Weight loss medication prescription prevalence in the active component, 2018-2023.

The U.S. military has witnessed rising obesity among active component service members. The Department of Defense authorized coverage of weight loss medications in 2018, but no study has evaluated prescription prevalence within the active component. This descriptive retrospective cohort study analyzed data from active component U.S. military service members from January 2018 through June 2023. The study used data from the Defense Medical Surveillance System to determine prescription period prevalence of weight loss medication. Data on demographics, body mass index, and history of diabetes were considered. The study revealed a 100-fold increase in the prescription period prevalence of weight loss agents in the active component from their initial authorization date. Demographics associated with higher prescription period prevalence were non-Hispanic Black race and ethnicity, female sex, and older age. Service members in the health care occupations and the Navy had higher prevalence compared to other service branches and occupations. The findings indicate a significant rise in the period prevalence of weight loss prescriptions over time. Further research is recommended to assess the effectiveness, safety, and use in austere military environments.

Update: Heat illness, active component, U.S. Armed Forces, 2021.

In 2021, there were 488 incident cases of heat stroke and 1,864 incident cases of heat exhaustion among active component service members of the U.S. Armed Forces. The unadjusted annual rates of incident heat stroke and heat exhaustion peaked in 2018 and then declined in 2019 and 2020. Between 2020 and 2021, the rate of incident heat stroke was relatively stable (0.37 cases per 1,000 person-years [p-yrs]) while the rate of heat exhaustion increased slightly (1.40 cases per 1,000 p-yrs). In 2021, subgroup-specific rates of incident heat stroke and heat exhaustion were highest among male service members, those less than 20 years old, Marine Corps and Army members, recruit trainees, and those in combat-specific occupations. During 2017­2021, a total of 312 heat illnesses were documented among service members in the U.S. Central Command (CENTCOM) area of responsibility (AOR); 6.4% (n=20) were diagnosed as heat stroke. Commanders, small unit leaders, training cadre, and supporting medical personnel must ensure that the military members whom they supervise and support are informed about the risks, preventive countermeasures, early signs and symptoms, and first-responder actions related to heat illnesses.

Skin and soft tissue infections, active component, U.S. Armed Forces, January 2016-September 2020.

During 1 January 2016-30 September 2020, there were 210,914 incident cases of skin and soft tissue infections (SSTIs) among active component U.S. military members, corresponding to a crude overall incidence rate of 352.8 per 10,000 person-years (p-yrs). An additional 4,250 cases occurred in theaters of operations (251.0 per 10,000 p-yrs). Of the total incident SSTI diagnoses, 64.5% were classified as cellulitis/abscess, 30.0% were "other SSTIs" (e.g., folliculitis, impetigo), 5.3% were carbuncles/furuncles, and 0.2% were erysipelas. Crude annual incidence rates declined by 21.9% over the surveillance period. In general, higher rates of SSTIs were associated with younger age, recruit/trainee status, and junior enlisted rank. A total of 174,893 service members were treated for SSTIs, which accounted for 307,160 medical encounters and 14,819 hospital bed days. SSTIs in the military are associated with significant operational and health care burden. Strategies for the prevention, early diagnosis, and definitive treatment of SSTIs are warranted, particularly in initial military training and operational settings associated with increased risk of infection.

Diabetes mellitus and gestational diabetes, active and reserve component service members and dependents, 2008-2018.

During 2008-2018, a total of 12,582 active component service members received incident diagnoses of any diabetes mellitus (DM), for a crude overall incidence rate of 84.8 per 100,000 person-years. More than four-fifths of incident cases were type 2 DM. The overall rates of this form of DM among Asian/Pacific Islander and non-Hispanic black active and reserve component service members were 1.5 or more times the rates among their respective counterparts in other race/ethnicity groups. Crude annual rates of type 2 DM diagnoses among active and reserve component members peaked in 2010 and then decreased to their lowest points in 2018. From 2010 through 2018, decreases in rates of incident type 2 DM diagnoses were observed among active and reserve component members in all subgroups examined (sex, age, race/ethnicity, service), with the greatest slopes of decline seen among service members aged 40 years or older, Asian/Pacific Islanders, and Army members. During 2008-2018, total counts of incident diagnoses of type 2 DM among Military Health System (MHS) dependents decreased by 66.0%, from 29,625 to 10,066. The overall crude prevalence of gestational DM ranged from 7.3% among active component service women to 8.4% among female MHS dependents. Comparisons to data from U.S. civilian populations are made when appropriate.

