This retrospective cohort study followed 9,496,285 US Vietnam War-era veterans from 1979 to 2021, using adjusted Cox models. Theater veterans (2,443,567) had higher risk of all (HR 1.03) and accidental (HR 1.08) overdose mortality than non-theater veterans. Their risk of intentional overdose mortality was lower (HR 0.90). For 1999–2021, the largest excess was in accidental overdoses involving stimulants without opioids (HR 1.20). Crude overdose rates rose in both groups and were higher overall among non-theater veterans (12.87 versus 10.01). As an observational comparison adjusted only for recorded covariates, it cannot exclude residual confounding.
Why it is interesting: Crude overdose mortality rates rose in both groups over four decades after service ended. Deployment to Vietnam was linked to higher accidental but lower intentional overdose risk than service elsewhere.
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