Military Occupational Blast Exposure and Mortality Risk Among Veterans: The Role of TBI and Service Factors

Background and/or Objectives: Military occupational blast and impulse exposure (MOBE) is a common occurrence in both training and combat, with associations to chronic neuropathology, psychiatric disorders, and increased mortality risk. This study investigates the relationship between MOBE and all-cause as well as cause-specific mortality among Veterans, with a focus on the role of TBI and other service-related factors.

Design: Retrospective longitudinal cohort study.

Setting : VA and DoD Long-term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC Phenotype Study).

Participants : A nationally representative sample of 2,381,191 Service Members and Veterans (SM/V) after exclusions from an initial cohort of 2,530,875.

Interventions: Not applicable.

Main Outcome Measures: All-cause mortality and cause-specific mortality (suicide, substance-related deaths, cardiovascular disease, accidental deaths, and violent deaths), stratified by demographic and service-related factors.

Results: Among 2,381,191 SM/V, 21% had high-risk MOBE occupations. MOBE was associated with increased all-cause mortality (OR=1.05; 95% CI: 1.03, 1.07). Cause-specific analyses showed higher risk of suicide (OR=1.14), accidental deaths (OR=1.08), violent deaths (OR=1.10), and substance-related deaths (OR=1.12), with no significant association for cardiovascular mortality. Mild/moderate TBI further increased mortality risk (OR=1.22). Combat engineers had a 24.9% higher mortality risk (OR=1.249), and infantry had a 20.6% higher risk (OR=1.206) compared to non-MOBE Veterans.

Conclusions: These findings underscore the need for targeted interventions to mitigate long-term health consequences among MOBE-exposed Veterans. High-risk MOBE occupations exhibited elevated mortality risk, particularly from suicide, accidental, violent, and substance-related deaths. The modifying role of TBI and occupational category highlights the importance of targeted prevention, early identification, and tailored care. Structured reintegration programs, routine mental health screenings, and proactive care coordination should prioritize high-risk occupations with disproportionately higher mortality. Addressing TBI-related complications through early screening and long-term management may further reduce excess mortality.