Skip to main content

Military Health System

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Non-service Member Beneficiaries of the Military Health System, 2021

Image of 6_beneficiary morbidity. 6_beneficiary morbidity

Recommended Content:

Medical Surveillance Monthly Report

What are the new findings?

In 2021, mental health disorders accounted for the largest proportions of the morbidity and health care burdens that affected the pediatric and younger adult beneficiary age groups. Among adults aged 45–64 and those aged 65 or older, musculoskeletal diseases accounted for the most morbidity and health care burdens. As in previous years, this report documents a substantial majority of non-service member beneficiaries received care for current illness and injury from the Military Health System as outsourced services at non-military medical facilities.

What is the impact on readiness and force health protection?

Illness and injury among military family member dependents may negatively impact service members’ readiness and their focus on the mission by contributing to stress or by affecting the mental health status of the service member. The provision of health care services to non-service member beneficiaries is an important benefit that can improve military family readiness and, in turn, improve the overall readiness of the force.

Individuals who are eligible for care through the Military Health System (MHS) (“beneficiaries”) include active component service members and their eligible family members, activated National Guard and Reserve service members and their eligible family members, and retirees and their eligible family members. In fiscal year 2020, there were approximately 9.62 million beneficiaries eligible for health care in the MHS: 1.41 million active duty and activated reserve component service members, 1.64 million active duty family members, 230,000 Guard/Reserve members, 830,000 Guard/Reserve family members, and 5.51 million retirees and their family members.1 Some beneficiaries of MHS care do not enroll in the health care plans provided by the MHS (e.g., they use insurance through their own employment), and some of those who are enrolled do not seek care through the MHS.

MHS beneficiaries may receive care from resources provided directly by fixed military medical treatment facilities (MTFs) or from civilian health care resources (i.e., outsourced [purchased] care) that supplement direct military medical care.1 In 2021, approximately 6.36 million non-service member beneficiaries utilized inpatient or outpatient services provided by the MHS (data source: the Defense Medical Surveillance System [DMSS]).

Since 1998, the MSMR has published annual summaries of the numbers and rates of hospitalizations and outpatient medical encounters to assess the health care burdens among active component military members. Beginning in 2001, the MSMR complemented those summaries with annual reports on the combined health care burden of both inpatient and outpatient care for 25 categories of health care. Since then, the MSMR’s annual burden issue has contained a report on hospital care, ambulatory care, and the overall burden of care each for active component service members. In 2014, for the first time and using similar methodology, the MSMR published a report that quantified the health care burden for illnesses and injuries among non-service members in calendar year 2013.2 The current report represents an updated summary of care provided to non-service members in the MHS during calendar year 2021. Health care burden estimates are stratified by direct versus outsourced care and across 4 age groups of health care recipients.

Methods

The surveillance period was 1 January through 31 December 2021. The surveillance population included all non-service member beneficiaries of the MHS who had at least 1 hospitalization or outpatient medical encounter during 2021 either through a military medical facility/provider or a civilian facility/provider (if reimbursed through the MHS). For this analysis, all inpatient and outpatient medical encounters were summarized according to the primary (first-listed) International Classification of Diseases, 10th Revision (ICD-10) codes that indicate the natures of illnesses or injuries (i.e., ICD-10 codes A00–T88, U07.0, U07.1, and U09.9). Nearly all records of encounters with first-listed diagnoses that were Z-codes (care other than for a current illness or injury—e.g., general medical examinations, after care, vaccinations) or V/W/X/Y-codes (indicators of the external causes but not the natures of injuries) were excluded from the analysis; however, encounters with primary diagnoses of Z37 (“outcome of delivery, single liveborn”) were retained.

For summary purposes, all illness- and injury-specific diagnoses (as defined by the ICD-10) were grouped into 153 burden of disease-related conditions and 25 major morbidity categories based on a modified version of the classification system developed for the Global Burden of Disease Study.3 The methodology for summarizing absolute and relative morbidity burdens is described on page 2 of this issue of the MSMR. Results were stratified by source of health care (direct [military treatment facilities] vs outsourced [non-military medical facilities]) and by age group (0–17 years, 18–44 years, 45–64 years, and 65 years old or older). For the purposes of the analysis of morbidity burdens within the youngest age group, developmental disorders were classified as “mental health” disorders.