Incidence and temporal presentation of visual dysfunction following diagnosis of traumatic brain injury, active component, U.S. Armed Forces, 2006-2017.

This analysis describes the incidence of visual dysfunctions following a diagnosis of traumatic brain injury (TBI) among active component service members. The visual dysfunctions were divided into 9 major categories. A comparison group of service members with no history of TBI was used to determine relative incidence rates. The most commonly diagnosed visual dysfunctions were subjective visual disturbances, convergence insufficiency (CI), visual field loss, and accommodative dysfunction (AD). Service members with mild or moderate/severe TBI had significantly higher incidences of AD and CI compared to service members with no TBI. Results of survival analysis showed that service members with mild or moderate/severe TBI had lower probabilities of remaining without the visual dysfunction outcome at almost every week of follow-up in the first year after TBI diagnosis compared to those with no TBI. The findings of this report suggest opportunities to improve both documentation and access to care for service members with these conditions.

Incident and recurrent cases of central serous chorioretinopathy, active component, U.S. Armed Forces, 2001-2018.

Central serous chorioretinopathy (CSCR) is a condition that affects central visual function. It can produce blurred and/or distorted vision that can impact the performance of military duties. CSCR can recur in susceptible individuals. Incident cases of CSCR among active component service members were found to average 18.3 per 100,000 person-years (p-yrs) during 2001-2018. Incidence rates increased during the surveillance period by 60.7% and were more common with increasing age. Overall rates of incident CSCR diagnoses were highest among Air Force (20.7 per 100,000 p-yrs) and Navy members (19.9 per 100,000 p-yrs) and lowest among Marine Corps members (12.5 per 100,000 p-yrs). Pilot/air crew occupational groups had rates almost twice that of other groups. Annual recurrence rates increased 71.4% over the course of the 18-year period.

Cardiovascular disease-related medical evacuations, active and reserve components, U.S. Armed Forces, 1 October 2001-31 December 2017.

From 1 October 2001 through 31 December 2017, a total of 697 medical evacuations of service members from the U.S. Central Command (CENTCOM) area of responsibility were followed by at least one medical encounter in a fixed medical facility outside the operational theater with a diagnosis of a cardiovascular disease (CVD). The vast majority of those (n=660; 94.7%) evacuated were males. More than a third of CVD-related evacuations (n=278, 39.9%) occurred in service members 45 years of age or older; slightly more than half (n=369; 52.9%) occurred in reserve or guard members. The most common CVD risk factors which had been diagnosed among evacuated service members prior to their deployment were hypertension (n=236; 33.9%) and hyperlipidemia (n=241; 34.9%). Much lower percentages had been previously diagnosed with obesity (n=74, 10.6%) or diabetes (n=21, 3.0%). More than 1 in 4 service members with a CVD-related medical evacuation had been diagnosed with more than one risk factor (n=182, 26.1%). Both limitations to the data available and strategies to reduce CVD morbidity in theater are discussed.

Update: Accidental drownings and near drownings, active component, U.S. Armed Forces, 2013-2017.

Service members are at risk for unintentional drownings or near drownings during training, occupational activities, and off-duty recreation. During 2013-2017, there were 359 incident accidental drowning episodes (includes drownings and near drownings) for a crude rate of 5.7 cases per 100,000 person-years. Compared with their respective counterparts, the overall incidence rates of drowning episodes were highest among males, those aged 29 years or younger, those who were unmarried, and enlisted service members. Across the services, crude overall rates were highest among Marine Corps and Navy members and lowest among Air Force members. Overall rates of drowning episodes were highest among those working in motor transport and lowest among those in repair/engineering or communications/intelligence occupations. The overall rate of drowning episodes among service members with any history of alcohol-related disorder was nearly twice that of those without any history of alcohol-related disorder. Between 2015 and 2017, annual rates of drowning episodes decreased in each service, with the greatest decline observed among Navy and Marine Corps members. The results of this report may be useful to increase awareness regarding the ongoing risks and effects of drowning episodes among U.S. service members.

Coccidioidomycosis, active component, U.S. Armed Forces, 2007-2017.

