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The Effect of Veteran Status on Mortality among Older Americans and its Pathways
Authors:Email author" target="_blank">Xian?LiuEmail author  Jr" target="_blank">Charles?C?EngelJr  Han?Kang  David?Cowan
Institution:(1) Deployment Health Clinical Center, Walter Reed Army Medical Center, Washington, DC 20307, USA;(2) Department of Psychiatry, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA;(3) Department of Veterans Affairs, Environmental Epidemiology Service, Washington, DC 20420, USA;(4) Deployment Health Clinical Center, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA
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 analysis
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