title: A systematic review of post-deployment injury-related mortality among military personnel deployed to conflict zones.
abstract: BACKGROUND
  This paper reports on a systematic review of the literature on the post-conflict injury-related mortality of service members who deployed to conflict zones.
  
  
  METHODS
  Literature databases, reference lists of articles, agencies, investigators, and other sources were examined to find studies comparing injury-related mortality of military veterans who had served in conflict zones with that of contemporary veterans who had not served in conflict zones. Injury-related mortality was defined as a cause of death indicated by International Classification of Diseases E-codes E800 to E999 (external causes) or subgroupings within this range of codes.
  
  
  RESULTS
  Twenty studies met the review criteria; all involved veterans serving during either the Vietnam or Persian Gulf conflict. Meta-analysis indicated that, compared with non-conflict-zone veterans, injury-related mortality was elevated for veterans serving in Vietnam (summary mortality rate ratio (SMRR) = 1.26, 95% confidence interval (95%CI) = 1.08-1.46) during 9 to 18 years of follow-up. Similarly, injury-related mortality was elevated for veterans serving in the Persian Gulf War (SMRR = 1.26, 95%CI = 1.16-1.37) during 3 to 8 years of follow-up. Much of the excess mortality among conflict-zone veterans was associated with motor vehicle events. The excess mortality decreased over time. Hypotheses to account for the excess mortality in conflict-zone veterans included post-traumatic stress, coping behaviors such as substance abuse, ill-defined diseases and symptoms, lower survivability in injury events due to conflict-zone comorbidities, altered perceptions of risk, and/or selection processes leading to the deployment of individuals who were risk-takers.
  
  
  CONCLUSIONS
  Further research on the etiology of the excess mortality in conflict-zone veterans is warranted to develop appropriate interventions.
authors: US Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD, USA. joseph.knapik@us.army.mil
authors: Joseph J
authors: JJ
authors: Knapik
authors: Roberto E
authors: RE
authors: Marin
authors: Tyson L
authors: TL
authors: Grier
authors: Bruce H
authors: BH
authors: Jones
mesh_terms: D002423:Cause of Death; D006801:Humans; D008889:Military Personnel; D014728:Veterans; D014857:Warfare; D014947:Wounds and Injuries / Q000401:mortality*