Mortality Among Norwegian Military Women Veterans from International Peacekeeping Missions Between 1978 and 2023

Most mortality studies among Norwegian military veterans from international peacekeeping missions were conducted among men, as the number of women participants in each mission has been too small to give statistically robust results. However, women have served in every peacekeeping operation since 1978. As the number of military women increases, knowledge about the causes of death among female military peacekeepers is increasingly important to ensure the Armed Forces' military operability and preventive initiatives. Hence, we aimed to study mortality in a cohort comprising all military women who participated in such service back to 1978.

The cohort was established by the Norwegian Armed Forces Health Registry and included 2,365 women eligible for follow-up from their first day of peacekeeping service through 2023. We calculated standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) by comparing the observed numbers of deaths with the expected numbers calculated from national population rates in Norway.

A total of 65 deaths observed during follow-up gave a lower-than-expected all-cause SMR of 0.79 bordering on statistical significance (95% CI, 0.61-1.01). This was because of low mortality from diseases. Mortality from (nonmalignant) respiratory diseases was lower than expected (SMR = 0.18, 95% CI, 0.00-0.99), on the other hand, the risk of dying from cerebrovascular diseases (stroke) was elevated (SMR = 2.64, 95% CI, 1.21-5.01). Mortality from all external causes combined, as well as from accidents and suicide, did not differ from that of the national rates, the same was true for breast cancer and lung cancer mortality.

Generally, military women peacekeepers did not have an increased risk of mortality overall, but the risk of death from stroke was increased. Most of the stroke deaths were haemorrhagic, for which parity and old age at menopause are known risk factors.