Post-9/11 veterans are dying at higher rates than Americans overall, particularly through accidents, suicide and homicide, new research has found. The numbers are even higher for veterans who have suffered a traumatic brain injury.
Veterans who have served since Sept. 11, 2001, are dying via suicide at twice the rate of Americans overall, with homocide claiming retired service members at one-and-a-half times the rate of the general population.
They also had slightly higher rates of accidental deaths, according to a study published Friday in JAMA Network Open.
The death rates were significantly higher for those with a history of traumatic brain injury: Veterans who experienced a mild traumatic brain injury died at nearly twice the general rate for accidents from 2002 to 2018 and three times the rate by suicide, while those with moderate to severe brain injuries were five times as likely to die by suicide and faced a threefold risk of being murdered or dying in an accident.
The study is the first to look at "excess deaths" among veterans who have served since Sept. 11, 2001, examining the number of deaths over and above what normally would have been expected during the 17-year study period.
The researchers, led by Jeffrey Howard, an associate professor of public health at the University of Texas at San Antonio, reviewed records of more than 2.5 million post-9/11 veterans to catalog their long-term health outcomes with a focus on those with a history of a brain injury.
They found an estimated 3,858 excess deaths among post-9/11 veterans. Compared with the general population, more of those deaths were attributed to accidents and homicides.
Those veterans also died at much higher rates of suicide, cancer and cardiovascular disease when compared with civilians the same age, gender and ethnic and racial makeup.
The particularly elevated rates for those who suffered a mild, moderate or severe traumatic brain injury while serving were striking, the researchers said.
"We already knew that suicide was high among this group, but we didn't necessarily know these other causes of death," Howard said during an interview with Military.com about the research.
"The risks are higher across all of these different causes of death, especially for the individuals who were exposed to TBI," Howard said.
The research found that the excess deaths were concentrated among younger veterans, ages 18 to 44, and those who have suffered a TBI, with suicide and accidental deaths accounting for the bulk of the deaths.
While the study didn't explain why veterans may be more vulnerable to accidental deaths and homicide, Howard said prior research shows that younger veterans who are newly separated from the military are susceptible toward engaging in risky behaviors like substance abuse, speeding, or placing themselves in dangerous situations.
They also may suffer from impulse control, anger or post-traumatic stress, increasing their risk of being placed in dangerous situations.
"What this indicates is that there is a multidimensional set of risk factors that are not necessarily medical that need to be addressed in this population, especially for those with TBI," Howard said.
The research also showed higher-than-expected deaths from cardiovascular disease and cancer among post-9/11 veterans.
Howard said the deaths from heart disease, especially among those with brain injuries, are not surprising given that earlier research indicates that combat injuries place veterans at risk for hypertension, coronary artery disease, diabetes and other chronic illnesses.
"There are several possible mechanisms in these associations, including accelerated cellular aging, chronic inflammation, behavioral factors and neurological and cognitive decline," the study stated.
The authors also noted that environmental exposures such as burn pits and other chemicals "may help explain the higher cancer mortality rates" in the population.
The research follows numerous other studies focused on post-9/11 veterans, including those with traumatic brain injury, to assess the effects of their military service on their lives, health, productivity and futures.
Howard said much of the research shows "essentially, when you get these serious injuries, it effectively changes your physiology and accelerates the aging process, which leads not only to cardiovascular disease but even some other chronic diseases."
But, he added, it's not all bad news for veterans. Calling his study "an awareness-generating article," he said he hopes it places attention on the deaths among vetearns that are preventable, such as accidents, suicide and homicide, through non-medical interventions.
"It shouldn't be just all doom and gloom, 'Oh, my gosh, I have a TBI, I'm destined to have one of these bad outcomes.' I don't think that's the message," Howard said.
"The takeaway is that having these exposures puts individuals at greater risk for a variety of outcomes, so, what we need to be focused on -- as a whole, not only within the military, within the VA, but as a society in general -- is supporting individuals who served our country and doing everything we can to help them transition from military service to civilian life," Howard said.
-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.