TBIs, who served after 9/11 compared to the general US population.

The cohort study analyzed administrative and mortality data from January 1, 2002, through December 31, 2018, for more than 2.5 million military men and women who served in the Global War on Terror. The researchers included veterans who received treatment for 3 or more years in the military healthcare system or who required 3 or more years of care in the military healthcare system as well as 2 or more years of treatment with the Veterans Health Administration. They used data from the Veterans Affairs/Department of Defense Repository database and compared it to information from the CDC and Prevention WONDER database for the general US population.

Data analysis was performed from June 16 to September 8, 2021.

The results showed that 17.5% of post-9/11 veterans had mild traumatic brain injury and 3% had moderate to severe traumatic brain injury. There have been 30,654 deaths. Adjusted and age-specific mortality rates were higher for veterans than for the total US population and increased with TBI severity.

There were approximately 3,858 (95% CI, 1,225-6,490) additional deaths among all veterans after 9/11. Of these, approximately 275 (95% CI, 1435-1985) had no TBI, 2285 (95% CI, 1637-2933) had mild TBI, and 1298 ( 95%, 1023-1572) had moderate to severe TBI.

Further analysis showed that the estimated excess mortality came largely from suicide (4,218; 95% CI, 3,621-4,816) and accidents (2,631; 95% CI, 1,929-3,333). Additionally, veterans with moderate to severe TBI accounted for 33.6% of the total excess deaths, 11 times more than expected.

“Our study suggests that post-9/11 military veterans face a higher mortality burden from multiple causes of death than the total US population,” Howard and colleagues wrote. “After 20 years of war, it is essential to focus on what puts veterans at risk of accelerated aging and increased mortality, and how it can be mitigated.”

In a related editorial, Mark A. Reger, PhD, from the Puget Sound Veterans Health Care System, and colleagues said Howard’s study provides a necessary and vital counterweight to the traditional analysis of deaths in military populations.

“This finding adds to literature that suggests the post-9/11 cohort differs significantly from previous military cohorts,” Reger and colleagues wrote. “Historically, military populations have generally had lower death rates than the general population.”

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