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Arthritis
More than 52 million Americans have arthritis, a condition that can cause severe, chronic joint pain. Arthritis is a leading cause of disability among American adults, and more than half of people living with arthritis say it interferes with their daily activities. Research shows that arthritis affects those with military service more often than civilians, and tends to have a younger age of onset among those who have served. Carrying heavy loads, long periods of sitting or crouching, and traumatic or overuse injuries incurred during combat are aspects of military service that may predispose those who have served to developing arthritis. Arthritis is also frequently diagnosed among veterans who are overweight or obese.
Highlights:
- Overall, arthritis is more common among those who have served.
- Females, especially those who have served, have higher rates of arthritis than males.
- American Indian/Alaska Natives who have served have a higher rate of arthritis than people of all other race/ethnic groups.
- In adults under age 60, arthritis is more common for those who have served. In adults age 60 and older, arthritis is more common for those who have not served.
- By income, those who have served earning less than $25,000 annually have the highest rate of arthritis.
Cancer
In recent decades, cancer diagnoses have declined nationwide and survivorship is on the rise. However, cancer remains the second-leading cause of death in both the general population and veterans, trailing only heart disease. Among VA patients, the most frequently diagnosed cancers are prostate (32%), lung (19%), and colorectal (9%). Some cancers may be related to environmental exposures unique to military service. For example, the CDC’s Selected Cancers Study found exposure to the Vietnam-era herbicide Agent Orange is associated with a 50% increase in risk for non-Hodgkin’s lymphoma in Vietnam veterans. The study also noted relative cancer risk increased with length of service in Vietnam.
Highlights:
- Cancer rates are slightly higher among those who have served than not served, overall and for males and females.
- Whites and American Indian/Alaska Natives have rates of cancer higher than those of any other race/ethnic group.
- Adults aged 60 years and over who have served have much higher rates of cancer than adults of the same age who have not served.
COPD
People with chronic obstructive pulmonary disease (COPD) experience persistent breathing problems and low respiratory function. Three quarters of COPD cases are linked to a history of smoking, with genetics and exposure to environmental irritants also contributing to the disease. Fifteen million Americans have been diagnosed with COPD, while 12 million more may have undiagnosed COPD. Veterans who have COPD are hospitalized more frequently and have higher rates of co-occurring diabetes, heart failure, heart attack, and cancer than veterans who do not. Tobacco use in active duty military and veterans, along with exposure to airborne hazards during deployment, may increase the burden of COPD among those who have served.
Highlights:
- Rates of COPD are slightly higher overall and for males and females who have served.
- Asians who have served have more than double the rate of COPD than Asians who have not served.
- Generally, COPD is more common among adults aged 60 years and over and those with lower incomes.
- Among individuals earning less than $25,000 annually, COPD is more common for those who have served than those who have not.
Coronary Heart Disease
More than 27 million Americans live with heart disease, the leading cause of death in the nation. Coronary heart disease, the most common type of heart disease, kills more than 370,000 Americans annually. Studies document that those who have served have nearly twice the risk of developing heart disease as those who have not served, even after controlling for socioeconomic status, behaviors, body mass index, and depressive symptoms. More than half of veterans have either hypertension or high cholesterol, which are key risk factors for coronary heart disease. Physical inactivity, smoking, and obesity also contribute substantially to heart disease risk. And among veterans, past research shows that one in two with heart disease are overweight or obese.
Highlights:
- Those who have served have a higher rate of coronary heart disease than those who have not served. Rates slightly declined since 2011 to 2012.
- Males generally have a higher rate of coronary heart disease than females.
- Across most race and ethnic groups, those who have served have a significantly higher rate of coronary heart disease than those who have not.
- Among adults aged 60 years and over, the rate of coronary heart disease for those who have served is almost twice that of those who have not served.
Depression
Depression is one of the most prevalent and disabling mental disorders in the United States. Approximately 16 million adults, or 7% of the nation’s population, have experienced a major depressive episode in the past year, and about 17% will have depression at some point in their life. In veterans, depression often co-occurs with other mental illness like PTSD and anxiety. Mortality from depression is primarily due to suicide, and veterans with depression are four times more likely to report suicidal thinking than those without. Over a one-year period, approximately 4% of veterans report suicidal thinking, and of those, one in ten makes a suicide attempt.
