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Military Health System Studies Inventory Tool

Welcome to the Military Health System Studies Inventory Tool (MSIT). Military Health System (MHS) data are used by Department of Defense, Veterans Administration, and academic health professionals and scientists to implement health care studies. These studies reflect the MHS interest to rigorously assess and improve our beneficiaries’ access to the high quality health care services they need. Additionally, these studies are frequently used to develop or improve MHS policy and often adopt useful, relevant comparisons to the national health care experience.

The MSIT allows easy review of recent studies that are either conducted or sponsored by the MHS, or accomplished using datasets developed or maintained by the Defense Health Agency for administrative, operational, or research purposes. The studies within this website represent important contributions of the MHS to the national health care dialogue and reflect our capacity to tackle the challenging issues needed to support evidence-informed health policy. Thank you for your interest in them.

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Compliance with antimalarial chemoprophylaxis recommendations for wounded United States military personnel admitted to a military treatment facility.

Study

Abstract

Malaria chemoprophylaxis is used as a preventive measure in military personnel deployed to malaria-endemic countries. However, limited information is available on compliance with chemoprophylaxis among trauma patients during hospitalization and after discharge. Therefore, we assessed antimalarial primary chemoprophylaxis and presumptive antirelapse therapy (primaquine) compliance among wounded United States military personnel after medical evacuation from Afghanistan (June 2009-August 2011) to Landstuhl Regional Medical Center in Landstuhl, Germany, and then to three U.S. military hospitals. Among admissions at Landstuhl Regional Medical Center, 74% of 2,540 patients were prescribed primary chemoprophylaxis and < 1% were prescribed primaquine. After transfer of 1,331 patients to U.S. hospitals, 93% received primary chemoprophylaxis and 33% received primaquine. Of 751 trauma patients with available post-admission data, 42% received primary chemoprophylaxis for four weeks, 33% received primaquine for 14 days, and 17% received both. These antimalarial chemoprophylaxis prescription rates suggest that improved protocols to continue malaria chemoprophylaxis in accordance with force protection guidelines are needed.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center/Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: June 01, 2014
  • Citation: Rini EA, et.al., . Compliance with antimalarial chemoprophylaxis recommendations for wounded United States military personnel admitted to a military treatment facility. Am J Trop Med Hyg. 2014 Jun;90(6):1113-6.

The association of percentage energy from fat and colon cancer risk among members of the US military.

Study

Abstract

Epidemiologic studies have previously reported an association between high fat intake and colon cancer risk. However, findings have generally been inconclusive. This study aimed to investigate the association between fat as a percentage of energy intake and colon cancer risk. Study subjects included 215 cases and 215 matched controls identified by the Defense Medical Surveillance System. Percentage energy from fat (Pfat) was estimated using a short dietary screener developed by the National Cancer Institute for two time periods: the year before the first blood draw and the year before colon cancer diagnosis. Conditional logistic regression analysis was used to assess the relationship between colon cancer risk and Pfat. Odds ratios and 95% confidence intervals (CIs) were calculated. Compared with the lowest quartile of Pfat, the adjusted odds of having colon cancer were 2.00 (95% CI 0.96-4.18), 2.83 (95% CI 1.41-5.66), and 3.37 (95% CI 1.58-7.17), respectively, for the second, third, and highest quartiles in the year before cancer diagnosis. Similar results were observed for Pfat at an earlier time point. Our findings suggest a positive association between Pfat and colon cancer in the US military population.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: July 01, 2014
  • Citation: Shao S, Kao TC, Eckhaus J, Bourgeois J, Perera K, Zhu K. The association of percentage energy from fat and colon cancer risk among members of the US military. Eur J Cancer Prev. 2014 Jul 29.

Trends in rates of chronic obstructive respiratory conditions among US militarypersonnel, 2001-2013.

