Mortality rates higher for post-9/11 U.S. military personnel with TBI

U.S. military veterans with traumatic brain injuries who served after the Sept. 11, 2001, terrorist attacks had higher mortality rates compared with other veterans and the general U.S. population, according to study results.

“There is emerging evidence that TBI is associated with significant increases in the 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 San Antonio, and colleagues wrote in JAMA Network Open. “However, the extent of the all-cause and cause-specific mortality associated with exposure to TBI among post-9/11 military veterans remains unclear.”

Researchers sought to assess mortality rates and estimate the number of excess deaths among U.S. veterans, with and without TBI, who served after 9/11 compared with the general U.S. population.

The cohort study analyzed administrative and mortality data from Jan. 1, 2002, through December 31, 2018, for more than 2.5 million military men and women who served during the Global War on Terrorism. Researchers included veterans who were provided treatment for 3 or more years in the Military Health System or who required 3 or more years of care in the Military Health 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 with information from the CDC and Prevention WONDER database for the general U.S. population.

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

Results showed that 17.5% of post-9/11 military veterans had mild TBI and 3% had moderate to severe TBI. There were 30,654 deaths. Adjusted, age-specific mortality rates were higher for veterans than for the total U.S. population and rose with severity of TBI.

There were an estimated 3,858 (95% CI, 1,225-6,490) excess deaths among all post-9/11 military veterans. Of those, an estimated 275 (95% CI, 1,435-1,985) did not have TBI, 2,285 (95% CI, 1,637-2,933) had mild TBI and 1,298 (95% CI, 1,023-1,572) had moderate to severe TBI.

Further analysis showed that estimated excess deaths arose largely from suicide (4,218; 95% CI, 3,621-4,816) and accidents (2,631; 95% CI, 1,929-3,333). In addition, veterans who presented with moderate to severe TBI accounted for 33.6% of total excess deaths — 11 times higher than expected.

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

In a related editorial, Mark A. Reger, PhD, of the Veterans Affairs Puget Sound Health Care System, and colleagues stated that Howard’s study provides a necessary and vital counterbalance to traditional analysis of deaths within military populations.

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