Risk of medically-treated injuries among Iraq and Afghanistan combat veterans

Objective: Veterans have increased risk of injury after military discharge. We examined incidence of, and potential risk factors for, medically-treated injuries among Iraq and Afghanistan combat veterans enrolled in the Veteran's Affairs (VA) healthcare system.

Methods: We surveyed a national sample of combat veteran VA users in 2008. The sample was stratified by gender, race, and geographic region. We assessed mental, behavioral, and physical health using standard validated measures. Medically-treated injuries sustained after discharge were identified. Veterans' risk of injury was estimated in reference to demographics; overall physical/mental health status; probable traumatic brain injury, posttraumatic stress disorder (PTSD), and depression; and health behaviors. Stratified odds ratios (OR) and 95% confidence intervals (CI) were calculated using survey logistic regression. Directed acyclic graphs guided development of multivariate models. Results were adjusted for non-response and weighted to represent the target population.

Results: Of veterans contacted, 754 (62%) responded. Nearly half (47.3%; CI=42.0%-52.6%) reported sustaining at least one injury since discharge; there was no difference by gender. Increased odds of injury were associated with lower overall physical and mental health. Controlling for potential confounders, veterans with probable PTSD (OR=2.0; CI=1.2-3.3) and diagnosed depression (OR=2.6; CI=1.5-4.5) were more likely to have sustained an injury. Problem substance use was suggestive of increased risk (OR=1.6; CI=0.98-2.6).

Conclusions: Results suggest a large burden of injury among male and female Iraq and Afghanistan combat veteran VA users. Symptoms of PTSD and depression may be important indicators of increased risk. Further, longitudinal research examining these associations is warranted.