Study

Abstract

BACKGROUND: The US military has been continuously engaged in combat operations since 2001. Assessing trends in respiratory health diagnoses during this time of prolonged military conflict can provide insight into associated changes in the burden of pulmonary conditions in the US military population. PURPOSE: To estimate and evaluate trends in rates of chronic obstructive pulmonary diseases in the active duty US military population from 2001 through 2013. METHODS: A retrospective analysis of ambulatory medical encounter diagnosis data corresponding to a study base of over 18 million personnel-years was performed to estimate average rates and evaluate temporal trends in rates of chronic obstructive lung conditions. Differences in rates and the time trends of those rates were evaluated by branch of military service, military occupation, and military rank. RESULTS: During the 13-year period, we observed 482,670 encounters for chronic obstructive pulmonary disease and allied conditions (ICD-9 490-496) among active duty military personnel. Over half (57%) of the medical encounters in this category were for a diagnosis of bronchitis, not specified as acute or chronic. There was a statistically significant 17.2% average increase in the annual rates of this nonspecific bronchitis diagnosis from 2001-2009 (95% CI: 13.5% to 21.1%), followed by a 23.6% annual decline in the rates from 2009 through 2013 (95% CI: 8.6% to 36.2%). Statistically significant declines were observed in the rates of chronic bronchitis over time (annual percentage decline: 3.1%; 95% CI: 0.5% to 6.6%) and asthma (annual percentage decline: 5.9%; 95% CI: 2.5% to 9.2%). A 1.6% annual increase in the rate of emphysema and a 0.1% increase in the rate of chronic airways obstruction (not elsewhere classified) over the study period were not statistically significant (P>.05). The magnitude of the estimated rates of these chronic obstructive lung conditions, and, to a lesser extent, the temporal trends in these rates, were sensitive to the requirement that there be persistence of the diagnosis evidenced in the medical record in order qualify as an incident case.

  • Publication Status: Published
  • Sponsoring Organization: Army
  • Sponsoring Office: US Army Public Health Command
  • Congressionally Mandated: No
  • Funding Source: Army
  • Release Date/Publication: July 01, 2014
  • Citation: Abraham JH, Clark LL, Sharkey JM, Baird CP. Trends in rates of chronic obstructive respiratory conditions among US military personnel, 2001-2013. US Army Med Dep J. 2014 Jul-Sep:33-43.

Sexual Assault and Sexual Harassment in the U.S. Military Volume 1. Design of the 2014 RAND Military Workplace Study

Study

Abstract

In early 2014, the Department of Defense Sexual Assault Prevention and Response Office asked the RAND National Defense Research Institute to conduct an independent assessment of sexual assault, sexual harassment, and gender discrimination in the military — an assessment last conducted in 2012 by the department itself with its Workplace and Gender Relations Survey of Active Duty Personnel. This volume documents the methodology used in the resulting RAND Military Workplace Study, which invited close to 560,000 service members to participate in a survey fielded in August and September of 2014. It describes the survey methods, how the new questionnaire was designed, and how sampling, recruitment, and analytic weighting were pursued. It also includes the entire survey instrument.

  • Publication Status: Published
  • Sponsoring Organization: DoD agency, office, or organization other than the Army, Navy, Air Force, or Defense Health Agency
  • Sponsoring Office: National Development and Research Institutes, Inc.
  • Congressionally Mandated: No
  • Funding Source: Federally Funded Research and Development Center
  • Release Date/Publication: July 01, 2014
  • Citation: Rand Corporation, National Defense Research Institute

Associations between mental health disorders and body mass index among military personnel.

Study

Abstract

OBJECTIVE: To determine if overweight or obesity is associated with mental health disorder (MHD) symptoms among military personnel Methods: Secondary analysis using the 2005 Department of Defense Health Related Behaviors Survey (N = 15,195). Standard Body Mass Index (BMI) categories were used to classify participants' body composition. RESULTS: For women, obesity was associated with symptoms of serious psychological distress (SPD), post-traumatic stress disorder, and depression. For men, obesity and overweight was associated with symptoms of generalized anxiety disorder and SPD, respectively. Self-reported high personal stress was the strongest predictor of MHD symptoms and suicide attempts. CONCLUSION: Self-reported stress was a stronger predictor of MHD symptoms than BMI. There is potential value in screening personnel for personal stress as a MHD risk factor.

  • Publication Status: Published
  • Sponsoring Organization: Army
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: July 01, 2014
  • Citation: Smith TJ, White A, Hadden L, Young AJ, Marriott BP. Associations between mental health disorders and body mass index among military personnel. Am J Health Behav. 2014 Jul;38(4):529-40.