Highlights:
- Adults who have served have a lower overall rate of depression than those who have not served, and both rates have increased since 2011 to 2012.
- Females, especially those who have served, have substantially higher rates of depression.
- Rates of depression vary by race and ethnicity. For some minorities, such as Asians, depression is more common for those who have served.
- Lower income individuals have the highest depression diagnosis rates, especially those who have served and earn less than $25,000 annually.
Diabetes
More than 29 million Americans live with diabetes, the seventh-leading cause of death in the nation. People with diabetes undergo two-thirds of all lower limb amputations, are two to four times more likely to have cardiovascular disease or a stroke, and also experience higher rates of kidney failure and blindness. Many veterans are at risk of diabetes due to being overweight or having hypertension. As many as one quarter of people with diabetes may not be aware they have the condition, making it likely that diabetes estimates among both veterans and non-veterans underestimate the actual prevalence.
Highlights:
- Those who have served have a slightly higher overall rate of diabetes than those who have not.
- Rates of diabetes for males and females who have served and not served are similar.
- Rates of diabetes vary by race and ethnicity, with minorities generally having higher rates.
- Diabetes is less common at higher incomes. Still, among people earning at least $75,000 annually, those who have served have a significantly higher rate than those who have not served.
Frequent Mental Distress
Frequent mental distress occurs if an individual says he or she has had 14 or more mentally unhealthy days in the previous month. It is not specific to any mental health diagnosis or symptoms. Nationwide, frequent mental distress has increased gradually over the past two decades. Frequent mental distress among veterans is closely linked to social factors like income and education. Past research indicates unemployed veterans have three times greater odds of reporting frequent mental distress than employed veterans, while veterans who say they have adequate social and emotional support have decreased odds of experiencing frequent mental distress. Insufficient sleep is also common among veterans with frequent mental distress.
Highlights:
- Overall rates of frequent mental distress are similar for those who have served and those who have not, and have slightly declined since 2011 to 2012.
- Females are generally more likely to report frequent mental distress than males.
- Across most race and ethnic groups, frequent mental distress is generally lower among those who have served. Among Asians, however, frequent mental distress is nearly twice as high for those who have served.
- Frequent mental distress is generally higher at lower incomes and for individuals under the age of 60 years.
Frequent Physical Distress
Frequent physical distress occurs if an individual says he or she has had 14 or more physically unhealthy days in the previous month. It is not specific to any health behavior or condition. Research suggests that veterans report frequent physical distress more often than non-veterans, while active duty service members do so less often than civilians. In both veterans and non-veterans, chronic illness, unhealthy behaviors, and old age are associated with frequent physical distress. People with limited health care access report frequent physical distress more often, and about 18% of people with frequent physical distress are uninsured. Veterans who have frequent physical distress have four times the odds of also reporting frequent mental distress.
Highlights:
- Overall rates of frequent physical distress are the same for those who have and have not served.
- Frequent physical distress varies by race and ethnicity. It is reported most commonly by American Indians/Alaska Natives, and least often by Asians.
- Generally, frequent physical distress rates are higher for older adults and those with lower incomes.
Functional Impairment
More than 53 million Americans live with a functional impairment or disability. Disability can impact physical, mental, emotional, intellectual, or cognitive function and may limit a person’s ability to perform basic activities like personal care or household chores. Generally, disability becomes more prevalent with age in both veteran and non-veteran populations. Past research suggests that visual impairments and independent living limitations may impact veterans substantially more than the general population. According to national data, nearly two-thirds of veterans with disabilities have disabilities that are considered partially or fully service-connected; that is, any disability, disease, or injury that was incurred or aggravated during time in the military.
Highlights:
- Those who have served have a higher overall rate of functional impairment than those who have not served.
- Overall rates of functional impairment have declined since 2011 to 2012.
- Asians have the lowest rate of functional impairment of any race and ethnic group, while American Indians/Alaska Natives have the highest.
