The Hidden Costs of War: Healthcare Utilization among Individuals Sustaining Combat-related Trauma (2007-2018)

Michael K. Dalton, Molly P. Jarman, Adoma Manful, Tracey P. Koehlmoos, Zara Cooper, Joel S. Weissman, Andrew J. Schoenfeld*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: We sought to evaluate long-term healthcare requirements of American military servicemembers with combat-related injuries. Summary of Background Data: US military conflicts since 2001 have produced the most combat casualties since Vietnam. Long-term consequences on healthcare utilization and associated costs remain unknown. Methods: We identified servicemembers who were treated for combat-related injuries between 2007 and 2011. Controls consisted of active-duty servicemembers injured in the civilian sector, without any history of combat-related trauma, matched (1:1) on year of injury, biologic sex injury severity, and age at time of injury. Surveillance was performed through 2018. Total annual healthcare expenditures were evaluated overall and then as expenditures in the first year after injury and for subsequent years. Negative binomial regression was used to identify the adjusted influence of combat injury on healthcare costs. Results: The combat-injured cohort consisted of 3981 individuals and we identified 3979 controls. Total healthcare utilization during the follow-up period resulted in median costs of $142,214 (IQR $61,428, $323,060) per combat-injured servicemember as compared to $50,741 (IQR $26,669, $104,134) among controls. Median expenditures, adjusted for duration of follow-up, for the combat-injured were $45,211 (IQR $18,698, $105,437). In adjusted analysis, overall costs were 30% higher (1.30; 95% confidence interval: 1.23, 1.37) for combat-injured personnel. Conclusion: This investigation represents the longest continuous observation of healthcare utilization among individuals after combat injury and the first to assess costs. Expenditures were 30% higher for individuals injured as a result of combat-related trauma when compared to those injured in the civilian sector.

Original languageEnglish
Pages (from-to)159-164
Number of pages6
JournalAnnals of surgery
Issue number1
StatePublished - 1 Jan 2023
Externally publishedYes


  • combat injury
  • healthcare costs
  • trauma
  • war


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