title: Long-term disability associated with war-related experience among Vietnam veterans: retrospective cohort study.
abstract: BACKGROUND
  Recent combat operations have involved large numbers of personnel. Long-term health effects of military deployment remain largely unknown.
  
  
  OBJECTIVE
  To examine patterns and trends in long-term disability among combat veterans and to relate disability to aspects of wartime experience.
  
  
  METHODS
  A total of 60,228 Australian military personnel deployed between 1962 and 1975 during the Vietnam War, and 82,877 military personnel who were not deployed overseas.
  
  
  METHODS
  Accepted physician-assessed disability claims were evaluated over follow-up periods up to 50 years after deployment, and compared with age-matched controls. Multivariable analysis was used to examine differences by service branch, rank, age, and deployment duration.
  
  
  RESULTS
  The steepest rise in disability incidence was observed among Vietnam veterans starting in the 1990s, around 20-30 years after deployment for most veterans. After 1994, when Statements of Principles were introduced to guide evaluation of disability claims, the hazard ratio for disability incidence was 1.53 (95% confidence interval, 1.32-1.77) compared with the prior period. By January 2011, after an average follow-up of 42.5 years, 69.7% (95% confidence interval, 69.4%-70.1%) of veterans had at least 1 war-related disability. Many veterans had multiple disabilities, with leading causes being eye and ear disorders (48.0%), mental health conditions (47.9%), and musculoskeletal disorders (18.4%). For specific categories of disability, relative risks for accepted claims among veterans compared with controls were highest for mental health disorders, at 22.9 (21.9-24.0) and lowest for injuries, at 1.5 (1.4-1.6) with a relative risk for any disability of 3.7 (3.7-3.8). Veterans with service of >1 year were 2.5 (2.2-2.7) times more likely to have a mental health disability than those who served <100 days, and 2.3 (2.1-2.5) times more likely to have other disabilities.
  
  
  CONCLUSIONS
  Long-term effects of deployment into military conflicts are substantial, and likelihood of war-related disability is associated with service history. If similar patterns follow from more recent conflicts, significant additional resources will be needed to prevent and treat long-term health conditions among veterans.
authors.affiliation: *Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC †Research School of Economics, Australian National University, Canberra, ACT, Australia ‡Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Clarke
authors.forename: Robert
authors.initials: R
authors.lastname: Gregory
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Salomon
mesh_terms: D000367:Age Factors; D000368:Aged; D001315:Australia; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014728:Veterans / Q000706:statistics & numerical data*; D047829:Vietnam Conflict; D014857:Warfare