Service-Connected Disability and the Veteran Mortality Disadvantage

• Date: 01 July 2021
• DOI: 10.1177/0095327X19884721
• Author: Scott D. Landes,Janet M. Wilmoth,Andrew S. London
• Published date: 01 July 2021
• Subject Matter: Articles

Article

Service-Connected

Disability and the Veteran

Mortality Disadvantage

Scott D. Landes

1

, Andrew S. London

1

and Janet M. Wilmoth

1

Abstract

Research consistently reports a veteran mortality disadvantage relative to non-

veterans, but has not considered the contribution of service-connected disability to

this differential. We use data from the 1986 and 1989 National Health Interview

Survey-2011 Linked Mortality Files (N¼124,122) to estimate multivariate Cox

regression models of the association between veteran status and mortality, taking

service-connected disability status into account. Bivariate analyses demonstrate

higher mortality risk, lower socioeconomic status, and poorer health and functioning

among veterans with a service-connected disability than among nonveterans and

veterans without a service-connected disability. Multivariate models confirm a

mortality disadvantage for all veteran service-connected disability subgroups, which

is reduced by the inclusion of exogenous sociodemographic variables and substan-

tially mediated by the health/functional limitation status measures. Results indicate

that service-connected disability status accounts for some variation in, and may have

a cumulative effect on, the veteran mortality disadvantage. When possible, future

research should account for service-connected disability status when studying

veteran–nonveteran mortality differentials.

1

Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs,

Syracuse University, NY, USA

Corresponding Author:

Scott D. Landes, Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship

and Public Affairs, Syracuse University, 314 Lyman Hall, Syracuse, NY 13244, USA.

Email: sdlandes@maxwell.syr.edu

Armed Forces & Society

2021, Vol. 47(3) 457-479

ªThe Author(s) 2019

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/0095327X19884721

journals.sagepub.com/home/afs

Keywords

veterans, mortality, service-connected disability, socioeconomic status, health,

functional limitation

Recent studies comparing mortality risk among veterans and nonveterans generally

find a veteran mortality disadv antage, meaning veterans have a n overall higher

mortality risk than nonveterans (Kaplan, Huguet, McFarland, & Newsom, 2007;

Landes, Ardelt, & Landes, 2018; Landes, London, & Wilmoth, 2018; Landes,

Wilder, & Williams, 2017; Liu, Engel, Kang, & Cowan, 2005; London & Wilmoth,

2006). The veteran mortality disadvantage in these studies is partially to fully

explained by various sociodemographic and/or health characteristics including age,

race, war cohort, combat experience, type of military-veteran health care coverage,

smoking behavior, and suicidality. One salient characteristic that has not been taken

into consideration in analyses of the veteran mortality disadvantage is service-

connected disability status.

While policy briefs and reports based on American Commu nity Survey (ACS )

data provide estimates of the prevalence of service-connected disability among

U.S. military veterans (Duggan, 2014; U.S. Census Bureau, 2016; U.S. Depart-

ment of Veterans Affairs, 2015c), these resources do not examine differentials in

life-course and health outcomes among those with and without service-connected

disability. Therefore, we begin by using data from the 1986 and 1989 (2011)

National Health Interview Survey-Linked Mortality Files (NHIS-LMF) to describe

the characteristics of four veteran service-connected disability status su bgroups:

nonveterans; veterans with no service-connected disability; veterans with a

service-connected disability, but no Veterans Affairs (VA) compensation; veterans

with a service-connected disability and VA compensation. We then use Cox

regression models to analyze the contribution of service-connected disability to

the veteran mortality disadvantage. Drawing on a conceptual model of the life -

course consequences of military service (Wilmoth & London, 2013a, Figure 1.2),

we also examine the extent to which the association between service-connected

disability and mortality is explained by mediating social/economic and/or health/

functional limitation variables.

Background

Service-Connected Disability Status

Veterans with a service-connected disability “are determined by the U.S. Depart-

ment of Veterans Affairs to be disabled by an injury or illness that was incurred or

aggravated during active military service” (U.S. Department of Veterans Affairs,

2015a). Since most military service occurs in early adulthood, from a life-course

458 Armed Forces & Society 47(3)