Brig. Gen. William Smith, 36th Infantry Division deputy commander of maneuvers, addresses soldiers with Alpha and Bravo Company, 1st Regiment of the 141st Infantry Battalion, 72nd Infantry Brigade Combat Team after their arrival at Fort Bliss, TX, in 2010. The two units returned from Camp Victory, Baghdad after deploying to Iraq with the 72nd IBCT in December 2009. A new study looked at accidental deaths among returning soldiers from Iraq and Afghanistan. Photo by Sgt. Melissa Bright
BOSTON — Following the return of Army soldiers from deployment in Afghanistan and Iraq, motor vehicle accident (MVA) rates were highest among soldiers in the first few years after deployment and decreased considerably over time, while accidental overdose deaths were lowest immediately after deployment and increased steeply over time, according to a recent study.
The longitudinal cohort study, published in the Annals of Epidemiology, determined if risk for accidental death overall, or the most common types of accidental deaths, varied over time in relation to when a soldier returned from a combat deployment.1
Prior research with military members who have served since 9/11 has found that accidental death is the most common type of mortality among this population, yet very little is known about “time-dependent risk following deployment and, if there are differences by type of accidental death,” the study authors explained. This information can “inform more tailored and targeted prevention and intervention planning as soon as military members return from deployment and throughout their lives as veterans,” the authors suggested.
The study authors are affiliated with VA Rocky Mountain Mental Illness Research Education and Clinical Center in Aurora, CO; Boston University School of Public Health in Boston; Brandeis University in Waltham, MA; University of Colorado in Aurora, CO; and Vanderbilt University Medical Center in Nashville, TN.
Data for the study were from the Substance Use and Psychological Injury Combat Study (SUPIC), an observational, population-based, longitudinal cohort study of all Army soldiers returning from an Afghanistan/Iraq deployment ending in fiscal years 2008 to 2014, the study reported. Deployment data were from the Contingency Tracking System maintained by the Defense Manpower Data Center, and demographic characteristics were from the Defense Enrollment Eligibility Records System, the authors pointed out.
All-cause mortality data were from the VA/DoD Mortality Data Repository (MDR), which contains National Death Index (NDI) data of death records from state vital statistics offices, the study explained. The Defense Health Agency at the DoD provided access to de-identified study data after appropriate human subjects’ approvals and data sharing agreements were in place, according to the authors.
In the study, accidental deaths (motor vehicle accidents [MVA], accidental overdose and other accidental deaths) were identified through 2018. The researchers compared “crude and age-adjusted mortality rates, rate ratios, time-dependent hazard rates and trends postdeployment” across demographic and military characteristics, according to the study.
“In our study of over 860,000 Army soldiers who returned from an Afghanistan/Iraq deployment in 2008 to 2014, we found divergent trends in mortality rates for the two most common types of accidental death in the years following deployment return: motor vehicle accidents (MVA) and accidental overdose death,” Rachel Sayko Adams, PhD, MPH, a research associate professor at Boston University School of Public Health, told U.S. Medicine. “Specifically, we found that MVA mortality rates were highest among soldiers in the first few years following their return from deployment, and these rates decreased substantially over time. Death rates from accidental overdoses, however, were lowest in the immediate years post-deployment, and increased sharply over time.”
The authors observed that “risk for accidental overdose deaths steadily increased during the first decade after returning from combat deployment, with no observed leveling off of risk through the end of 2018,” Adams explained.
Substance-Use Screening
“This implies that healthcare professionals working in the Department of Defense, Veterans Affairs, the Indian Health Service or civilian settings serving veterans should continue to screen for excessive substance use and refer to treatment when needed,” she noted. “Our findings suggest that efforts to reduce excessive alcohol use and prevent development of addiction for military members and veterans should be high priority.”
The study also found that “among all accidental deaths, younger soldiers between 18 and 24 years old were at highest risk, followed by soldiers aged 25 to 34, compared to soldiers ages 40 and above, and males were at higher risk than females,” Adams pointed out.
“In addition to the accidental overdose deaths being directly related to substance use, we speculate that a portion of the MVA deaths may have also been related to driving while under the influence of alcohol,” she advised. “Interventions to reduce risky driving and excessive substance use, and to prevent overdose, are of critical importance following combat deployment, particularly for the youngest, predominantly male military members.”
These accidental death trends are also found in Army soldiers who returned from other deployment locations and time periods. “Similar to our findings, previous studies with both Persian Gulf War veterans and Vietnam veterans have found that risk for MVA deaths were highest in the first several years following return from deployment,” Adams wrote. A study published in the American Journal of Epidemiology investigated mortality among U.S. veterans of the Persian Gulf War.2
The current study’s findings are “consistent with studies from previous conflicts which found that MVA mortality rates were highest among soldiers in the first few years following their return from deployment, which suggests that efforts to reduce risky driving and driving while under the influence are critical as military members are reintegrating following deployment,” she added.
“Because younger, male soldiers—who comprise the majority of those who serve and deploy—had the highest risk for MVA death following deployment, this finding suggests that universal public health interventions would be most efficient,” Adams explained.
The nation’s opioid epidemic also could play a role in the current study’s findings.
“Our study period overlapped with the opioid and overdose epidemic in the U.S., which meant that soldiers in this study were serving and returning from deployment during a time when prescription opioids were being prescribed at very high rates and in more risky ways,” according to Adams. “In fact, our previous research with this cohort found that prescription opioid receipt was very high during the first year following deployment return. Future studies should examine if military members who received prescription opioids while in military service are at higher risk for accidental overdose death years later.”3
- 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 Jan 5;91:23-29. doi: 10.1016/j.annepidem.2024.01.002. Epub ahead of print. PMID: 38185289.
- Han K. Kang, Tim A. Bullman, Mortality among US Veterans of the Persian Gulf War: 7-Year Follow-up, American Journal of Epidemiology, Volume 154, Issue 5, 1 September 2001, Pages 399–405, https://doi.org/10.1093/aje/154.5.399
- Rachel Sayko Adams, Cindy Parks Thomas, Grant A Ritter, Sue Lee, Mayada Saadoun, Thomas V Williams, Mary Jo Larson, Predictors of Postdeployment Prescription Opioid Receipt and Long-term Prescription Opioid Utilization Among Army Active Duty Soldiers, Military Medicine, Volume 184, Issue 1-2, January-February 2019, Pages e101–e109, https://doi.org/10.1093/milmed/usy162