Survival of U.S. Military Service Members with Hodgkin Lymphoma by Post 9/11 Deployment Status

Abstract

Classic Hodgkin lymphoma (CHL) commonly affects adolescents and young adults (AYAs), including service members (SMs). Impact of deployment on CHL outcomes remains unknown. Tricare beneficiaries diagnosed with CHL from 2001–2022 were identified through the Department of War cancer registry. Deployment history came from the Defense Manpower Data Center, and mortality data from the National Death Index. Mortality was compared between SMs with and without post 9/11 deployment, and associations with deployment specific variables were evaluated using Cox models adjusted for demographic and clinical factors. An exploratory analysis was performed to assess survival of AYA SMs by race and to compare mortality to the SEER database. Among 752 SMs identified, 369 (49%) had deployed post 9/11. Deployment was not associated with overall mortality (aHR 1.64, 95% CI 0.84–3.19) or disease-specific mortality (aHR 0.67, 95% CI 0.13–3.55). No deployment specific variable meaningfully influenced mortality. There were 21/417 (5%) all-cause deaths in white AYA SMs compared to 0/89 in black AYA SMs (log rank test p=0.0198). Compared to SEER, SMs had lower all-cause mortality (aHR 0.52, 95% CI 0.38-0.72) and disease-specific mortality (aHR 0.29, 95% CI 0.15-0.59). Post 9/11 deployment did not adversely affect survival among SMs with CHL, highlighting the need for exposure specific and survivorship focused research. Survival disparities by race were not appreciated, and mortality in SMs was lower than SEER, highlighting access to care within the Military Health System and the healthy soldier effect.