Results

In the population of non-service member MHS care recipients in 2021, there were more female (57.1%) than male beneficiaries (42.9%); more infants, children, and adolescents (those younger than 20 years old: n=1.55 million; 24.3%) and more seniors (those aged 65 or older: n=2.06 million; 32.4%) than younger (aged 20–44: n=1.33 million; 20.8%) or older (aged 45–64: n=1.43 million; 22.4%) adults (data not shown).

In 2021, a total of 6,364,951 non-service member beneficiaries of the MHS had 86,581,149 medical encounters (Table). Thus, on average, each individual who accessed care from the MHS had 14 medical encounters over the course of the year. The top 3 morbidity-related categories, which accounted for more than one-third (36.3%) of all medical encounters, were signs/symptoms and ill-defined conditions (12.2%), mental health disorders (12.1%), and musculoskeletal diseases (12.0%) (Figures 1a, 1b). The morbidity-specific categories that affected the most beneficiaries (individuals affected) who received any care were signs/symptoms and ill-defined conditions (47.3%), injury/poisoning (32.8%), and musculoskeletal diseases (29.4%) (data not shown).

Cardiovascular diseases accounted for more hospital bed days (n=948,005) than any other illness/injury category and 16.2% of total hospital bed days (Figures 1a, 1b). An additional 44.0% of all bed days were attributable to injury/poisoning (16.0%), infectious/parasitic diseases (13.1%), mental health disorders (9.3%), and digestive diseases (5.7%).

Of note, among all beneficiaries, maternal conditions (including pregnancy complications and delivery) accounted for relatively more hospital bed days (n=308,245; 5.3%) than individuals affected (n=161,174; 2.5%) (Figure 1a).

Direct CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”Direct care vs. outsourced care

In 2021, among non-service member beneficiaries, most medical encounters (90.5%) were in non-military medical facilities (outsourced care) (Table). Of all non-service member beneficiaries (individuals affected) with any illness or injury-related encounters during the year, many more exclusively received outsourced care (n=4,712,772; 74.0%) than either military medical (direct) care only (n=667,265; 10.5%) or both outsourced and direct care (n=984,914; 15.5%). By far, most inpatient care (93.0% of all bed days) was received in non-military facilities.

The proportions of medical encounters by morbidity-related categories were broadly similar for direct and outsourced care (Figures 2a, 2b, 3a, 3b). However, encounters for cardiovascular diseases and musculoskeletal diseases were relatively more common in outsourced (9.1% and 12.3%, respectively) compared to direct (5.6% and 8.9%, respectively) care.

Maternal conditions accounted for 20.0% of all direct care bed days but only 4.1% of all outsourced care bed days (Figures 2b, 3b). However, cardiovascular diseases, musculoskeletal diseases, infectious/parasitic diseases, and neurologic conditions accounted for relatively more of all outsourced than direct care bed days (% of outsourced vs. % of direct care bed days: cardiovascular, 16.6% vs. 10.8%; musculoskeletal, 9.7% vs 4.3%; infectious/parasitic, 13.4% vs. 9.4%; neurologic, 5.6% vs. 1.6%).

Pediatric beneficiaries (aged 0–17)

In 2021, pediatric beneficiaries accounted for 14.2% of all medical encounters, 21.9% of all individuals affected, and 7.9% of all hospital bed days (Table). On average, each affected individual had 9 medical encounters during the year. 

Mental health disorders accounted for almost two-fifths (39.8%; n=4,902,671) of all medical encounters and more than three-fifths (61.0%; n=464,040) of all hospital bed days among pediatric beneficiaries (Figures 4a, 4b). On average, pediatric beneficiaries affected by a mental health disorder had 16 encounters related to this morbidity category during the year. More than twothirds (66.7%) of all medical encounters for mental health disorders among pediatric beneficiaries were attributed to 3 groups of disorders, including autistic disorders (32.7%), followed by developmental disorders of speech and language (24.6%), and attention-deficit hyperactivity disorders (9.4%) (Figures 4c, 4d). On average, there were 47 autism-related encounters per individual affected by an autistic disorder (data not shown). Despite the high numbers of encounters associated with these 3 categories of mental health disorders, approximately three-quarters (74.8%) of mental health disorder-related hospital bed days were attributable to mood disorders, and 30.1% of mood disorder-related bed days were attributable to “major depressive disorder, recurrent, severe without psychotic features” (data not shown).

Among pediatric beneficiaries overall, perinatal conditions (i.e., conditions arising during the perinatal period) accounted for the second highest number of hospital bed days (n=41,857; 9.0%) (Figures 4a, 4b). Of note, among pediatric beneficiaries with at least 1 illness or injury-related diagnosis, those with malignant neoplasms had the second highest number of related encounters per affected individual (13). The highest numbers of malignant neoplasm-related encounters and hospital bed days were attributable to leukemias, all other malignant neoplasms, and malignant neoplasms of the brain (data not shown).

Finally, respiratory infections (including upper and lower respiratory infections and otitis media) accounted for relatively more medical encounters among pediatric beneficiaries (7.1%) when compared to any older age group of beneficiaries (Figures 4b, 5b, 6b, and 7b). Respiratory infections accounted for relatively more hospital bed days among pediatric beneficiaries (2.4%) than among beneficiaries aged 18–64 (18–44, 0.4%; 45–64, 1.1%; ); however, among those aged 65 or older, respiratory infections accounted for approximately the same proportion (2.4%) of total hospital bed days.

Beneficiaries aged 18–44

In 2021, non-service member beneficiaries aged 18–44 accounted for 15.4% of all medical encounters, 23.2% of all individuals affected, and 11.6% of hospital bed days (Table). On average, each individual affected with an illness or injury (any cause) had 9 medical encounters during the year.

Among beneficiaries aged 18–44, the morbidity-related category that accounted for the most medical encounters was mental health disorders (n=3,091,190; 23.2% of all encounters) (Figures 5a, 5b). Among these adult beneficiaries, mental health disorders accounted for almost one-fifth (19.1%) of all bed days, and, on average, each adult affected by a mental health disorder had 8 mental health disorder-related encounters during the year. Anxiety disorders (32.7%), mood disorders (30.5%), and adjustment disorders (17.3%) accounted for approximately four-fifths (80.6%) of all mental health disorder-related medical encounters among beneficiaries aged 18–44 (data not shown). Among adult beneficiaries in this age group, mood and substance abuse disorders accounted for over threequarters (54.0% and 21.7%, respectively) of total mental health disorder-related hospital bed days.

Among adults aged 18–44, maternal conditions accounted for more than two-fifths (44.9%) of all bed days and, on average, 6 medical encounters per affected individual (Figures 5a, 5b). Deliveries accounted for 10.1% of maternal conditionrelated medical encounters (data not shown). Adults aged 18–44 accounted for nearly all (99.2%) maternal condition-related bed days among non-service member beneficiaries of any age. Although adults aged 18–44 had the second lowest percentage of total medical encounters (15.4%), if morbidity burdens associated with maternal conditions were excluded from the overall analysis, this age group would account for even lower percentages of total medical encounters (14.3%) and the lowest percentage of total hospital bed days (6.4%) when compared to any other age group (data not shown).

Among beneficiaries aged 18–44 with at least 1 illness or injury-related diagnosis, those with malignant neoplasms had the second most category-specific encounters per affected individual (7). Malignant neoplasm of the breast accounted for the most malignant neoplasm-related encounters for this age group (29.2% of the total) (data not shown).

Beneficiaries aged 45–64

In 2021, non-service member beneficiaries aged 45–64 accounted for approximately one-fifth (20.4%) of all medical encounters, 22.4% of all individuals affected, and 15.5% of hospital bed days (Table). On average, each affected individual had 12 medical encounters during the year.

Of all morbidity-related categories, musculoskeletal diseases accounted for the most medical encounters (n=2,627,272; 14.9%) among older adult beneficiaries aged 45-64 (Figures 6a, 6b). In addition, in this age group, back problems accounted for 43.2% of all musculoskeletal disease-related encounters (data not shown). Infectious/parasitic diseases accounted for more hospital bed days (16.8% of the total) than any other category of illnesses or injuries. COVID-19 accounted for more than half (54.3%) of the total infectious/parasitic disease-related hospital bed days. Within the injury/poisoning morbidityrelated category, the majority of bed days were attributed to complications not otherwise specified (43.9%) and leg injuries (19.5%) (data not shown). Digestive diseases accounted for a larger percentage (8.4%) of total hospital bed days among beneficiaries in this age group compared to those in the other age groups.

The most medical encounters per affected individual were associated with malignant neoplasms (7), mental health disorders (6), and musculoskeletal diseases (5) (data not shown). Malignant neoplasms (7.4%) accounted for a larger proportion of total bed days among beneficiaries aged 45–64 than among the other age groups of beneficiaries. Malignant neoplasm of the breast accounted for more than one-quarter (25.6 %) of all malignant neoplasm-related encounters among older adult beneficiaries (data not shown).

