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The 2022 Health of Those Who Have Served Report was developed with guidance from a national Advisory Committee, representing military, veteran and public health organizations, who informed the selection of health measures and other methodological features of the report.
Data
As in previous editions, the primary source of data for this report is the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS), the world’s largest annual population-based telephone survey system tracking health conditions and risk behaviors in the U.S. since 1984. With an annual sample of over 400,000 respondents, BRFSS also has one of the most robust samples of those who have served, totaling between 50,000 and 60,000 each year.
This report also draws on data from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH), the CDC’s National Health Interview Survey (NHIS) and the U.S. Census Bureau’s American Community Survey (ACS). NSDUH provides national and state data on the use of tobacco, alcohol, illicit drugs and mental health in the U.S. and includes an annual sample of about 2,500 individuals who have served. NHIS is the nation’s largest in-person household health survey, conducted since 1957, and includes an annual sample of nearly 7,000 individuals who have served. ACS provides social, demographic and economic data at the national, state and community levels in the U.S. and includes an annual sample of about 125,000 individuals who have served.
Definition of Those Who Have Served
Those who have served are defined in this report as “those who have ever served in the U.S. Armed Forces.” While all four data sources use this common definition, some differences exist in who is included among those with service.
Measures
The 2022 Health of Those Who Have Served Report is based on 30 measures. Informed by the latest literature and guidance from the National Advisory Committee, the selection of these measures was driven by three criteria:
- Measures must represent overall health conditions, behaviors and care issues most pertinent to those who have served in the U.S. Armed Forces, including those addressing mental illness and chronic disease.
- Individual measures must have sufficient sample sizes to assure reliable estimates for those who have served and not served overall, and where possible, by age, gender, race/ethnicity, education, income and metropolitan status.
- Each selected measure must be amenable to change. In other words, each measure can be modified by policy or intervention to achieve measurable improvement.
Data and Analysis
This report utilizes ten years of data, 2011 through 2020, drawn from ACS, BRFSS, NSDUH and NHIS. Data were weighted and age-adjusted into two-year periods as follows:
- Baseline reporting period, 2011-2012: provides a baseline by which to compare trends across editions, and over time.
- Prior reporting period, 2017-2018: these rates were presented as the “current” rate in the 2020 Edition and now represent the most recent interim period in the trends analysis.
- Current, 2019-2020: provides the most current rates and an opportunity to measure change since the prior and baseline reporting period. Unless otherwise noted, this report mainly features data from 2019-2020 and tracks progress since the baseline reporting period, 2011-2012.
Age Adjustment
Those who have served on active duty have a different age distribution from the general U.S. population. To prevent age from skewing results, most data included in this report were age-adjusted to the 2000 U.S. Standard Population. The able-bodied measure and its disability-related components were not age-adjusted due to methodological concerns. This adjustment produces fairer, more realistic comparisons between those who have and have not served. Age-adjusted prevalence estimates should be understood as relative estimates, not as actual measures of burden.