Preventing deaths in the Canadian military.
BACKGROUND
Combat fatalities are reported by the media as a frequent cause of military deaths, yet they may not reflect the most common and preventable ways that soldiers die.


OBJECTIVE
The purpose of this study was to quantify the leading causes of death in the military and to identify modifiable behaviors that potentially contributed to death.


METHODS
This was a retrospective chart review of all Canadian Forces members who died during the past quarter century (January 1, 1983, to December 31, 2007) and included autopsy reports, death certificates, coroner reports, hospital records, military reports, and other miscellaneous sources. Underlying cause of death and modifiable behaviors potentially contributing to death were determined.


RESULTS
A total of 1889 individuals died during the study period, and a cause of death was identified for 1710 cases (91%). Traumatic injuries caused 57% of deaths, and medical disease was responsible for 43%. The four leading specific causes of death were motor-vehicle crashes (384 deaths, 22%); neoplasms (374 deaths, 22%); suicide (289 deaths, 17%); and cardiovascular disease (285 deaths, 17%). Combat deaths accounted for less than 5% of all deaths (70 deaths). Approximately 35% of all deaths were attributable to potentially modifiable behaviors, which included suicide (219 non-alcohol-related deaths, 13%); smoking (159 deaths, 9%); and alcohol use (186 deaths, 11%).


CONCLUSIONS
Public attention focuses on combat fatalities, yet most military members die from other causes. Avoiding future deaths requires targeting suicide, smoking, and alcohol consumption, in addition to trauma care for combat injuries.
Tien
Homer C N
HC
Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada. homer.tien@sunnybrook.ca
Acharya
Sanjay
S
Redelmeier
Donald A
DA
D000063:Accidents, Traffic / Q000401:mortality; D000328:Adult; D019973:Alcohol-Related Disorders / Q000401:mortality; D002170:Canada; D002423:Cause of Death; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012907:Smoking / Q000401:mortality; D013405:Suicide / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality*