Disparities in COVID-19 Vaccine Initiation and Completion Among Active Component Service Members and Health Care Personnel, 11 December 2020-12 March 2021.

The objective of this study was to assess overall vaccine initiation and completion in the active component U.S. military, with a focus on racial/ethnic disparities. From 11 December 2020 through 12 March 2021, a total of 361,538 service members (27.2%) initiated a COVID-19 mRNA vaccine. Non-Hispanic Blacks were 28% less likely to initiate vaccination (95% confidence interval: 25%-29%) in comparison to non-Hispanic Whites, after adjusting for potential confounders. Increasing age, higher education levels, higher rank, and Asian/Pacific Islander race/ethnicity were also associated with increasing incidence of initiation after adjustment. When the analysis was restricted to active component health care personnel, similar patterns were seen. Overall, 93.8% of those who initiated the vaccine series completed it during the study period, and only minor differences in completion rates were noted among the demographic subgroups. This study suggests additional factors, such as vaccine hesitancy, influence COVID-19 vaccination choices in the U.S. military. Military leadership and vaccine planners should be knowledgeable about and aware of the disparities in vaccine series initiation.

Increased risk for stress fractures and delayed healing with NSAID receipt, U.S. Armed Forces, 2014-2018.

Previous studies have suggested that the use of nonsteroidal antiinflammatory drugs (NSAIDs) is associated with an increased risk of stress fractures due to their inhibitory effect on bone formation. The current study evaluated the relative risk of stress fractures in active duty service members with and without previous receipt of NSAIDs. A total of 7,036 cases of stress fracture and 28,141 matched controls were identified between June 2014 and December 2018 and included in the analysis. A subset of cases were evaluated for delayed healing diagnoses within 90 days following incident case diagnosis using International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes. Prior receipt of NSAIDs was associated with an increased incidence of stress fractures (adjusted incidence rate ratio=1.70; 95% confidence interval [CI]:1.58-1.82; p<.0001). Among stress fracture cases, prior receipt of NSAIDs was associated with increased diagnosis of delayed healing (adjusted odds ratio=1.41; 95% CI: 1.12-1.77; p=.004). These findings may have significant implications for military readiness because NSAIDs are used extensively and stress fractures are already a major contributor to the burden of healthcare encounters and lost duty time.