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Open Access Research article

A systematic review of post-deployment injury-related mortality among military personnel deployed to conflict zones

Joseph J Knapik1*, Roberto E Marin2, Tyson L Grier1 and Bruce H Jones1

Author Affiliations

1 US Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD, USA

2 Occupational Medicine Department, Womack Army Medical Center, Fort Bragg, NC, USA

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BMC Public Health 2009, 9:231  doi:10.1186/1471-2458-9-231

Published: 13 July 2009



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.


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.


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.


Further research on the etiology of the excess mortality in conflict-zone veterans is warranted to develop appropriate interventions.