#52 Risk of motor vehicle fatality associated with prior morbidity among gulf war era veterans

Abstract

PURPOSE: Motor vehicle fatalities (MVFs) are the leading cause of mortality among military personnel. Previous studies of our population of all U.S. Gulf War veterans (GWVs) and a comparable number of contemporaneous non-deployed veterans (NDVs) found that the GWVs had a nearly 50% higher rate of MVFs. We sought to identify the role of prior morbidity as an indicator of underlying physical and mental health, lifestyle, or behavioral characteristics contributing to MVFs among GW-era veterans. METHODS: Our 980 cases were the male drivers from a population of 1,441,807 GW-era personnel who were MVFs between 1991 and 1995 having a record in NHTSA's Fatality Analysis Reporting System. For each case, 10 controls alive at the end of the match year in which the case died were randomly selected from the same population. We analyzed all admissions to Department of Defense (DoD) or Veterans Affairs (VA) hospitals and outpatient visits to VA facilities in the interval following the GW and before the end of the match year as risk factors for MVF. RESULTS: After adjustment for demographic factors (age, marital status, education, race) and military characteristics (rank, occupation, branch, duty component), we found that use of these medical resources for any cause was associated with subsequent MVFs. Prior treatment for mental health problems, especially the subset related to drug or alcohol abuse, was strongly related to subsequent MVFs, particularly for the NDVs. Admissions for injuries due to a prior motor vehicle crash (available only for DoD hospitalizations) were also associated with the occurrence of a subsequent MVF, particularly among GWVs. CONCLUSIONS: Men with prior military hospitalizations or VA clinic visits were at higher risk for MVFs than those without such morbidity. This relationship held for the entire military population, but health care for substance abuse was more predictive of MVFs for NDVs, while prior motor vehicle injuries were for GWVs. Patients treated for certain diagnoses may be a population to target for interventions to reduce MVFs.