Beneficiaries aged 65 or older

In 2021, non-service member beneficiaries aged 65 or older accounted for approximately half (49.9%) of all medical encounters, nearly one-third (32.4%) of all individuals affected, and almost two-thirds (65.0%) of hospital bed days (Table 1). On average, each affected individual had 21 medical encounters during the year.

Of all morbidity-related categories, musculoskeletal diseases (n=6,195,523; 14.3%) and cardiovascular diseases (n=6,000,188; 13.5%) accounted for the most medical encounters, but cardiovascular diseases accounted for the most bed days (787,739 days; 20.6%) (Figures 7a, 7b). Back problems accounted for a little more than one-third (36.3%) of all musculoskeletal disease-related medical encounters and 41.0% of hospital bed days (data not shown). Taken together, essential hypertension (26.9%), ischemic heart disease (13.3%), and cerebrovascular disease (9.8%) accounted for approximately half (50.1%) of all cardiovascular disease-related medical encounters, and cerebrovascular disease accounted for almost one-third (31.9%) of all cardiovascular disease-related bed days (data not shown).

Among the oldest age group of beneficiaries, the most medical encounters per affected individual were associated with musculoskeletal diseases (7), malignant neoplasms (6), respiratory diseases (6), diseases of the genitourinary system (5), mental health disorders (5), and cardiovascular diseases (5) (data not shown).

In this age group, melanomas and other malignant neoplasms of the skin (20.4%) and malignant neoplasms of the prostate (14.4%), breast (12.6%), trachea, bronchus, and lung (9.5%) accounted for more than half (56.9%) of all malignant neoplasm-related encounters (data not shown). Chronic obstructive pulmonary disease accounted for nearly one-third of all medical encounters (38.2%) and 28.8% of all bed days attributable to respiratory diseases (data not shown).

Infectious and parasitic diseases (14.9%) accounted for a larger proportion of total bed days among the oldest age group compared to the other age groups of beneficiaries (Figures 7a, 7b). COVID-19 accounted for more than one-third (36.3%) of infectious/parasitic-related medical encounters and 42.0% of hospital bed days (data not shown). In contrast to infectious/parasitic diseases, mental health disorders accounted for smaller percentages of medical encounters (2.6%) and bed days (2.1%) among the oldest age group compared to the younger age groups.

Editorial Comment 

This report documents a large majority of non-service member beneficiaries receive MHS care for current illness and injury (excluding encounters with diagnoses identified by Z-codes) in non-military medical facilities (i.e., outsourced [purchased] care). The report also documents pronounced differences in the types of morbidity-related diagnoses and disease-specific conditions across age groups of beneficiaries. Of particular note, individuals aged 65 or older —32.4% of all non-service member beneficiaries receiving an illness or injury specific diagnosis in 2021—accounted for approximately half (49.9%) of all medical encounters and nearly two-thirds (65.0%) of all hospital bed days delivered to all such beneficiaries. In 2021, as in previous years, mental health disorders accounted for the largest proportions of the morbidity and health care burdens that affected the pediatric (aged 0–17) and younger adult (aged 18–44) beneficiary age groups. Developmental disorders were a significant driver of health care utilization among pediatric beneficiaries with 66.7% of medical encounters for mental health disorders attributable to autistic disorder, specific developmental disorders of speech and language, or attention-deficit hyperactivity disorders. Of particular note, children affected by autistic disorder had, on average, 47 autism-related encounters each during the 1-year surveillance period.

Although mental health disorders also accounted for more medical encounters among young adult (aged 18–44) beneficiaries than any other major category of illnesses or injuries, the proportion of all encounters attributable to mental health disorders was markedly lower among young adult (23.2%) than pediatric (39.8%) beneficiaries. Also, as expected, the mental health disorders that accounted for the largest health care burdens among younger adults (18–44 years)—anxiety, mood, and adjustment disorders—differed from those that most affected the pediatric age group.

It is not surprising that the highest numbers and proportions of hospital bed days among adults aged 18–44 were for maternal conditions because this age group encompasses nearly all women of childbearing age. In 2021, among adults aged 45–64 and those aged 65 or older, musculoskeletal diseases were the greatest contributors to morbidity and health care burdens. Cardiovascular diseases accounted for the second highest number of medical encounters among adults in the oldest age group.