The Experience, Expression, and Control of Anger Following Traumatic Brain Injury in a Military Sample.

Study

Abstract

OBJECTIVE: To investigate the impact of traumatic brain injury (TBI) on the experience and expression of anger in a military sample. PARTICIPANTS: A total of 661 military personnel with a history of TBI and 1204 military personnel with no history of TBI. DESIGN: Cross-sectional, between-group design, using multivariate analysis of variance. MAIN MEASURE: State-Trait Anger Expression Inventory-2 (STAXI-2). RESULTS: Participants with a history of TBI had higher scores on the STAXI-2 than controls and were 2 to 3 times more likely than the participants in the control group to have at least 1 clinically significant elevation on the STAXI-2. Results suggested that greater time since injury (ie, months between TBI and assessment) was associated with lower scores on the STAXI-2 State Anger scale. CONCLUSION: Although the results do not take into account confounding psychiatric conditions and cannot address causality, they suggest that a history of TBI increases the risk of problems with the experience, expression, and control of anger. This bolsters the need for proper assessment of anger when evaluating TBI in a military cohort.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Defense and Veterans Brain Injury Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: February 01, 2014
  • Citation: Bailie JM, Cole WR, Ivins B, Boyd C, Lewis S, Neff J, Schwab K. The Experience, Expression, and Control of Anger Following Traumatic Brain Injury in a Military Sample. J Head Trauma Rehabil. 2014 Feb 28.

Outcomes after bankart repair in a military population: predictors for surgical revision and long-term disability.

Study

Abstract

PURPOSE: To quantify the rate of surgical failure after anterior shoulder stabilization procedures, as well as to identify demographic and surgical risk factors associated with poor outcomes. METHODS: All Army patients undergoing arthroscopic or open Bankart repair for shoulder instability were isolated from the Military Health System Management Analysis and Reporting Tool between 2003 and 2010. Demographic variables (age, gender) and surgical variables (treatment facility volume, admission status, surgical technique) were extracted. Rates of surgical failure, defined as subsequent revision surgery or medical discharge with persistent shoulder complaints, were recorded from the electronic medical record and US Army Physical Disability Agency database. Risk factor analysis was performed with univariate t tests, χ(2) tests, and a multivariable logistic regression model with failure as the outcome. RESULTS: A total of 3,854 patients underwent Bankart repair during the study period, with most procedures having been performed arthroscopically (n = 3,230, 84%) and on an outpatient basis (n = 3,255, 84%). Patients were predominately men (n = 3,531, 92%), and the mean age was 28.0 years (SD, 7.5 years). A total of 193 patients (5.0%) underwent revision stabilization whereas 339 patients (8.8%) were medically discharged with complaints of shoulder instability, for a total combined failure rate of 13.8% (n = 532). Univariate analyses showed no significant effect for gender; however, younger age, higher facility volume, open repair, and inpatient status were significant factors associated with subsequent surgical failure. Multivariable analyses confirmed that young age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91 to 0.96; P < .001), open repair (OR, 0.52; 95% CI, 0.36 to 0.75; P = .001), and inpatient status (OR, 0.58; 95% CI, 0.40 to 0.84; P = .004) were independently associated with failure by revision surgery. CONCLUSIONS: Young age remains a significant risk factor for surgical failure after Bankart repair. Patients who underwent arthroscopic Bankart repair had a significantly lower surgical failure rate (4.5%) than patients who underwent open anterior stabilization (7.7%). Despite advances in surgical technique, 1 in 20 military service members required revision surgery after failed primary stabilization in this study.

  • Publication Status: Published
  • Sponsoring Organization: Army
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Army
  • Release Date/Publication: February 01, 2014
  • Citation: Waterman BR, Burns TC, McCriskin B, Kilcoyne K, Cameron KL, Owens BD. Outcomes after bankart repair in a military population: predictors for surgical revision and long-term disability. Arthroscopy. 2014 Feb;30(2):172-7.

Mental health outcomes in US and UK military personnel returning from Iraq.

