Sex Differences in the Incidence and Risk of Ankle–Foot Complex Stress Fractures Among U.S. Military Personnel

MacGregor, Andrew J.; Fogleman, Sarah; Dougherty, Amber L.; Ryans, Camille P.; Janney, Cory; Fraser, John J.

doi:10.1089/jwh.2021.0292

Cited by 13 publications

(6 citation statements)

References 33 publications

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“…Prevalence calculations of patients diagnosed with AT were conducted for male and female military members, enlisted and officers, in each service branch (Army, Navy, Marine Corps, and Air Force) and occupational category. 7,8 Prevalence ratio (PR) point estimates and 95% confidence intervals (CIs), risk difference point estimates, attributable risk (AR), number needed to harm (NNH), and chi-square statistics were calculated in the assessment of sex and occupation category using Microsoft Excel for Mac 2016 (Microsoft Corp., Redmond, WA) and a custom epidemiological spreadsheet. 10 In the unadjusted assessment of sex and occupation on AT risk, male service members, enlisted infantry, and ground/naval gunfire officer groups were used as the reference categories.…”

Section: Methodsmentioning

confidence: 99%

“…The database is HIPAA compliant, does not include any personal identifiable or personal health information, and has been used previously for the epidemiological study of ankle-foot injury in the military. 7,8 This study was approved as non–human-subjects research by the Institutional Review Board at the Naval Health Research Center (NHRC.2020.0207-NHSR). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines 9 were used to guide reporting.…”

Section: Methodsmentioning

confidence: 99%

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Burden and risk factors for Achilles tendinopathy in the military population from 2006 to 2015. A retrospective cohort study

Sullivan

Janney

Fraser

2023

Preprint

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BackgroundAnkle-foot conditions are ubiquitous in the US Military. The objective of this study was to evaluate the burden and associated factors of Achilles tendinopathy (AT).MethodsThe Defense Medical Epidemiology Database was used to identify all diagnosed AT in military personnel from 2006 to 2015. Prevalence of AT was calculated and compared by year, service branch, and military rank. Unadjusted and adjusted assessment of injury risk were calculated.ResultsOfficers incurred 37,939 episodes at a prevalence of 17.65 per 1000 (male officers: 18.20 per 1000; female officers: 14.80 per 1000). Among enlisted personnel, there were 116,122 episodes of AT that occurred in 12.22 per 1000 (male enlisted: 12.07 per 1000; female enlisted: 13.22 per 1000). All officer specialties had significantly higher risk of AT episodes compared to the ground and naval gunfire officers (PR: 1.04-1.43), with aviation demonstrating a significant protective effect (PR: 0.65). Among enlisted specialties, maritime/naval specialties had reduced risk (PR: 0.82), with all specialties (except aviation) having increased risk of AT compared to infantry (PR: 1.07-1.71). There were multiple associated factors identified, to include sex, age, rank, military occupation, and service branch.ConclusionsAT was ubiquitous in the US military, with a progressive increase in prevalence during the study epoch. There were multiple associated factors identified, to include sex, age, rank, military occupation, and service branch. These findings highlight both the need for prophylactic interventions and identification of the populations with the greatest need.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Burden and risk factors for Achilles tendinopathy in the military population from 2006 to 2015. A retrospective cohort study

Sullivan

Janney

Fraser

2023

Preprint

Self Cite

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“…The database is HIPAA compliant, does not include any personally identifiable or personal health information, and has been used previously for the epidemiological study of ankle-foot injury in the military. 8, 9 This study was approved as non–human-subjects research by the Institutional Review Board . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines 10 were used to guide reporting.…”

Section: Methodsmentioning

confidence: 99%

Burden and risk factors for Achilles tendon rupture in the military population from 2006 to 2015: A retrospective cohort study

Fraser,

Zellers,

Sullivan

et al. 2023

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BackgroundAchilles tendon rupture (ATR) is a serious musculoskeletal injury that results in substantial functional decline, especially in highly physically demanding occupations such as service in the militaryPurposeThe objective of this study was to evaluate the burden and associated factors of ATR in US military service members.Study DesignDescriptive Epidemiology StudyMethodsThe Defense Medical Epidemiology Database was used to identify all diagnosed ATR in military personnel from 2006 to 2015. Prevalence of ATR was calculated and compared by year, service branch, and military rank. Unadjusted and adjusted assessments of injury risk were calculated.ResultsOfficers incurred 15 978 episodes at a prevalence of 7.43/1000 (male: 8.11/1000; female: 3.89/1000). Among enlisted personnel, there were 59 242 episodes of ATR that occurred at a prevalence of 6.23 episodes per 1000 (male enlisted: 6.49/1000; female enlisted: 4.48/1000). Apart from enlisted aviation specialists (where there was no significant difference in risk between men and women), both female officers and enlisted service members had significantly lower risk of ATR compared with their male counterparts in all occupations (prevalence ratio [PR]: 0.26-0.73). Aviation and service officers demonstrated significantly lower risk of ATR episodes (PR: 0.87-0.91) and administration, operations, intelligence, and logistic officers demonstrated increased risk (PR: 1.16-1.31) compared with ground and naval gunfire officers. Among enlisted specialties, all but mechanized/armor and combat engineers had significantly higher risk of ATR risk compared with infantry (PR: 1.14-2.13), with the highest risk observed in the administration, intelligence, and communication fields.ConclusionsATR was ubiquitous in the US military, with multiple risk factors identified, including male sex, older age, rank, military occupation, and service branch.Clinical RelevanceBased on the burden of ATR in the US military observed in this study, these findings highlight both the need for prophylactic interventions and identification of the populations who can most greatly benefit from preventive screening and care.What is known about the subjectIn an earlier study of the ATR burden in US military members, 1441 ATR cases were identified between 1998 and 2001, occurring at a rate of 30.9 per 100 000 person-years. In a more recent study of care episodes for Achilles tendinopathy in the military, the prevalence was 17.65 per 1000 in officers and 12.22 per 1000 in enlisted members, with male sex, older age, senior rank, military occupation, and service branch found to be salient associated factors. It is highly plausible that occupation may also be a salient factor for ATR, given that tendinopathy may be a prodromal sign of future tendon failure.What this study adds to existing knowledgeDue to the changes in operational requirements, training, engagement in overseas contingency operations, and force composition that have occurred over the past 22 years, this provides an updated assessment of burden and the associated risk factors of ATR.

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“…These factors, in addition to the suspected latent factors such as careseeking behaviors, access to care, and the mode and duration of exposure, plausibly drive these outcomes in the military. 1 This likely includes periods of reduced operational demand, [3][4][5][6] something that occurred during 2020 COVID-19 pandemic as the US military shifted to a health protection posture required to mitigate the spread of this respiratory illness. A decline in NMSKI over time was observed in recent studies of the military, a finding that was attributed to the change in geopolitics, decline in combat operations, return to peacetime operations, and decreased exposure to hazards incurred during training and operations.…”

Section: Introductionmentioning

confidence: 99%

“…A decline in NMSKI over time was observed in recent studies of the military, a finding that was attributed to the change in geopolitics, decline in combat operations, return to peacetime operations, and decreased exposure to hazards incurred during training and operations. [3][4][5][6] This supposition can now be assessed in a more recent study epoch, where training and non-essential operations were halted to mitigate the spread of COVID-19. 7 While military personnel frequently experience rapid recovery and return to occupational duties following NMSKI, others have protracted periods of activity limitation that preclude participation in organizational mission objectives.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with neuromusculoskeletal injury and disability in Navy and Marine Corps personnel

Fraser

MacGregor

Fechner

et al. 2022

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Introduction: Neuromusculoskeletal injuries (NMSKI) are ubiquitous in the military, which contribute to short- and long-term disability. Methods: NMSKI, limited duty (LIMDU), and long-term disability episode counts in the US Navy (USN) and Marine Corps (USMC) from December 2016 to August 2021 were extracted from the Musculoskeletal Naval Epidemiological Surveillance Tool. NMSKI, LIMDU, and long-term disability episodes incidence were calculated. A hurdle negative binomial regression evaluated the association of body region, sex, age, rank, age by rank, and service branch on NMSKI, LIMDU, and long-term disability incidence. Results: From December 2016 to August 2021, there were 2004196 NMSKI episodes (USN: 3285/1000 Sailors; USMC: 4418/1000 Marines), 16791 LIMDU episodes (USN: 32/1000 Sailors; USMC: 29/1000 Marines), and 2783 long-term disability episodes (USN: 5/1000 Sailors; USMC: 5/1000 Marines). There was a large-magnitude protective effect on NMSKI during the pandemic (RR, USN: 0.70; USMC: 0.75). Low back and ankle-foot were the most ubiquitous, primarily affecting female personnel, aged 25-44 years, senior enlisted, in the USMC. Shoulder, arm, pelvis-hip, and knee conditions had the greatest risk for disability, with female sex, enlisted ranks, ages 18-24 years, and service in the USMC the most salient factors. Discussion: The significant protective effect during the pandemic was likely a function of reduced physical exposure and access to non-urgent care. Geographically accessible specialized care and resources aligned with communities with the greatest risk is needed for the timely prevention, assessment, and treatment of NMSKI. Conclusion: Body region, sex, age, rank, and branch were salient factors for NMSKI.

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Sex Differences in the Incidence and Risk of Ankle–Foot Complex Stress Fractures Among U.S. Military Personnel

Abstract: doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Cited by 13 publications

References 33 publications

Burden and risk factors for Achilles tendinopathy in the military population from 2006 to 2015. A retrospective cohort study

Burden and risk factors for Achilles tendinopathy in the military population from 2006 to 2015. A retrospective cohort study

Burden and risk factors for Achilles tendon rupture in the military population from 2006 to 2015: A retrospective cohort study

Factors associated with neuromusculoskeletal injury and disability in Navy and Marine Corps personnel

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