Key takeaways:

• Authors examined 36,641 veterans over 12 years.
• High-level blasts can include explosive devices and land mines.
• Low-level blasts were linked to lower likelihood of some conditions, but more research is needed.

Self-reported exposure to high-level blasts in the military was associated with several chronic health conditions, including seizures, neuropathy and a range of cardiovascular conditions, according to research published in Neurology.

Although past research has explored the associations between blast exposure and traumatic brain injuries, psychiatric disorders and cognitive dysfunction, little research has explored non-mental health consequences and chronic disease burden, said Sarah L. Martindale, PhD, research health scientist with the Salisbury VA Health Care System of the U.S. Department of Veterans Affairs in North Carolina.

Data derived from Martindale SL, et al. Neurology. 2026: doi:10.1212/WNL.0000000000218595

“Our findings broaden that picture and reinforce that blast exposure is not exclusively an acute injury or brain health issue,” Martindale told Healio. “It is a whole-body issue. Its potential effects extend well beyond the brain and the time of exposure.”

Martindale and colleagues examined 36,641 veterans (68.5% men; 56.2% born after 1979; 70.2% white) enrolled in the Millennium Cohort Study between 2001 and 2013. Participants all had used VHA care for at least 2 years during the follow-up period.

Overall, 17.4% of participants had an occupation associated with high risk for low-level blasts, which included general infantry, combat operations control and combat engineering.

A total of 10.6% of participants self-reported high-level blast exposure, such as explosive devices or land mines. A total of 4.8% both had a high-risk low-level blast occupation and self-reported high-level blast exposure, Martindale and colleagues wrote.

After adjusting for age, sex and number of days deployed, high-level blast exposure was significantly associated with:

• hypercholesterolemia (adjusted prevalence ratio = 1.31; 95% CI, 1.18–1.46);
• seizures (APR = 1.79; 95% CI, 1.47–2.18);
• neuropathy (APR = 1.38; 95% CI, 1.24–1.54);
• hyperlipidemia (APR = 1.12; 95% CI, 1.06–1.18);
• angina (APR = 1.43; 95% CI, 1.18–1.73);
• hypertension (APR = 1.08; 95% CI, 1.02–1.15);
• hepatitis C (APR = 1.89; 95% CI, 1.3–2.75);
• hepatitis B (APR = 1.46; 95% CI, 1.13–1.89);
• diabetes (APR = 1.28; 95% CI, 1.07–1.52);
• other heart conditions (APR = 1.15; 95% CI, 1.05–1.28);
• chronic bronchitis (APR = 1.28; 95% CI, 1.07–1.52);
• emphysema (APR = 1.26; 95% CI, 1.05–1.52);
• sinusitis (APR = 1.13; 95% CI, 1.04–1.23);
• and bladder infection (APR = 1.54; 95% CI, 1.14–2.08).

Veterans exposed to high-level blast also had an increased likelihood of experiencing stroke (APR = 1.35), but the association was not significant.

High-level blast was not associated with a lower likelihood of any clinical outcome.

By contrast, occupations with a high risk for low-level blast were not associated with significantly greater likelihood of any clinical outcome.

However, those occupations were associated with lower likelihood of several diagnoses, including hepatitis C (APR = 0.67; 95% CI, 0.45–0.97), diabetes (APR = 0.84; 95% CI, 0.72–0.99), hyperlipidemia (APR = 0.94; 95% CI, 0.9–0.99), sinusitis (APR = 0.91; 95% CI, 0.85–0.99) and Crohn’s disease (APR = 0.62; 95% CI, 0.41–0.94).

Martindale and colleagues wrote that low-level blast findings should be considered exploratory until they are replicated. Study limitations, including the relatively young age of participants, the short follow-up period and using occupational risk as a proxy for low-level blast exposure, could have played into the lower likelihood of veterans exposed to low-level blast being diagnosed with some conditions, they wrote.

According to Martindale, the overall findings suggest that the consequences of blast exposure may be broader than previously thought, and physical health concerns veterans face should not automatically be attributed to PTSD or stress.

Developing a better understanding of blast exposure associations can give physicians more information about how to think about the long-term health of veterans and spot opportunities to address problems earlier, she added.

“Ultimately, better understanding these relationships could help us move toward exposure-informed surveillance and prevention, rather than waiting until chronic disease is established,” Martindale said.

One challenge with the research involved trying to accurately capture how blasts affect people, which Martindale said is complex and goes beyond total counts or distance from a blast. To fully understand the effects, future research would need to examine cumulative exposure over a lifetime, including frequency, intensity, proximity and context, she said.

“In this study, military occupation was a useful proxy for low-level blast risk, but it cannot capture individual variability in exposure history,” Martindale told Healio.

Research into how changes following blast exposure accumulate and progress would also provide more clarity into how interventions should be tailored to individuals, she added. Research should examine variables such as prior blast exposure, prior brain injury, general health and activity and stress levels after a blast.

“Ultimately, it would help to know what patterns of exposure increase risk, for whom, and when we can do something about it,” Martindale said.

For more information:

Sarah L. Martindale, PhD, can be reached at neurology@healio.com.