Study

Abstract

BACKGROUND: Research of military personnel who deployed to the conflicts in Iraq or Afghanistan has suggested that there are differences in mental health outcomes between UK and US military personnel. AIMS: To compare the prevalence of post-traumatic stress disorder (PTSD), hazardous alcohol consumption, aggressive behaviour and multiple physical symptoms in US and UK military personnel deployed to Iraq. METHOD: Data were from one US (n = 1560) and one UK (n = 313) study of post-deployment military health of army personnel who had deployed to Iraq during 2007-2008. Analyses were stratified by high- and low-combat exposure. RESULTS: Significant differences in combat exposure and sociodemographics were observed between US and UK personnel; controlling for these variables accounted for the difference in prevalence of PTSD, but not in the total symptom level scores. Levels of hazardous alcohol consumption (low-combat exposure: odds ratio (OR) = 0.13, 95% CI 0.07-0.21; high-combat exposure: OR = 0.23, 95% CI 0.14-0.39) and aggression (low-combat exposure: OR = 0.36, 95% CI 0.19-0.68) were significantly lower in US compared with UK personnel. There was no difference in multiple physical symptoms. CONCLUSIONS: Differences in self-reported combat exposures explain most of the differences in reported prevalence of PTSD. Adjusting for self-reported combat exposures and sociodemographics did not explain differences in hazardous alcohol consumption or aggression.

  • Publication Status: Published
  • Sponsoring Organization: Army
  • Sponsoring Office: United States Army Medical Research and Materiel Command
  • Congressionally Mandated: No
  • Funding Source: Army
  • Release Date/Publication: March 01, 2014
  • Citation: Sundin J, Herrell RK, Hoge CW, Fear NT, Adler AB, Greenberg N, Riviere LA, Thomas JL, Wessely S, Bliese PD. Mental health outcomes in US and UK military personnel returning from Iraq. Br J Psychiatry. 2014 Mar;204(3):200-7.

Melanoma incidence rates in active duty military personnel compared with a population-based registry in the United States, 2000-2007.

Study

Abstract

OBJECTIVES: This study was conducted to investigate whether incidence rates of malignant cutaneous melanoma in U.S. Department of Defense active duty military personnel differed from rates in the U.S. general population between 2000 and 2007. METHODS: The study population included active duty military personnel and the general population aged 18 to 56 years. Data were obtained from the U.S. Department of Defense medical data systems and from the Surveillance Epidemiology and End Results program. Melanoma risk was estimated by incidence rate ratios (IRRs). RESULTS: Melanoma risk was higher among active duty personnel than the general population (IRR = 1.62, 95% confidence interval = 1.40-1.86). Incidence rates were higher for white military personnel than for white rates in general population (36.89 and 23.05 per 100,000 person-years, respectively). Rates were also increased for military men and women compared with SEER (men, 25.32 and 16.53 per 100,000; women, 30.00 and 17.55 per 100,000). Air Force service personnel had the highest rates and Army had the lowest. CONCLUSION: Melanoma rates were marginally higher among active duty military personnel than the general population between 2000 and 2007.

  • Publication Status: Published
  • Sponsoring Organization: Undetermined
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: March 01, 2014
  • Citation: Lea CS, Efird JT, Toland AE, Lewis DR, Phillips CJ. Melanoma incidence rates in active duty military personnel compared with a population-based registry in the United States, 2000-2007. Mil Med. 2014 Mar;179(3):247-53.

Legionellosis in Military Health System beneficiaries, 1998-2013.

Study

Abstract

Legionellosis is an infection caused by exposure to mist or vapor contaminated with Legionella bacteria. During the 16-year surveillance period, 73 cases of legionellosis were identified in active component service members; 37 were identified among the reserve component; and 1,044 were identified among all other beneficiaries of the Military Health System (MHS). Of the total 1,154 cases of legionellosis, 11 percent (n=126) were confirmed cases (i.e., reportable medical events); 52 percent (n=599) were probable cases (i.e., hospitalizations); and 37 percent (n=429) were suspected cases (i.e., ambulatory visits). Most of the cases (59%) were identified in individuals aged 60 years and older. The annual number of cases increased during the surveillance period and demonstrated a seasonal trend with more cases occurring in the summer and early fall. Recent trends in the incidence of legionellosis among MHS beneficiaries and civilian populations in the United States highlight the importance of correctly identifying the etiologic agents of bacterial pneumonia and submitting reports of cases of legionellosis through the appropriate reporting system.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Armed Forces Health Surveillance Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: March 01, 2014
  • Citation: AFHSC. Legionellosis in Military Health System beneficiaries, 1998-2013. MSMR. 2014 Mar;21(3):6-9.

