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PURPOSE: Motor vehicle crashes (MVC) are the leading cause of death among military personnel, and deployment has been associated with an increased risk of fatal MVC within military populations. Gulf War (GW) deployment has also been associated with an increased risk of fatal MVC. We evaluated selected variables as predictors of fatal MVC among GW era veterans using existing Department of Defense, Department of Veterans Affairs, and Department of Transportation (DoT) databases. METHODS: This is a nested case-control study of a cohort comprised of 696,516 Gulf War veterans and 746,291 non-deployed veterans. 1,343 cases of fatal MVC occurring between 1991 and 1995 were identified from the cohort by linking to the DoT Fatality Analysis Reporting System (FARS). Ten controls were selected per case, matched by gender and year of case ascertainment. We examined data on demographic and military characteristics; hospitalizations and outpatient visits; self-reported behaviors, lifestyle, and psychosocial factors; and possible GW exposures as potential risk factors for fatal MVC. RESULTS: Fatal MVC on US public roads that caused the death of the driver were not randomly distributed across our study population. Fatalities involving female drivers were few (n = 28). Male fatalities were more likely to be younger, less educated, and never married compared to controls. Cases were also more likely to be enlisted, deployed to the GW, have combat occupations, be in the Guard or Reserve, and be other than Air Force. Inpatient and outpatient data and socio-behavioral data, as well as information from FARS will be reported separately. CONCLUSION: Our findings are consistent with previous studies that have reported military deployment as a risk factor for fatal MVC. We also identified several other factors that increase this risk. Additional studies to investigate potential risk factors for all MVC, not just fatalities, are warranted so that appropriate interventions can be designed and evaluated.

PURPOSE: Motor vehicle fatalities (MVFs) are the leading cause of mortality among military personnel. Previous studies of our population of all U.S. Gulf War veterans (GWVs) and a comparable number of contemporaneous non-deployed veterans (NDVs) found that the GWVs had a nearly 50% higher rate of MVFs. We sought to identify the role of prior morbidity as an indicator of underlying physical and mental health, lifestyle, or behavioral characteristics contributing to MVFs among GW-era veterans. METHODS: Our 980 cases were the male drivers from a population of 1,441,807 GW-era personnel who were MVFs between 1991 and 1995 having a record in NHTSA's Fatality Analysis Reporting System. For each case, 10 controls alive at the end of the match year in which the case died were randomly selected from the same population. We analyzed all admissions to Department of Defense (DoD) or Veterans Affairs (VA) hospitals and outpatient visits to VA facilities in the interval following the GW and before the end of the match year as risk factors for MVF. RESULTS: After adjustment for demographic factors (age, marital status, education, race) and military characteristics (rank, occupation, branch, duty component), we found that use of these medical resources for any cause was associated with subsequent MVFs. Prior treatment for mental health problems, especially the subset related to drug or alcohol abuse, was strongly related to subsequent MVFs, particularly for the NDVs. Admissions for injuries due to a prior motor vehicle crash (available only for DoD hospitalizations) were also associated with the occurrence of a subsequent MVF, particularly among GWVs. CONCLUSIONS: Men with prior military hospitalizations or VA clinic visits were at higher risk for MVFs than those without such morbidity. This relationship held for the entire military population, but health care for substance abuse was more predictive of MVFs for NDVs, while prior motor vehicle injuries were for GWVs. Patients treated for certain diagnoses may be a population to target for interventions to reduce MVFs.