February 1, 2013
The Veterans Affairs Department has kicked off a massive study in cooperation with the Centers for Disease Control and Prevention and the Defense Department to determine the cause of veterans’ deaths since 1979, an effort that requires matching records of 34 million service personnel with death certificates.
Aaron Schneiderman, acting director of VA’s epidemiology program, said the National Mortality Study will first focus on roughly 1 million veterans who served on active duty during the Afghanistan and Iraq wars from 2001 through 2010, which among other things will help the VA determine the scope of veteran suicides on a national basis. These matches only will include personal information such as name, date of birth and Social Security number; they will not include Defense health records.
A veteran commits suicide every 80 minutes, according to recent estimates from the VA. Suicides by active duty military personnel in 2012 hit 349, more than the 295 Americans who died in combat in Afghanistan.
CDC’s Division of Vital Statistics at the National Center for Health Statistics will match records provided by Defense with death certificate information from all 50 states contained in the National Death Index, said NDI director Lillian Ingster.
The NDI is a computerized index of death record information on file in state vital statistics offices and is used by epidemiologists and other health and medical investigators to help determine causes of death. Ingster said the 34 million records include everyone who has served in the military since 1979 -- when the NDI went into operation. The study will involve the largest matching exercise in which she has ever engaged.
“This is enormous,” Ingster said. Her division has been grinding through the data since the end of 2012, with completion of the 34 million matches expected in a matter of months. She said the veteran matching process encountered a few hiccups as the NDI was switched from a mainframe to a server-based environment.
Schneiderman said death certificates include standardized sources of information on causes of deaths, including drug overdoses and chronic diseases. Once the matches are completed, the results will help VA determine “how to care for veterans.”
Schneiderman said once VA receives the data match file from CDC its first task will be to conduct a mortality study of Afghanistan and Iraq veterans that will include an evaluation of traumatic injury deaths (suicides and car crashes) and poisonings (drug overdose).
He added that the study also will help VA determine if there are factors that result in a higher number of veteran deaths than in the general population. VA can then use information to “drive down” particular causes of death, he said.
Ingster agreed, and said the medical research community and VA can use the study to improve care.
Dr. Remington Nevin, a former Army epidemiologist who left the service this fall to pursue a degree in public health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said Defense and VA have made a good start in developing a national veteran mortality database, but cautioned that death certificates prepared by local coroners “can be pretty sloppy and there is no quality control.”
Nevin said VA could get better insight into veteran suicides if it also tapped into the CDC’s National Violent Death Reporting System, which covers only 18 states. Ingster said CDC is not using this system for the VA national mortality study.
If all 50 states signed on to the National Violent Death Reporting System it would be a valuable resource to help VA pinpoint veteran suicides, Nevin said.
February 1, 2013