Military healthcare providers reporting of adverse events following immunizations to the vaccine adverse event reporting system.

Study

Abstract

OBJECTIVES: We studied military health care provider (HCP) practices regarding reporting of adverse events following immunization (AEFI). METHODS: A convenience sample of HCP was surveyed to assess familiarity with Vaccine Adverse Event Reporting System (VAERS), AEFI they were likely to report, methods used and preferred for reporting, and perceived barriers to reporting. We analyzed factors associated with HCP reporting AEFI to VAERS. RESULTS: A total of 547 surveys were distributed with 487 completed and returned for an 89% response rate. The percentage of HCP aware of VAERS (54%) varied by occupation. 47% of respondents identified knowledge of at least one AEFI with only 34% of these indicating that they had ever reported to VAERS. More serious events were more likely to be reported. Factors associated with HCP reporting AEFIs in bivariate analysis included HCP familiarity with filing a paper VAERS report, HCP familiarity with filing an electronic VAERS report, HCP familiarity with VAERS, and time spent on immunization tasks. In a multivariable analysis, only HCP familiarity with filing a paper VAERS report was statistically significant (Odds ratio = 115.3; p < 0.001). CONCLUSIONS: Specific educational interventions targeted to military HCP likely to see AEFIs but not currently filing VAERS reports may improve vaccine safety reporting practices.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: April 01, 2014
  • Citation: Li R, McNeil MM, Pickering S, Pemberton MR, Duran LL, Collins LC, Nelson MR, Engler RJ. Military healthcare providers reporting of adverse events following immunizations to the vaccine adverse event reporting system. Mil Med. 2014 Apr;179(4):435-41

Absolute and relative morbidity burdens attributable to various illnesses and injuries, non-service member beneficiaries of the Military Health System, 2013.

Study

Abstract

Individuals who are eligible for care through the Military Health System (MHS) (“beneficiaries”) include family members of active component service members, family members of National Guard and Reserve service members, and retirees and eligible family members of retirees. In 2013, there were approximately 1.98 million active component family members, 550,000 Guard/Reserve family members, and 5.29 million retirees and their family members eligible for medical care from the MHS. Some beneficiaries of MHS care do not enroll in the healthcare plans provided by the MHS (e.g., if they use insurance through their own employment); also, some of those who are enrolled do not seek care through the MHS. MHS beneficiaries may receive care from resources provided directly by the Uniformed Services (i.e., military medical treatment facilities [MTFs]) or from civilian healthcare resources (i.e., outsourced [purchased] care) that supplement direct military medical care. In 2013, approximately 6.8 million individuals utilized inpatient or outpatient services provided by the MHS. In the population of MHS care recipients in 2013, there were more females (58%) than males (42%) and more infants, children, and adolescents (<20 years: n=1.9 million; 28.9%) and more seniors (65 years or older: n=1.8 million; 26.1%) than younger (20–44 years: n=1.4 million; 20.1%) or older (45–64 years: n=1.7 million; 24.9%) adults. Since 1998, the MSMR has published annual summaries of the numbers and rates of hospitalizations and outpatient medical encounters to assess the healthcare “burdens” of 16 categories of illnesses and injuries among active component military members. This year, for the first time and using similar methodology, this report quantifies the illnesses and injuries among non-service members who received care in the MHS in 2013. Healthcare burden estimates are stratified by direct versus outsourced care and across four age groups of healthcare recipients.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Armed Forces Health Surveillance Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: April 01, 2014
  • Citation: AFHSC. Absolute and relative morbidity burdens attributable to various illnesses and injuries, non-service member beneficiaries of the Military Health System, 2013. MSMR. 2014 Apr;21(4):23-30; discussion 30.

Variation in rates of autoimmune thyroid disease by race/ethnicity in US military personnel.