Of musculoskeletal diseases, back problems were a major source of health care burden; of cardiovascular diseases, essential hypertension, ischemic heart disease, and cerebrovascular disease accounted for the largest health care burdens. These findings are not unexpected and reflect the inevitable effects of aging on the health and health care needs of the older segment of the MHS beneficiary population. However, many of the health conditions associated with the largest morbidity and health care burdens among beneficiaries in older age groups are also associated with unhealthy lifestyles (e.g., unhealthy diet, inadequate exercise, or tobacco use). As such, to varying extents, the most costly health conditions may be preventable and their disabling or life-threatening long-term consequences may be avoidable. It is important to note, however, that among the oldest group of beneficiaries, COVID-19 accounted for more than two-fifths (42.0%) of hospital bed days attributed to infectious/parasitic diseases. Illnesses and injuries that disproportionately contribute to morbidity and health care burdens in various age groups of MHS beneficiaries should be targeted for early detection and treatment by comprehensive prevention and research programs.

References

  1. Department of Defense. Evaluation of the TRICARE Program: Fiscal Year 2021 Report to Congress: Access, Cost, and Quality Data Through Fiscal Year 2021. Accessed 4 May 2022. https://www.health.mil/Reference-Center/Reports/2021/07/20/ Evaluation-of-the-TRICARE-Program-FY-2021-Report-to-Congress
  2. Armed Forces Health Surveillance Center. Absolute and relative morbidity burdens attributable to various illnesses and injuries, non-service member beneficiaries of the Military Health System, 2013. MSMR. 2014;21(4):23–30.
  3. Murray CJ and Lopez AD, eds. In: Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Cambridge, MA: Harvard University Press; 1996:120–122.

FIGURE 1a. Numbers of medical encounters,a individuals affected,b and hospital bed days, by burden of disease major category,c non-service member beneficiaries, direct and outsourced care, 2021

FIGURE 1b. Percentages of medical encountersa and hospital bed days, by burden of disease major category,b non-service member beneficiaries, direct and outsourced care, 2021

FIGURE 2a. Numbers of medical encounters,a individuals affected,b and hospital bed days, by burden of disease major category,c non-service member beneficiaries, direct care only, 2021

FIGURE 2b. Percentages of medical encountersa and hospital bed days, by burden of disease major category,b non-service member beneficiaries, direct care only, 2021

FIGURE 3a. Numbers of medical encounters,a individuals affected,b and hospital bed days, by burden of disease major category,c non-service member beneficiaries, outsourced care only, 2021

FIGURE 3b. Percentages of medical encountersa and hospital bed days, by burden of disease major category,b non-service member beneficiaries, outsourced care only, 2021

FIGURE 4a. Medical encounters,a individuals affected,b and hospital bed days, by burden of disease major category,c non-service member beneficiaries, pediatric non-service member beneficiaries, aged 0–17, direct and outsourced care, 2021

FIGURE 4b. Percentages of medical encountersa and hospital bed days, by burden of disease category,b pediatric non-service member beneficiaries, aged 0–17, direct and outsourced care, 2021

FIGURE 4c . Medical encounters,a individuals affected,b and hospital bed days, by the mental health disorders accounting for the most morbidity burden, pediatric non-service member beneficiaries, aged 0–17, 2021

FIGURE 4d. Percentages of medical encountersa and hospital bed days for mental health disorders by the conditons accounting for the most morbidity burden, pediatric non-service member beneficiaries, aged 0–17, 2021

FIGURE 5a. Medical encounters,a individuals affected,b and hospital bed days, by burden of disease major category,c non-service member beneficiaries, aged 18–44, direct and outsourced care, 2021

FIGURE 5b. Percentages of medical encountersa and hospital bed days, by burden of disease major category,b non-service member beneficiaries, aged 18–44, direct and outsourced care, 2021

FIGURE 6a. Medical encounters,a individuals affected,b and hospital bed days, by burden of disease major category,c non-service member beneficiaries, aged 45–64, direct and outsourced care, 2021

FIGURE 6b. Percentages of medical encountersa and hospital bed days, by burden of disease major category,b non-service member beneficiaries, aged 45–64, direct and outsourced care, 2021

FIGURE 7a. Medical encounters,a individuals affected,b and hospital bed days, by burden of disease major category,c non-service member beneficiaries, aged 65 or older, direct and outsourced care, 2021

FIGURE 7b. Percentages of medical encountersa and hospital bed days, by burden of disease major category,b non-service member beneficiaries, aged 65 or older, direct and outsourced care, 2021

TABLE. Medical encounters,a individuals affected,b and hospital bed days, by source and age group, non-service member beneficiaries, 2021

You also may be interested in...

