Executive BriefForewordIntroductionDesignKey FindingsOverviewMental HealthPhysical HealthHigh Health StatusAccess to Health Care and Preventive ServicesSubstance UseSeniorsConclusionsAppendixTable 1. MeasuresMethodology2022 Health of Those Who Have Served Advisory Committee
Those who have served experience higher rates of chronic conditions, chronic pain and disabilities.
Even as they are more likely to report that they are in very good or excellent health, those who have served are more likely to experience chronic pain; more likely to have arthritis, cancer, cardiovascular disease and chronic obstructive pulmonary disease (COPD); and less likely to be able-bodied.
Among those who have served, American Indians/Alaska Native adults have rates of chronic disease that are two or more times higher than one or more other racial/ethnic groups: cancer (12.6%), cardiovascular disease (14.1%) and COPD (11.1%). Similarly, those in the lowest income bracket are 2.3 and 3.3 times more likely to be diagnosed with cardiovascular disease (16.7% vs. 7.3%) and COPD (13.0% vs. 4.0%), respectively, than those earning $75,000 or more.
Rates of arthritis are also higher among those who have served than not (24.5% vs. 21.8%). However, arthritis seems to develop at earlier ages in those who have served in the military, as those ages 26-34 are 1.7 times more likely to have been told by a health professional that they have some form of arthritis than those who have not served (11.7% vs. 7.0%). In addition, those ages 35-49 who have served are 1.4 times more likely to report arthritis (20.6% and 14.9%) than their civilian counterparts.
Chronic pain often limits a person’s ability to work and perform activities of daily living. It is also associated with higher rates of smoking and receiving opioid pain prescriptions, both of which carry a high risk of addiction.11,12 Despite reporting higher rates of excellent or good health, those who have served are 1.3 times more likely to report chronic pain, defined as having pain most days or every day in the past three months (29.1% vs. 22.0%).
Notable differences appear in subpopulations between those who have served and those who have not. Asian adults with a history of military service report 2.7 times higher rates of chronic pain than their civilian counterparts (24.2% vs. 9.1%), and Hispanic adults who have served report 1.8 times higher rates of chronic pain than those who have not (30.9% vs. 17.3%). Furthermore, those in the lowest income group are 1.8 times more likely to report chronic pain than those in the highest income group (43.2% vs. 24.6%). In addition, among those ages 26-34, those who have served have 2.6 times higher rates of chronic pain than their civilian counterparts (27.3% vs. 10.6%).
Various disabilities are also higher among those who have served, as they are less likely to report being able-bodied than civilians (71.9% vs. 85.3%) — defined as having none of six types of difficulties: cognitive, visual, auditory, ambulatory, self-care or independent living (See Table 1 in Appendix for definitions). Notably, those who have served are almost four times more likely to be living with severe hearing impairment (14.1% vs. 3.7%) than those who have not served, 1.9 times more likely to have ambulatory difficulties (14.8% vs. 8.0%) and 1.7 times more likely to have self-care difficulties (5.3% vs. 3.2%). They are also 1.8 times more likely than their civilian counterparts to have three or more disabilities (7.6% vs. 4.2%). People with disabilities report higher rates of frequent mental distress, are more likely to engage in poor health behaviors (e.g., smoking and physical inactivity) and are more likely to be victims of violence, abuse or neglect.13,14,15,16,17
The difference in severe hearing impairment between those who have and have not served is pronounced among certain subpopulation groups. Among American Indian/Alaska Native (17.3% vs. 5.5%), Asian (8.3% vs. 2.2%), Hispanic (10.2% vs. 2.4%) and white (15.8% vs. 4.4%) adults, those who have served had rates of hearing impairment more than three times greater than those who had not served. In addition, males who have served had rates of severe hearing impairment 3.0 times higher than females who have served (15.1% vs. 5.0%).
11. Carroll Chapman, S.L. & Wu, L.T. “Associations between Cigarette Smoking and Pain Among Veterans.” Epidemiologic Reviews 37, no. 1 (2015): 86-102. https://doi.org/10.1093/epirev/mxu008
12. Volkow, N. D., & McLellan, A. T. “Opioid abuse in chronic pain—misconceptions and mitigation strategies.” New England Journal of Medicine 374, no. 13 (2016): 1253-1263. https://doi.org/10.1056/NEJMra1507771
13. Courtney-Long, E., Stevens, A., Caraballo, R., Ramon, I., & Armour, B. S. “Disparities in current cigarette smoking prevalence by type of disability, 2009-2011.” Public Health Reports 129, no. 3 (2014): 252–260. https://doi.org/10.1177/003335491412900307
14. Weil, E., Wachterman, M., McCarthy, E. P., Davis, R. B., O'Day, B., Iezzoni, L. I., & Wee, C. C. “Obesity among adults with disabling conditions.” JAMA 288, no. 10 (2002): 1265–1268. https://doi.org/10.1001/jama.288.10.1265
15. Hollis, N. D., Zhang, Q. C., Cyrus, A. C., Courtney-Long, E., Watson, K., & Carroll, D. D. “Physical activity types among US adults with mobility disability, Behavioral Risk Factor Surveillance System, 2017.” Disability and Health Journal 13, no. 3 (2020): 100888. https://doi.org/10.1016/j.dhjo.2020.100888
16. Petersilia, J. R. “Crime Victims with Developmental Disabilities: A Review Essay.” Criminal Justice and Behavior 28, no. 6 (2001): 655–694. https://doi.org/10.1177/009385480102800601
17. Cree, R. A., Okoro, C. A., Zack, M. M., & Carbone, E. “Frequent mental distress among adults, by disability status, disability type, and selected characteristics—United States, 2018.” Morbidity and Mortality Weekly Report 69, no. 36 (2020): 1238. http://dx.doi.org/10.15585/mmwr.mm6936a2