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Adams RS, Forster JE, Gradus JL, Hoffmire CA, Hostetter TA, Larson MJ, Smith AA, Walsh CG, Brenner LA. Divergent trends in accidental deaths since return from an Afghanistan/Iraq deployment among army soldiers. Ann Epidemiol 2024; 91:23-29. [PMID: 38185289 DOI: 10.1016/j.annepidem.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
PURPOSE Accidental death is a leading cause of mortality among military members and Veterans; however, knowledge is limited regarding time-dependent risk following deployment and if there are differences by type of accidental death. METHODS Longitudinal cohort study (N = 860,930) of soldiers returning from Afghanistan/Iraq deployments in fiscal years 2008-2014. Accidental deaths (i.e., motor vehicle accidents [MVA], accidental overdose, other accidental deaths), were identified through 2018. Crude and age-adjusted mortality rates, rate ratios, time-dependent hazard rates and trends postdeployment were compared across demographic and military characteristics. RESULTS During the postdeployment observation period, over one-third of deaths were accidental; most were MVA (46.0 %) or overdoses (37.9 %). Across accidental mortality categories (all, MVA, overdose), younger soldiers (18-24, 25-29) were at higher risk compared to older soldiers (40+), and females at lower risk than males. MVA death rates were highest immediately postdeployment, with a significant decreasing hazard rate over time (annual percent change [APC]: -6.5 %). Conversely, accidental overdose death rates were lowest immediately following deployment, with a significant increasing hazard rate over time (APC: 9.9 %). CONCLUSIONS Observed divergent trends in risk for the most common types of accidental deaths provide essential information to inform prevention and intervention planning for the immediate postdeployment transition and long-term.
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Affiliation(s)
- Rachel Sayko Adams
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, MA, USA; Brandeis University, The Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA, USA; Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA.
| | - Jeri E Forster
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA; University of Colorado, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, Aurora, CO, USA
| | - Jaimie L Gradus
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Claire A Hoffmire
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA; University of Colorado, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, Aurora, CO, USA
| | - Trisha A Hostetter
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
| | - Mary Jo Larson
- Brandeis University, The Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA, USA
| | - Alexandra A Smith
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
| | - Colin G Walsh
- Vanderbilt University Medical Center, Departments of Biomedical Informatics, Medicine, and Psychiatry, Nashville, TN, USA
| | - Lisa A Brenner
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA; University of Colorado, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, Aurora, CO, USA; University of Colorado, Departments of Psychiatry and Neurology, Anschutz Medical Campus, Aurora, CO, USA
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