Wehrmedizinische Monatsschrift

The five most important (“The Big Five”) non-communicable
in military personnel and civilians in Germany

Peter Richter a , Melanie Schmeil a , Dieter Leyk a, b

a Bundeswehr Institute for Preventive Medicine, Andernach/Koblenz, Germany

b German Sport University Cologne – Research Group Epidemiology of Performance, Institute for Physiology and Anatomy, Germany



Military personnel is exposed to occupation- specific stressors and demands, e.g. exposure to heat/ cold, heavy load-carrying or disadvantageous working hours. Simultaneously, recent studies reveal declining physical performance and resilience in soldiers. Soldiers are not immune to the negative impacts of unhealthy leisure time behavior and as a result are prone to the development of the corresponding lifestyle diseases.

Aim of the present study is the comparison of German military personnel with their civilian counterpart concerning incidence of the “Big Five” non-communicable diseases as defined by the WHO (cancer, type-II diabetes, cardiovascular disease, chronic respiratory disease and mental illness [3]).


Big Five” incidence based on sick days (unfit for service) were extracted from the registry databases at the Bundes­wehr Institute for Preventive Medicine for the years 2012 - 2016 and stratified for age and gender. Corresponding data for civilians were obtained from official reports of the statutory health insurance (GKV). Data were transformed into incidence rates (sick days per 10.000 persons) and standard mortality rates for both groups for better comparability.

Fig. 1: Incidence of the “Big Five“ diseases in civilian population vs. military personnel (civilian data taken from [1])


Civilians showed markedly higher incidence rates than soldiers. Except for chronic respiratory diseases, marked gender-specific differences were observed in civilians (e.g. cancer: 82.5 cases per 10.000 female persons vs. 70.2 cases per 10.000 male persons, 5 years arithmetic mean). In comparison, gender-related differences were less distinct in soldiers (e.g. cancer: 8.8 cases per 10.000 female soldiers vs. 9.3 cases per 10.000 male soldiers, 5 years arithmetic mean). Notable exception were mental illnesses: female soldiers showed an elevated rate of absence for the years 2012-2015 ( 23 393.8 sick days per 10.000 female soldiers vs. 14 546.81 sick days per 10.000 male soldiers, 5 years arithmetic mean). Standardized mortality rates 2 for soldiers were 0.4 for cancer and cardiovascular diseases, 0.85 for suicides.

Fig. 2: Incidence (left) and sick days (right) in civilian population vs. military personnel for the “Big Five“ (data for civilian population taken from [1])

Conclusion and Operational Relevance

These preliminary results must be taken with careful caveats due to unadjusted differences in age and gender distributions and the potential influence of socioeconomic status. The phenomenon of considerably lower “Big Five ”-related sick days in soldiers might be an indicator of positive effects of health and fitness promotion in the military , specific protective factors such as regular physical training/ activity on duty and close-meshed control by the medical corps. Further , root cause analyses with tighter control for socioeconomic factors, age, and gender distribution are needed to confirm this hypothesis .

Operational Relevance

Despite occupation-specific stressors and demands, higher levels of mandatory physical activity as well as health and fitness promotion in the armed forces may be a protective factor against the “Big Five” in soldiers.


  1. Federal Ministry of Health: Inability to work: cases and days after diagnoses. Results of the disease type statistics of the statutory health insurance, years 2012-2016., last access 14 June 2020 mehr lesen
  2. Robert Koch-Institute/Destatis: Health reporting. Interactive table deaths, death rates (since 1980). , last access 14 June 2020 mehr lesen
  3. World Health Organization: Fact sheets on sustainable development goals: health targets: Noncommunicable Diseases. WHO Europe, 2017; , last access 14 June 2020. mehr lesen


For the authors

Colonel (MC) Dr. Peter Richter

Bundeswehr Institute for Preventive Medicine

Division B – Health Information

Aktienstr. 87, D- 56626 Andernach

E-Mail: peter6richter@bundeswehr.org

Posterpresentation at the ICSSP 2020 in Quebec, ­Canada (11 to 14 February 2020)