Study

Abstract

The relationship between Graves disease and race/ethnicity is undefined. Based on thyroid antibody prevalence, the rates of Hashimoto thyroiditis may be highest in whites and lowest in blacks. Using a large and comprehensive data set of medical diagnoses for all US active duty service personnel, we calculated age-standardized incidence rates for Graves disease and Hashimoto thyroiditis by race/ethnicity. Compared with whites, the IRR for Graves disease was significantly elevated in black women (IRR, 1.92; 95% CI, 1.56-2.37) and men (IRR, 2.53; 95% CI, 2.01-3.18) and Asian/Pacific Islander women (IRR, 1.78; 95% CI, 1.20-2.66) and men (IRR, 3.36; 95% CI, 2.57-4.40) (Figure). In contrast, Hashimoto thyroiditis incidence was highest in whites and lowest in black women (IRR, 0.33; 95% CI, 0.21-0.51) and men (IRR, 0.22; 95% CI, 0.11-0.47) and Asian/Pacific Islander women (IRR, 0.31; 95% CI, 0.17-0.56) and men (IRR, 0.23; 95% CI, 0.07-0.72). The differences in incidence by race/ethnicity may be due to different environmental exposures, genetics, or a combination of both. Our results are not easily attributable to the strongest known environmental risk factor, cigarette smoking.

  • Publication Status: Published
  • Sponsoring Organization: Undetermined
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Government, academic, or industry source other than Federal Government
  • Release Date/Publication: April 01, 2014
  • Citation: McLeod DS, Caturegli P, Cooper DS, Matos PG, Hutfless S. Variation in rates of autoimmune thyroid disease by race/ethnicity in US military personnel. JAMA. 2014 Apr 16;311(15):1563-5.

Energy drinks: review of performance benefits, health concerns, and use by military personnel.

Study

Abstract

Energy drinks (EDs) are highly caffeinated beverages usually containing herbal ingredients promoted and consumed for purported improvements in attention and athletic performance. The popularity of EDs among adolescents and young adults has steadily increased for more than a decade. Reports suggest U.S. military populations consume EDs with greater frequency as compared to age-matched civilian populations. This article reviews the literature and outlines the current body of evidence evaluating the human performance benefits and potential harms associated with ED use.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: April 01, 2014
  • Citation: Johnson LA, Foster D, McDowell JC. Energy drinks: review of performance benefits, health concerns, and use by military personnel. Mil Med. 2014 Apr;179(4):375-80.

Lower obesity rate during residence at high altitude among a military population with frequent migration: a quasi experimental model for investigating spatial causation.

Study

Abstract

We sought to evaluate whether residence at high altitude is associated with the development of obesity among those at increased risk of becoming obese. Obesity, a leading global health priority, is often refractory to care. A potentially novel intervention is hypoxia, which has demonstrated positive long-term metabolic effects in rats. Whether or not high altitude residence confers benefit in humans, however, remains unknown. Using a quasi-experimental, retrospective study design, we observed all outpatient medical encounters for overweight active component enlisted service members in the U.S. Army or Air Force from January 2006 to December 2012 who were stationed in the United States. We compared high altitude (>1.96 kilometers above sea level) duty assignment with low altitude (<0.98 kilometers). The outcome of interest was obesity related ICD-9 codes (278.00-01, V85.3x-V85.54) by Cox regression. We found service members had a lower hazard ratio (HR) of incident obesity diagnosis if stationed at high altitude as compared to low altitude (HR 0.59, 95% confidence interval [CI] 0.54-0.65; p<0.001). Using geographic distribution of obesity prevalence among civilians throughout the U.S. as a covariate (as measured by the Centers for Disease Control and Prevention and the REGARDS study) also predicted obesity onset among service members. In conclusion, high altitude residence predicts lower rates of new obesity diagnoses among overweight service members in the U.S. Army and Air Force. Future studies should assign exposure using randomization, clarify the mechanism(s) of this relationship, and assess the net balance of harms and benefits of high altitude on obesity prevention.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences/Armed Forces Health Surveillance Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: April 01, 2014
  • Citation: Voss JD, Allison DB, Webber BJ, Otto JL, Clark LL. Lower obesity rate during residence at high altitude among a military population with frequent migration: a quasi experimental model for investigating spatial causation. PLoS One. 2014 Apr 16;9(4):e93493
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