Health-related quality of life of U.S. military personnel: A population-based study

Military Medicine,  Nov 2003  by Boehmer, Tegan K,  Boothe, Vickie L,  Flanders, W Dana,  Barrett, Drue H

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Objective: This study evaluated the association between military service and health-related quality of life (HRQOL), using a large, population-based sample of U.S. adults. Methods: Participants in the 2000 Behavioral Risk Factor Surveillance System were characterized as active duty personnel (N = 1,163), reserves (N = 1,055), veterans (N = 22,558), or no military service (N = 141,620). HRQOL was described by sex and military status. Logistic regression was used to calculate sex-specific adjusted odds ratios. Results: Active duty men were more likely than men without military service to report 14 or more days of activity limitation, pain, and not enough rest in the past 30 days. Reserve personnel reported better overall HRQOL than nonmilitary participants, and no difference in HRQOL was observed between veterans and persons with no military service. Conclusions: Recommendations are made to monitor HRQOL of active duty and reserve personnel over time and to include HRQOL measures in military-based surveys of active duty troops.

Introduction

Health-related quality of life (HRQOL) encompasses individual health perceptions, physical functioning, psychological well-being, and community and environmental indicators that affect either physical or mental health.1 HRQOL is associated with common health outcomes (e.g., mortality and morbidity), health care use, disability, and behavioral risk factors.2 Measures of HRQOL are used in epidemiological research to assess general population health, observe trends in physical and mental health status over time, establish national and local health priorities, monitor progress toward health objectives, and identify health disparities.2

Although military service may play a major role in the health and well-being of military personnel, only a few studies have investigated HRQOL among military populations. These studies compared either HRQOL of deployed and nondeployed Gulf War veterans3,4 or the mental health status of veterans and nonveterans.5,6 Studies of active duty, reserve, and National Guard military personnel are less common, despite the unique health concerns of these groups and the increasing contributions of reserve troops to the U.S. military.7 Thus, the relation between military status and HRQOL remains unknown.

The present study evaluates the association between military service and HRQOL, using a large, population-based sample of adults in the United States. The research objectives were to (1) report HRQOL among active duty, National Guard/reserve, and veteran military personnel and (2) determine whether HRQOL differs between military personnel and nonmilitary groups after controlling for confounding factors.

Methods

Subjects

The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based surveillance system supported by the Centers for Disease Control and Prevention to measure health behaviors and risk factors of the U.S. adult noninstitutionalized population.8,9 Data are collected by computer-assisted telephone interviews from a random probability sample of persons age 18 years or older living in households with a telephone. In 2000, all 50 states plus the District of Columbia and Puerto Rico participated in the BRFSS, for a total of 184,450 completed interviews. The median response rate was 49%.10

The BRFSS comprises a core section, optional modules, and state-added questions. The core is a uniform set of questions asked by all states and territories and includes items on health status, demographics, and tobacco use, among others. In addition, states can select from standardized optional modules on specific topics. In 2000, the Quality of Life and Care Giving (QOL) optional module was used by 18 states (4 western, 4 midwestern, 6 southern, and 4 northeastern) plus the District of Columbia, for a total of 61,291 interviews.

Variables

The following two veteran status questions were introduced to the BRFSS core in 2000: (1) "Have you ever served on active duty in the U.S. armed forces, either in the regular military or in a National Guard or military reserve unit," and if yes, (2) "Which of the following best describes your current military status: currently on active duty, currently in reserves, or no longer in military service?" These two questions were used to classify current military status for each respondent as active duty, reserve, veteran, or nonmilitary. The category of "reserves" includes members of the National Guard and reserve units of the U.S. Armed Forces.

Four health status items from the core were used to measure general self-rated health, recent physical health, recent mental health, and recent activity limitation. Specifically, respondents were asked to rate their general health as excellent, very good, good, fair, or poor and to report the number of days in the preceding 30 days in which their physical health (including illness and injury) was not good, mental health (including stress, depression, and problems with emotions) was not good, and usual activities (including self-care, work, and recreation) were limited as a result of either poor physical or mental health.