Review of the X-Factor 2023: Changes to Civilian Life
Abstract: This report has been produced by Incomes Data Research (IDR) for the Office of Manpower Economics (OME), on behalf of the Armed Forces Pay Review Body (AFPRB). The aim of this report is to provide the AFPRB with evidence on changes in civilian life relevant to those compensated by the X-Factor addition to basic military pay between 2017 and 2022. The X-Factor components reflect a range of aspects of military life, some of which are difficult to measure. Evidence used in this review varies in suitability and depth, however assessments for most components have been made with reasonable certainty. The exceptions are promotion and early responsibility, separation, and leave where we have limited confidence in the evidence due to a lack of suitability and depth of evidence. There is a lack of suitable evidence for promotion and early responsibility as there is limited time series data to conduct trend analysis. Furthermore, limited sources are available providing a ‘convincing measure’ of separation experienced by civilians, and no available data analysing the ability for civilians to take leave at the time of their choosing. Turbulence is a complex component and, in our view, while we have depth of evidence, a question remains as to how robustly the evidence measures turbulence. Overall, we conclude there has been improvement in civilian life in five components (three of which show clear improvement, although one is based on limited evidence), no change in three of the components and deterioration in four components (one of which shows a clear deterioration). Although five components have shown an improvement in civilian life, the depth and suitability of the evidence for the promotion and early responsibility and separation components is limited, and therefore could not be fully relied upon. Therefore, our conclusion shows a slight deterioration in civilian life due to the deeper evidence seen to this effect
Abstract: Context: In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Objective: Examine temporal trends in opioid prescribing, pain, and opioid overdoses among Veterans near the end of life. Methods: Retrospective, time series analysis of VA decedents between October 2009 and September 2018 whose next-of-kin participated in VA's Bereaved Family Survey (BFS). Using multivariate regression to adjust for sociodemographic and clinical covariates, we examined temporal trends in outpatient opioid prescribing, uncontrolled pain based on BFS report, and opioid overdose-related hospitalizations, in the last month of life, overall and by clinical diagnosis (cancer versus non-cancer). Results: Among 79,409 decedents, mean daily outpatient opioid dose in morphine milligram equivalents in the last month of life decreased from 4.6 mg in 2010 to 2.1 mg in 2018 (adjusted change -0.20 mg/year; P