Strand Leif Åge, Rudvin Inger, Borud Einar Kristian, Bøe Hans Jakob, Nordstrand Andreas Espetvedt, Fadum Elin Anita
Norwegian Armed Forces Joint Medical Services, Institute of Military Medicine and Epidemiology, Sessvollmoen N-2018, Norway.
Department of Community Medicine, UiT The Arctic University of Norway, Tromsø N-9019, Norway.
Mil Med. 2023 Jul 22;188(7-8). doi: 10.1093/milmed/usac075. Epub 2022 Mar 26.
Norwegian military forces participated in the military campaign Operation Enduring Freedom in Afghanistan starting in 2001. Military personnel often show a "healthy soldier effect" in terms of lowered all-cause mortality when compared to the general population. However, military service in conflict areas is associated with an increased risk of death from external causes such as transport accidents and suicide after discharge. We aimed to investigate cause-specific mortality in a cohort of 9,192 Norwegian (7.5% women) veterans deployed to Afghanistan between 2001 and 2019.
We followed cohort members from their first day of service in Afghanistan through 2019. We computed standardized mortality ratios (SMRs) with 95% CIs by comparing the observed number of deaths in our cohort with the expected number of deaths in the general population. Standardized mortality ratios were calculated for the full follow-up period among men and women separately, and among men only for two time periods: during deployment and after discharge from service in Afghanistan.
We observed 77 deaths (3 women and 74 men), 10 of which occurred during deployment (war casualties, 1 woman and 9 men); all others occurred after discharge. All-cause mortality in women did not differ from that in the general population (SMR = 0.52, 95% CI 0.11-1.53). For men, the observed all-cause mortality was lower than the expected rate for the full follow-up period (SMR = 0.55, 95% CI 0.43-0.69), during deployment, and after discharge, while deaths because of transport accidents after discharge (13 cases) were more than twice as high as expected rates (SMR = 2.36, 95% CI 1.26-4.04). The 11 observed suicides gave a nonstatistically significant, lower suicide risk compared to the expected rates (SMR = 0.66, 95% CI 0.33-1.18).
In accordance with the "healthy soldier effect," military service in Afghanistan was generally associated with a lower than expected risk of death both during deployment and after discharge. The risk of death from transport accidents was higher than expected after discharge, while the observed incidence of suicide did not differ from the expected rate in the general population.
挪威军队自2001年起参与了阿富汗的“持久自由行动”军事行动。与普通人群相比，军事人员在全因死亡率降低方面常表现出“健康士兵效应”。然而，在冲突地区服役与退役后因交通事故和自杀等外部原因导致的死亡风险增加有关。我们旨在调查2001年至2019年间被部署到阿富汗的9192名挪威退伍军人（7.5%为女性）的特定病因死亡率。
我们从队列成员在阿富汗服役的第一天开始追踪，直至2019年。通过将我们队列中观察到的死亡人数与普通人群中的预期死亡人数进行比较，计算出标准化死亡率（SMR）及95%置信区间。分别计算了男性和女性在整个随访期的标准化死亡率，以及仅男性在两个时间段的标准化死亡率：部署期间和从阿富汗退役后。
我们观察到77例死亡（3名女性和74名男性），其中10例发生在部署期间（战争伤亡，1名女性和9名男性）；所有其他死亡均发生在退役后。女性的全因死亡率与普通人群无差异（SMR = 0.52，95%置信区间0.11 - 1.53）。对于男性，在整个随访期、部署期间和退役后的观察到的全因死亡率均低于预期率，而退役后因交通事故导致的死亡（13例）比预期率高出两倍多（SMR = 2.36，95%置信区间1.26 - 4.04）。观察到的11例自杀事件与预期率相比，自杀风险较低，但无统计学意义（SMR = 0.66，95%置信区间0.33 - 1.18）。
与“健康士兵效应”一致，在阿富汗服役总体上与部署期间和退役后低于预期的死亡风险相关。退役后因交通事故导致的死亡风险高于预期，而观察到的自杀发生率与普通人群的预期率无差异。