- Functional impairment is more common among those who have served at most ages.
- Those who have served and earn less than $25,000 annually have the highest rate of functional impairment of any income group.
High Health Status
Self-reported health status reflects a person’s opinion of their overall health, reported as poor, fair, good, very good, or excellent. It is generally a good predictor of future disability, hospitalization, and mortality. Adults who report one unhealthy behavior, such as smoking or excessive drinking, have double the odds of having fair or poor health, while odds of having fair or poor health are nine times greater among people reporting five unhealthy behaviors. Veteran populations with low health status also frequently report having multiple chronic diseases like diabetes, cancer, and heart disease. Non-health factors like social support and financial barriers to accessing care also correlate with lower health status in veterans.
Highlights:
- Those who have served, including both males and females, are slightly more likely to report excellent or very good health status than those who have not served.
- Blacks, Hispanics, and American Indian/Alaska Natives who have served report better health status than those who have not served. This difference in health status by service is greatest for Hispanics.
- Adults aged 18 to 39 years report better health status, especially those who have served.
- Generally, health status is higher at higher incomes. Even among those making less than $25,000 annually, those who have served report better health status than those who have not.
Heart Attack
Heart attacks can result from blockage or narrowing of blood vessels that carry blood to the heart, preventing it from receiving enough oxygen. Every year, 750,000 Americans have a heart attack, and about 15% of heart attacks are fatal. In veterans and non-veterans, most heart attacks are attributable to a handful of key risk factors, including smoking, high blood pressure, diabetes, unhealthy diet, physical inactivity, stress, and overuse of alcohol. Mental disorders including depression, anxiety, and PTSD have also been shown to contribute to heart attacks in veterans, and exposure to the Vietnam-era herbicide Agent Orange may also elevate heart attack risk.
Highlights:
- Those who have served report heart attacks at nearly twice the rate of those who have not served.
- Generally, the rate of heart attacks in males is about double the rate of females.
- Of all race and ethnic groups, American Indians/Alaska Natives who have served report the highest rate of heart attacks.
- Adults aged 60 years and over who have served are nearly twice as likely to report having a heart attack as those who have not served.
- At all income levels, the rate of heart attacks in those who have served is roughly double the rate of those who have not served.
Stroke
Approximately 800,000 strokes occur in America every year. Strokes kill one person every four minutes, and are responsible for one out of every 20 deaths in the nation. Stroke is a leading cause of adult disability, with 15% to 30% of stroke survivors experiencing serious, long-term complications. Stroke risk increases with age, and is elevated among persons who have high cholesterol, high blood pressure, or a previous stroke. Hypertension, which affects 37% of veterans, is the leading risk factor for stroke among those who have served. Between 6,000 and 11,000 veterans are admitted to VA hospitals for stroke every year, and as many as 80,000 veterans are estimated to be stroke survivors.
Highlights:
- Those who have served have a higher rate of stroke than those who have not, especially among people aged 80 years and over.
- Stroke varies by race and ethnicity. Hispanics who have served report stroke at twice the rate of Hispanics who have not served.
- Stroke rates are higher at lower incomes. Those who have served earning less than $25,000 annually report a higher rate of stroke than those who have not served.
Teeth Extraction
People who have had six or more teeth removed are defined to have high teeth extractions. Loss of adult teeth can have serious consequences for quality of life. Missing teeth can make chewing difficult or painful, and is often a result of poor oral hygiene, tooth decay, or gum disease. Whereas adults in the general population have an average of 25 teeth, veterans have an average of 19 to 22 teeth. Generally, older adults, current smokers, and those with lower incomes and less education have fewer teeth than average.
Highlights:
- Overall rates of teeth extractions are the same for those who have served and not served, with no major differences by sex.
- Overall rates of teeth extractions declined since 2011 to 2012 for both those who have served and not served.
- Blacks and American Indians/Alaska Natives have the highest rate of teeth extractions of all racial/ethnic groups.
- Teeth extractions are generally more common among adults aged 60 years and over, and those with annual incomes below $25,000.