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Validity of Military Service as Reported on U.S. Death Certificates
Candice Y Johnson1,2, Lucy Akushevich1, Heather R Batchelder1
1From the Department of Family Medicine and Community Health, Duke University, Durham, NC.
Epidemiology (Cambridge, Mass.)
|April 1, 2026
Summary
Military service is often underreported on death certificates, particularly for women and non-active duty personnel. This study quantifies misclassification bias for improved mortality research in military populations.
Area of Science:
- Public Health
- Epidemiology
- Military Health
Background:
- Death certificates are vital for general population mortality studies.
- Their utility for military populations is limited by unknown accuracy of reported service.
- Estimating bias parameters is crucial for accurate military mortality research.
Purpose of the Study:
- To estimate bias parameters for military service misclassification on death certificates.
- To enable quantitative bias analysis in military mortality studies.
Main Methods:
- Linked 2014-2021 death certificates (ages 18-64) from five states to military service records via DMDC.
- Defined military service using Defense Manpower Data Center records.
- Calculated sensitivity, specificity, and predictive values stratified by demographics and service characteristics.
Main Results:
- 9.3% of death certificates indicated military service; records confirmed 10.9% served.
- Overall sensitivity was 81.5%, specificity 99.5%.
- Lower sensitivity observed for females (72.3%) and non-active duty personnel (63.5%).
Conclusions:
- Military service is underreported on death certificates, especially for specific subgroups.
- Estimated bias parameters can correct for misclassification in mortality analyses.
- Improved data accuracy will enhance understanding of military veteran mortality patterns.
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