Testosterone Replacement Therapy Use Among Active Component Service Men, 2017

Article
3/1/2019
Testosterone

This analysis summarizes the prevalence of testosterone replacement therapy (TRT) during 2017 among active component service men by demographic and military characteristics. This analysis also determines the percentage of those receiving TRT in 2017 who had an indication for receiving TRT using the 2018 American Urological Association (AUA) clinical practice guidelines. In 2017, 5,093 of 1,076,633 active component service men filled a prescription for TRT, for a period prevalence of 4.7 per 1,000 male service members. After adjustment for covariates, the prevalence of TRT use remained highest among Army members, senior enlisted members, warrant officers, non-Hispanic whites, American Indians/Alaska Natives, those in combat arms occupations, healthcare workers, those who were married, and those with other/unknown marital status. Among active component male service members who received TRT in 2017, only 44.5% met the 2018 AUA clinical practice guidelines for receiving TRT.

Recommended Content:

Medical Surveillance Monthly Report

Vasectomy and Vasectomy Reversals, Active Component, U.S. Armed Forces, 2000–2017

Article
3/1/2019
Sperm is the male reproductive cell  Photo: iStock

During 2000–2017, a total of 170,878 active component service members underwent a first-occurring vasectomy, for a crude overall incidence rate of 8.6 cases per 1,000 person-years (p-yrs). Among the men who underwent incident vasectomy, 2.2% had another vasectomy performed during the surveillance period. Compared to their respective counterparts, the overall rates of vasectomy were highest among service men aged 30–39 years, non-Hispanic whites, married men, and those in pilot/air crew occupations. Male Air Force members had the highest overall incidence of vasectomy and men in the Marine Corps, the lowest. Crude annual vasectomy rates among service men increased slightly between 2000 and 2017. The largest increases in rates over the 18-year period occurred among service men aged 35–49 years and among men working as pilots/air crew. Among those who underwent vasectomy, 1.8% also had at least 1 vasectomy reversal during the surveillance period. The likelihood of vasectomy reversal decreased with advancing age. Non-Hispanic black and Hispanic service men were more likely than those of other race/ethnicity groups to undergo vasectomy reversals.

Recommended Content:

Medical Surveillance Monthly Report

Re-evaluation of the MSMR Case Definition for Incident Cases of Malaria

Article
2/1/2019
Anopheles merus

The MSMR has been publishing the results of surveillance studies of malaria since 1995. The standard MSMR case definition uses Medical Event Reports and records of hospitalizations in counting cases of malaria. This report summarizes the performance of the standard MSMR case definition in estimating incident cases of malaria from 2015 through 2017. Also explored was the potential surveillance value of including outpatient encounters with diagnoses of malaria or positive laboratory tests for malaria in the case definition. The study corroborated the relative accuracy of the MSMR case definition in estimating malaria incidence and provided the basis for updating the case definition in 2019 to include positive laboratory tests for malaria antigen within 30 days of an outpatient diagnosis.

Recommended Content:

Medical Surveillance Monthly Report

Update: Incidence of Glaucoma Diagnoses, Active Component, U.S. Armed Forces, 2013–2017

Article
2/1/2019
Glaucoma

Glaucoma is an eye disease that involves progressive optic nerve damage and vision loss, leading to blindness if undetected or untreated. This report describes an analysis using the Defense Medical Surveillance System to identify all active component service members with an incident diagnosis of glaucoma during the period between 2013 and 2017. The analysis identified 37,718 incident cases of glaucoma and an overall incidence rate of 5.9 cases per 1,000 person-years (p-yrs). The majority of cases (97.6%) were diagnosed at an early stage as borderline glaucoma; of these borderline cases, 2.2% progressed to open-angle glaucoma during the study period. No incident cases of absolute glaucoma, or total blindness, were identified. Rates of glaucoma were higher among non-Hispanic black (11.0 per 1,000 p-yrs), Asian/Pacific Islander (9.5), and Hispanic (6.9) service members, compared with non-Hispanic white (4.0) service members. Rates among female service members (6.6 per 1,000 p-yrs) were higher than those among male service members (5.8). Between 2013 and 2017, incidence rates of glaucoma diagnoses increased by 75.4% among all service members.

