Respiratory Health Among U.S. Veterans Across Age and Over Time

Many veterans and their advocates are concerned that military service may cause impaired respiratory function resulting from occupational exposures to environmental hazards (e.g., Agent Orange in the Vietnam War, burn pits in the Global War on Terror) or infectious diseases (e.g., pneumonia) that are associated with close living quarters in harsh environments. Such exposures occurring in young adulthood, when soldiers are in their peak years of strength, mobility, and overall good health, may not have immediately discernible effects on lung health; some symptoms (e.g., shortness of breath, wheezing) may emerge in the immediate months or years after separation from the military, and diagnosable conditions (e.g., lung cancer, chronic bronchitis) may not manifest until decades later in life.

Health care providers serving veteran populations must consider both the unique combat circumstances surrounding the time of veterans' service and the age-graded nature of health conditions that might result from military service.

To characterize lung health across a broad age range of veterans, the authors analyzed data from two nationally representative surveys of health and well-being that include samples of veterans and their civilian peers. With these data, the authors compare respiratory health outcomes observed for the veteran and civilian populations who were of prime age for military service during different periods of national conflict: the Korean War, the Vietnam War, Operation Desert Shield/Storm, and the Global War on Terror.

Key Findings

• Veterans and civilians have similar respiratory health profiles during their 20s and 30s, and key symptoms are generally not present at these younger ages.
• At older ages, veterans have worse respiratory health profiles than civilians. For instance, veterans over the age of 60 have higher rates of chronic obstructive pulmonary disease, lung cancer, functional limitations caused by poor lung health, and activity limitations caused by poor lung health than same-aged civilians do.
• Veterans who served during periods of peace had a similar prevalence of respiratory disease diagnoses and symptoms as veterans who served during wartime.
• Cigarette smoking may be a major reason why veterans have poor respiratory health. Differences in adult smoking behaviors are estimated to account for 20 percent to 25 percent of the differences in respiratory health outcomes between veterans and civilians. Overall differences in smoking behaviors—including differences prior to enlistment—are estimated to account for at least half of veteran–civilian disparities in respiratory outcomes.