During 2007-2017, there were 574 incident cases of coccidioidomycosis among active component service members, with an overall unadjusted incidence rate of 3.9 cases per 100,000 person-years (p-yrs). Compared to their respective counterparts, the overall rates were highest among those aged 40 years or older, Navy members, enlisted service members, and those in healthcare occupations. Overall incidence rates were similar for males and females. Within race/ethnicity groups, the overall rates of coccidioidomycosis were highest among Asian/Pacific Islanders and lowest among non-Hispanic whites. During the surveillance period, crude annual incidence rates decreased from a high of 5.2 cases per 100,000 p-yrs in 2007 to a low of 2.3 cases per 100,000 p-yrs in 2017. Of the total U.S. cases (n=547), the vast majority (85.0%) were associated with locations within states in the southwestern U.S. with Coccidioides-endemic areas, including California (47.3%), Arizona (32.5%), Texas (4.6%), and New Mexico (0.5%). Providers of health care to U.S. military members should consider coccidioidomycosis as a potential cause of febrile respiratory infectious illnesses, particularly when the individual has a history of recent travel to an endemic area (especially those who work or participate in activities where dust is generated).

Thyroid disorders, active component, U.S. Armed Forces, 2008-2017.

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.

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 adrenogenital 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 higher among non-Hispanic white service members compared with those in other race/ethnicity groups. In both sexes, the annual rates of adrenal insufficiency and other disorders of adrenal gland increased slightly during the 16-year period.

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.

Skin and soft tissue infections, active component, U.S. Armed Forces, 2013-2016.

During the 4-year surveillance period, there were 282,571 incident cases of skin and soft tissue infection (SSTI) among active component U.S. military members diagnosed in inpatient or outpatient settings, corresponding to an overall incidence of 558.2 per 10,000 person-years (p-yrs). An additional 10,904 cases occurred in theater of operations (460.0 per 10,000 p-yrs). Approximately half (49.4%) were classified as "other SSTI" (e.g., folliculitis, impetigo); 45.9% were cellulitis/abscess; 4.6% were carbuncles/furuncles; and 0.1% were erysipelas. Annual incidence rates declined by 46.6% over the surveillance period. In general, higher rates of SSTIs were associated with younger age, recruit trainee status, and junior enlisted rank. During the surveillance period, 238,924 service members were treated for SSTIs in outpatient or inpatient settings, which accounted for 395,361 medical encounters and 19,213 hospital bed days. The history of operational significance of skin infections in the military, the high healthcare costs associated with evaluating and treating skin infections, and the risk of infections by antibiotic-resistant organisms highlight the importance of prevention, early diagnosis, and definitive treatment of skin infections, particularly in high-risk settings such as new recruit/basic training populations.

Incidence of Campylobacter intestinal infections, active component, U.S. Armed Forces, 2007-2016.

During 2007-2016, there were 1,753 diagnosed cases of Campylobacter intestinal infection among active component service members. The overall rate for the period was 14.1 cases per 100,000 person-years (p-yrs), but the annual incidence rates steadily increased from 7.6 cases per 100,000 p-yrs in 2007 to 22.1 cases per 100,000 p-yrs in 2016. Overall rates were higher in females, those aged 45 years or older, members of the Air Force and Army, offi cers, and those in military healthcare occupations. Incidence rates were lowest among service members who were recruit trainees, younger than 20 years of age, non-Hispanic blacks, and Marines. For the entire 10-year surveillance period, more cases were diagnosed in the warmer months of the year. Only eight cases were diagnosed in deployment settings during the 10-year period. Discussion of the recognized risk factors for Campylobacter infections reviewed the hazards of undercooked meats (especially poultry), unpasteurized milk, and untreated surface water in the environment. The limitations of the study methodology were described.

Incidence of nontyphoidal Salmonella intestinal infections, active component, U.S. Armed Forces, 2007-2016.

During 2007-2016, there were 1,536 incident cases of nontyphoidal Salmonella infection among active component service members, with an overall crude incidence rate of 12.4 cases per 100,000 person-years (p-yrs). The overall rate for the period was higher among female service members than males. Service members aged 50 years or older and those aged 25-29 years had the highest rates of nontyphoidal Salmonella infection. Compared to their respective counterparts, overall rates were highest among non-Hispanic white service members, members of the Air Force, junior officers, recruits, and service members in healthcare occupations. Annual incidence rates were relatively stable during the first 9 years of the surveillance period. Rates peaked in 2016 at 15.9 cases per 100,000 p-yrs. The monthly distribution of the cumulative number of cases during the period showed a pattern of seasonality with a summer peak and the largest number of infections in July. During 2008-2016, a total of 132 cases were diagnosed in deployment settings, with an overall crude incidence rate of 12.6 cases per 100,000 p-yrs. Standard measures for the prevention of salmonellosis are reviewed.

Incidence of Shigella intestinal infections, active component, U.S. Armed Forces, 2007-2016.