Recommended Content:

Medical Surveillance Monthly Report

Update: Malaria, U.S. Armed Forces, 2018

Article
2/1/2019
Anopheles merus

Malaria infection remains an important health threat to U.S. service mem­bers who are located in endemic areas because of long-term duty assign­ments, participation in shorter-term contingency operations, or personal travel. In 2018, a total of 58 service members were diagnosed with or reported to have malaria. This represents a 65.7% increase from the 35 cases identi­fied in 2017. The relatively low numbers of cases during 2012–2018 mainly reflect decreases in cases acquired in Afghanistan, a reduction due largely to the progressive withdrawal of U.S. forces from that country. The percentage of cases of malaria caused by unspecified agents (63.8%; n=37) in 2018 was the highest during any given year of the surveillance period. The percent­age of cases identified as having been caused by Plasmodium vivax (10.3%; n=6) in 2018 was the lowest observed during the 10-year surveillance period. The percentage of malaria cases attributed to P. falciparum (25.9 %) in 2018 was similar to that observed in 2017 (25.7%), although the number of cases increased. Malaria was diagnosed at or reported from 31 different medical facilities in the U.S., Afghanistan, Italy, Germany, Djibouti, and Korea. Pro­viders of medical care to military members should be knowledgeable of and vigilant for clinical manifestations of malaria outside of endemic areas.

Recommended Content:

Medical Surveillance Monthly Report

Outbreak of Acute Respiratory Illness Associated with Adenovirus Type 4 at the U.S. Naval Academy, 2016

Article
2/1/2019
Malaria case definition

Human adenoviruses (HAdVs) are known to cause respiratory illness outbreaks at basic military training (BMT) sites. HAdV type-4 and -7 vaccines are routinely administered at enlisted BMT sites, but not at military academies. During Aug.–Sept. 2016, U.S. Naval Academy clinical staff noted an increase in students presenting with acute respiratory illness (ARI). An investigation was conducted to determine the extent and cause of the outbreak. During 22 Aug.–11 Sept. 2016, 652 clinic visits for ARI were identified using electronic health records. HAdV-4 was confirmed by real-time polymerase chain reaction assay in 18 out of 33 patient specimens collected and 1 additional HAdV case was detected from hospital records. Two HAdV-4 positive patients were treated for pneumonia including 1 hospitalized patient. Molecular analysis of 4 HAdV-4 isolates identified genome type 4a1, which is considered vaccine-preventable. Understanding the impact of HAdV in congregate settings other than enlisted BMT sites is necessary to inform discussions regarding future HAdV vaccine strategy.

Recommended Content:

Medical Surveillance Monthly Report

Thyroid Disorders, Active Component, U.S. Armed Forces, 2008–2017

Article
12/1/2018
Cover 1

This analysis describes the incidence and prevalence of five thyroid disorders (goiter, thyrotoxicosis, primary/not otherwise specified [NOS] hypothyroidism, thyroiditis, and other disorders of the thyroid) among active component service members between 2008 and 2017. During the 10-year surveillance period, the most common incident thyroid disorder among male and female service members was primary/NOS hypothyroidism and the least common were thyroiditis and other disorders of thyroid. Primary/NOS hypothyroidism was diagnosed among 8,641 females (incidence rate: 43.7 per 10,000 person-years [p-yrs]) and 11,656 males (incidence rate: 10.2 per 10,000 p-yrs). Overall incidence rates of all thyroid disorders were 3 to 5 times higher among females compared to males. Among both males and females, incidence of primary/NOS hypothyroidism was higher among non-Hispanic white service members compared with service members in other race/ethnicity groups. The incidence of most thyroid disorders remained stable or decreased during the surveillance period. Overall, the prevalence of most thyroid disorders increased during the first part of the surveillance period and then either decreased or leveled off.31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

Recommended Content:

Medical Surveillance Monthly Report

Adrenal Gland Disorders, Active Component, U.S. Armed Forces, 2002–2017

Article
12/1/2018
Adrenal Gland Disorders, Active Component, U.S. Armed Forces, 2002–2017

