Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Occup Med (Lond). 2019 Dec 31;69(8-9):570-576. doi: 10.1093/occmed/kqz023.
The 'healthy worker effect' predicts that longer employment is positively associated with reduced mortality, but few studies have examined mortality in military veterans irrespective of exposure to conflict.
To examine mortality in a large national cohort of Scottish veterans by length of service.
Retrospective cohort study comparing survival in up to 30-year follow-up among 57 000 veterans and 173 000 people with no record of service, matched for age, sex and area of residence, who were born between 1945 and 1985. We compared antecedent diagnoses in the two groups to provide information on probable risk factors.
By the end of follow-up, 3520 (6%) veterans had died, compared with 10 947 (6%) non-veterans. Cox proportional hazard analysis confirmed no significant difference overall unadjusted or after adjusting for deprivation. On subgroup analysis, those who left prematurely (early service leavers) were at significantly increased risk of death (hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.09-1.24, P < 0.001), although the increase became non-significant after adjusting for socioeconomic status (HR 1.05, 95% CI 0.99-1.12). Longer-serving veterans were at significantly lower risk of death than non-veterans; the risk decreased both with length of service and in more recent birth cohorts. Smoking-related disease was the greatest contributor to increased mortality in early leavers.
Among longer-serving veterans, there was evidence of a HWE partly attributable to selective attrition of early service leavers, but birth cohort analysis suggests improvements over time which may also reflect a causal effect of improved in-service health promotion.
“健康工人效应”预测，就业时间越长，死亡率越低，但很少有研究调查过军事退伍军人的死亡率，而不论其是否接触过冲突。
通过服役时间来检查苏格兰退伍军人的大型全国队列的死亡率。
这是一项回顾性队列研究，比较了多达 30 年的随访中，57000 名退伍军人和 173000 名没有服役记录的人的生存率，这些人按年龄、性别和居住地区与退伍军人相匹配，出生于 1945 年至 1985 年之间。我们比较了两组中的既往诊断，以提供可能的危险因素信息。
随访结束时，3520 名（6%）退伍军人死亡，而 10947 名（6%）非退伍军人死亡。Cox 比例风险分析证实，无论在未经调整还是在调整了贫困程度后，总体上都没有显著差异。在亚组分析中，那些提前离开（早期退伍军人）的人死亡风险显著增加（风险比（HR）1.16，95%置信区间（CI）1.09-1.24，P<0.001），但在校正了社会经济地位后，这种增加变得不显著（HR 1.05，95%CI 0.99-1.12）。与非退伍军人相比，服役时间较长的退伍军人死亡风险显著降低；风险随着服役时间的延长和出生队列的更新而降低。与吸烟有关的疾病是早期退伍军人死亡风险增加的最大原因。
在服役时间较长的退伍军人中，有证据表明存在“健康工人效应”，这在一定程度上归因于早期退伍军人的选择性流失，但出生队列分析表明随着时间的推移有所改善，这也可能反映出在职期间健康促进的因果效应。
