The effect of veteran status on mortality among older Americans
and its pathways
, CHARLES C. ENGEL Jr.
, HAN KANG
Deployment Health Clinical Center, Walter Reed Army Medical Center, Washington,
DC 20307, USA;
Department of Psychiatry, F. Edward Hebert School of Medicine,
Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA;
Department of Veterans Aﬀairs, Environmental Epidemiology Service, Washington, DC
Abstract. This research examines excess mortality among American veterans age
70 years or older during a two-to-three year interval from 1993/94 to the end of 1995.
Using a structural hazard rate model, we analyzed data on a sample of respondents age
70 or over from the Survey of Asset and Health Dynamics among the Oldest Old
(AHEAD). We found that at age 70, older veterans have a slightly higher death rate
than their nonveteran counterparts, implying a mortality crossover right before this age.
Such excess mortality among veterans increases considerably with age, when other
factors are held equal. The direct and indirect eﬀects of veteran status on mortality by
means of physical and mental health mostly perform in opposite directions, and such
eﬀects vary greatly in magnitude and direction as a function of age. The intervening
eﬀects of physical and mental health status decrease substantially with increasing age.
Many of the mechanisms inherent in the excess mortality among older veterans are not
captured by variations in their health status, especially among the oldest-old. A more
extensive study on this topic is urgently needed.
Keywords: Diﬀerential mortality, Older veterans, Structural equation models, Survival
Veterans’ quality of life has received increasing public attention and
U.S. government focus. According to the 2000 U.S. Census, there
were 26.4 million persons (approximately 13% of the total population
age 18 or older) residing in the United States who had previously
served at any time in the military (U.S. Census Bureau 2002). One
unique aspect of military service is veterans’ exposure to health haz-
ards encountered in intense and sometimes life-threatening military
environments. These military experiences may contribute to higher
prevalence and incidence of physical and mental illnesses among
Population Research and Policy Review (2005) 24: 573–592 Ó Springer 2006