During 2002–2017, the most common incident adrenal gland disorder among male and female service members was adrenal insufficiency and the least common was adrenomedullary hyperfunction. Adrenal insufficiency was diagnosed among 267 females (crude overall incidence rate: 8.2 cases per 100,000 person-years [p-yrs]) and 729 males (3.9 per 100,000 p-yrs). In both sexes, overall rates of other disorders of adrenal gland and Cushing’s syndrome were lower than for adrenal insufficiency but higher than for hyperaldosteronism, adrenogenital disorders, and adrenomedullary hyperfunction. Crude overall rates of adrenal gland disorders among females tended to be higher than those of males, with female:male rate ratios ranging from 2.1 for adrenal insufficiency to 5.5 for androgenital disorders and Cushing’s syndrome. The highest overall rates of adrenal insufficiency for males and females were among non-Hispanic white service members. Among females, rates of Cushing's syndrome and other disorders of adrenal gland were 31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

Recommended Content:

Medical Surveillance Monthly Report

Incidence and Prevalence of the Metabolic Syndrome Using ICD-9 and ICD-10 Diagnostic Codes, Active Component, U.S. Armed Forces, 2002–2017

Article
12/1/2018
Incidence and Prevalence of the Metabolic Syndrome Using ICD-9 and ICD-10 Diagnostic Codes, Active Component, U.S. Armed Forces, 2002–2017

This report uses ICD-9 and ICD-10 codes (277.7 and E88.81, respectively) for the metabolic syndrome (MetS) to summarize trends in the incidence and prevalence of this condition among active component members of the U.S. Armed Forces between 2002 and 2017. During this period, the crude overall incidence rate of MetS was 7.5 cases per 100,000 person-years (p-yrs). Compared to their respective counterparts, overall incidence rates were highest among Asian/Pacific Islanders, Air Force members, and warrant officers and were lowest among those of other/unknown race/ethnicity, Marine Corps members, and junior enlisted personnel and officers. During 2002–2017, the annual incidence rates of MetS peaked in 2009 at 11.6 cases per 100,000 p-yrs and decreased to 5.9 cases per 100,000 p-yrs in 2017. Annual prevalence rates of MetS increased steadily during the first 11 years of the surveillance period reaching a high of 38.9 per 100,000 active component service members in 2012, after which rates declined slightly to 31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

Recommended Content:

Medical Surveillance Monthly Report

2018 #ColdReadiness Twitter chat recap: Preventing cold weather injuries for service members and their families

Fact Sheet
2/5/2018

To help protect U.S. armed forces, the Armed Forces Health Surveillance Branch (AFHSB) hosted a live #ColdReadiness Twitter chat on Wednesday, January 24th, 12-1:30 pm EST to discuss what service members and their families need to know about winter safety and preventing cold weather injuries as the temperatures drop. This fact sheet documents highlights from the Twitter chat.

Recommended Content:

Medical Surveillance Monthly Report | Winter Safety | Medical and Dental Preventive Care Fitness | Health Readiness & Combat Support

Heat Illnesses by Location, Active Component, U.S. Armed Forces, 2012-2016 Fact Sheet

Fact Sheet
3/30/2017

This fact sheet provides details on heat illnesses by location during a five-year surveillance period from 2012 through 2016. 11,967 heat-related illnesses were diagnosed at more than 250 military installations and geographic locations worldwide. Three Army Installations accounted for close to one-third of all heat illnesses during the period.

Recommended Content:

Armed Forces Health Surveillance Division | Medical Surveillance Monthly Report

Demographic and Military Traits of Service Members Diagnosed as Traumatic Brain Injury Cases

Fact Sheet
3/30/2017

This fact sheet provides details on the demographic and military traits of service members diagnosed as traumatic brain injury (TBI) cases during a 16-year surveillance period from 2001 through 2016, a total of 276,858 active component service members received first-time diagnoses of TBI - a structural alteration of the brain or physiological disruption of brain function caused by an external force.

Recommended Content:

Armed Forces Health Surveillance Division | Medical Surveillance Monthly Report

Rhabdomyolysis by Location, Active Component, U.S. Armed Forces, 2012-2016 Fact Sheet

Fact Sheet
3/30/2017

This fact sheet provides details on Rhabdomyolysis by location for active component, U.S. Armed Forces during a five-year surveillance period from 2012 through 2016. The medical treatment facilities at nine installations diagnosed at least 50 cases each and, together approximately half (49.9%) of all diagnosed cases.

Recommended Content:

Armed Forces Health Surveillance Division | Medical Surveillance Monthly Report
<< < ... 11 12 13 14 > >> 
Showing results 196 - 208 Page 14 of 14
Refine your search
Last Updated: September 21, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery