Postservice Mortality in Vietnam Veterans

Background: During the 1980s, the postservice mortality component of the Vietnam Experience Study was conducted to examine the health effects of the Vietnam experience.Thisstudywaslimitedbytherelativelyshort follow-up and the young age of the veterans. Thus, a follow-up mortality investigation on this cohort was undertaken to further assess the impact of the Vietnam experience on chronic conditions. Methods:Vitalstatusandunderlyingcause-of-deathdata on the Vietnam Experience Study cohort (18313 male USArmyveterans)wereretrospectivelyascertainedfrom the end of the original study through 2000. Cox proportionalhazardsregressionwasusedtocalculatecrudeand adjusted rate ratios (RRs) for all-cause and causespecific mortality, comparing Vietnam and nonVietnam veterans. Results: All-cause mortality was 7% higher in Vietnam vsnon-Vietnamveteransduring30-yearfollow-up(95% confidence interval [CI], 0.97-1.18). The excess mortality among Vietnam veterans was isolated to the first 5 years after discharge from active duty and resulted from an increase in external causes of death (RR, 1.62; 95% CI, 1.16-2.26). Cause-specific analyses revealed no difference in disease-related mortality. Vietnam veterans, however,experiencedexcessunintentionalpoisoning(RR, 2.26;95%CI,1.12-4.57)anddrug-related(RR,1.70;95% CI, 1.01-2.86) deaths throughout follow-up. Conclusions: Vietnam veterans continued to experience higher mortality than non-Vietnam veterans from unintentionalpoisoningsanddrug-relatedcauses.Death rates from disease-related chronic conditions, including cancersandcirculatorysystemdiseases,didnotdifferbetween Vietnam veterans and their peers, despite the increasing age of the cohort (mean age, 53 years) and the longer follow-up (average, 30 years). Arch Intern Med. 2004;164:1908-1916