During 2007-2016, there were 428 incident cases of Shigella infection among active component service members, with an overall crude incidence rate of 3.4 cases per 100,000 person-years (p-yrs). Compared to their respective counterparts, overall incidence rates were highest among females, non-Hispanic black service members, those aged 35-39 years, members of the Army, and those in military healthcare occupations. With the exception of 2015, the annual incidence rates of shigellosis from 2007 through 2016 were relatively stable. The annual incidence rate in 2015 was twice that of the rate in 2014 (6.4 cases per 100,000 p-yrs and 3.1 cases per 100,000 p-yrs, respectively). This peak was followed by a decrease to 3.4 cases per 100,000 p-yrs in 2016. There was no marked pattern of seasonality of Shigella infections during the 10-year surveillance period. During 2008-2016, a total of 23 cases of Shigella infection were diagnosed in deployment settings. Risk factors for Shigella infection and standard measures for the prevention of shigellosis are reviewed.

Using records of diagnoses from healthcare encounters and laboratory test results to estimate the incidence of norovirus infections, active component, U.S. Armed Forces, 2007-2016: limitations to this approach.

During the 10-year surveillance period, there were 709 incident cases of norovirus (NoV) infection identified among active component service members, with an overall crude incidence rate of 5.7 cases per 100,000 person-years (p-yrs). The overall incidence rate of NoV infection was slightly higher among female service members than males. Compared to their respective counterparts, service members aged 24 years or younger, members of the Army, junior enlisted, and recruits had the highest rates of NoV infection. Overall rates were similar across all race/ethnicity groups. Service members in "other" occupations had the highest overall incidence rate, compared to service members in other occupational groups. Annual incidence rates of NoV infection ranged from a low of 2.5 cases per 100,000 p-years in 2008 to 11.2 cases per 100,000 p-yrs in 2010. The monthly distribution of the cumulative number of incident cases of NoV infection during the surveillance period showed a pattern of seasonality with higher numbers of diagnosed cases from November through March. Comparing the results of this analysis to modeled estimates of the underreported incidence of NoV infections demonstrated the limited utility of using only medical encounter diagnoses, reportable events, and laboratory data to report on NoV incidence. The disparity between such estimates highlights the importance of developing and using other methodologies to derive estimates of norovirus incidence and burden in future analyses.

Incidence of Escherichia coli intestinal infections, active component, U.S. Armed Forces, 2007-2016.

During 2007-2016, there were 290 incident cases of Escherichia coli infection among active component service members, with an overall crude incidence rate of 2.3 cases per 100,000 person-years (p-yrs). Subgroup-specific rates were higher among service members aged 50 years or older and those aged 25-29 years than those in other age groups. Compared to their respective counterparts, females, non-Hispanic white service members, members of the Air Force, and service members in healthcare occupations had the highest rates of E. coli infection. Crude overall incidence rates were highest among senior enlisted service members and junior officers, compared to those in other ranks/grades. Annual incidence rates of E. coli infection among active component service members peaked in 2011 (3.4 cases per 100,000 p-yrs) and in 2016 (4.7 cases per 100,000 p-yrs) but otherwise were relatively stable. The monthly distribution of the cumulative number of incident cases of infections during the 10-year period showed a modest pattern of seasonality. During 2008-2016, a total of 14 incident cases of E. coli infection were identified among active component service members during deployments. Standard measures for the prevention of intestinal E. coli infection are reviewed.

Medical evacuations, active and reserve components, U.S. Armed Forces, 2013-2015.

From 1 January 2013 through 31 December 2015, a total of 3,912 medical evacuations of service members from the U.S. Central Command area of responsibility were followed by at least one medical encounter in a fixed medical facility outside the operational theater. Overall, there were more medical evacuations for mental disorders than for any other category of illnesses or injuries. Among all service members, annual rates of medical evacuations attributable to battle injuries decreased from 3.4 per 1,000 deployed personyears (dp-yrs) in 2013 to a low of 0.7 per 1,000 dp-yrs in 2015. Annual rates of medical evacuations attributable to non-battle injuries and illnesses were relatively stable during 2013-2014 but decreased by 43.1% in 2015. The overall rate of medical evacuations was higher among females than males. Overall medical evacuation rates were highest among black, non-Hispanic and white, non-Hispanic service members and lowest among service members of "other" or unknown race/ethnicity. Compared to their respective counterparts, rates of evacuation were higher among deployers aged 40 years or older, in the Army or Marine Corps, in the reserve component, enlisted (junior or senior), and in armor/motor transport or combat-specific occupations. The majority of service members who were evacuated were returned to normal duty status following their post-evacuation hospitalizations or outpatient encounters.