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Risk factors for musculoskeletal-related occupational disability among US Army soldiers
  1. Daniel R Clifton1,2,3,
  2. D A Nelson1,2,3,
  3. Y S Choi3,
  4. D B Edgeworth1,2,3,
  5. K J Nelson3,
  6. D Shell4 and
  7. P A Deuster1
  1. 1Department of Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
  2. 2Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
  3. 3Womack Army Medical Center, Fort Bragg, North Carolina, USA
  4. 4Health Services Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, Falls Church, Virginia, USA
  1. Correspondence to Dr Daniel R Clifton, Department of Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; daniel.clifton.ctr{at}usuhs.edu

Abstract

Introduction Minimising temporary and permanent disability associated with musculoskeletal conditions (MSK-D) is critical to the mission of the US Army. Prior research has identified potentially actionable risk factors for overall military disability and its MSK-D subset, including elevated body mass index, tobacco use and physical fitness. However, prior work does not appear to have addressed the impact of these factors on MSK-D when controlling for a full range of factors that may affect health behaviours, including aptitude scores that may serve as a proxy for health literacy. Identifying risk factors for MSK-D when providing control for all such factors may inform efforts to improve military readiness.

Methods We studied 494 757 enlisted Army soldiers from 2014 to 2017 using a combined medical and administrative database. Leveraging data from the Army’s digital ‘eProfile’ system of duty restriction records, we defined MSK-D as the first restriction associated with musculoskeletal conditions and resulting in the inability to deploy or train. We used multivariable Cox proportional hazards regression to assess the associations between incident MSK-D and selected risk factors including aptitude scores, physical fitness test scores, body mass index and tobacco use.

Results Among the subjects, 281 278 (45.14%) experienced MSK-D. In the MSK-D hazards model, the highest effect size was for failing the physical fitness test (adjusted HR=1.63, 95% CI 1.58 to 1.67, p<0.001) compared with scoring ≥290 points.

Conclusions The analysis revealed the strongest associations between physical fitness and MSK-D. Additional efforts are warranted to determine potential mechanisms for the observed associations between selected factors and MSK-D.

  • musculoskeletal disorders
  • preventive medicine
  • epidemiology

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Footnotes

  • Contributors In accordance with the International Committee of Medical Journal Editors recommendations, all authors of this manuscript made substantial contributions to conception and design of the study and/or to data analysis and interpretation, revised the article for important intellectual content, and approved the final version of the submitted manuscript. DC contributed to conception and design of the study, results interpretation, manuscript writing, preparation and revision, and approved the final version of the submitted manuscript. DAN contributed to conception and design of the study, performed the data analysis, contributed to results interpretation and manuscript revision, and approved the final version of the submitted manuscript. YSC, DBE, KJN, DS and PD contributed to study planning, revision of the manuscript and approved the final version of the submitted manuscript.

  • Funding Financial support for this project was provided by Health Services Policy and Oversight, Office of the Assistant Secretary of Defense.

  • Disclaimer USU disclaimer: The opinions and assertions expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense. Henry M. Jackson Foundation disclaimer: The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions or policies of the Henry M Jackson Foundation for the Advancement of Military Medicine. Mention of trade names, commercial products or organisations does not imply endorsement by the US Government. Womack Army Medical Center disclaimer: The views expressed herein are those of the author(s) and do not necessarily reflect the official policy of the Department of the Army, Department of Defense or the US Government.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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