The cost of lower extremity fractures among active duty U.S. Army soldiers, 2017.

The estimated cost to the Army for lower extremity fractures in 2017 was approximately $116 million. Direct medical expenses totaled $24 million, and indirect medical costs totaled $92 million ($900 thousand lost duty; $91 million limited duty). Foot and toe fractures, along with lower leg and ankle fractures accounted for the majority of soldiers' initial visits for care (n=4,482; 91.6%), and more than $103 million (89.0%) of overall costs ($116 million). Costs varied by location of care. In outpatient settings, initial visits for foot and toe injuries accounted for the highest costs: $49 million overall. Direct medical costs totaled $1.2 million, and indirect medical costs (limited duty) were $48 million. Conversely, in inpatient settings, lower leg and ankle fractures accounted for slightly more than half of all costs (overall $9 million; $4.8 million in direct medical costs and $4.5 million in indirect medical costs). The finding that the majority of costs related to lower extremity fractures were due to estimated days of lost or limited duty and associated loss of productivity justifies the inclusion of indirect cost estimates as a part of overall injury cost calculations.

The Combined Effect of Cigarette Smoking and Fitness on Injury Risk in Men and Women.

BACKGROUND: Prior studies have identified cigarette smoking and low fitness as independent risk factors for injury; however, no studies have evaluated the combined effect of cigarette smoking and fitness on injury risk. OBJECTIVE: To evaluate the combined effect of cigarette smoking and fitness on injury risk in men and women. DESIGN: This is a secondary analysis of data collected from US Army recruits (n = 2000) during basic combat training within the United States in 2007. Physical training and fitness, cigarette smoking, and prior injury data were obtained from questionnaires, whereas demographic and injury data were obtained from medical and basic combat training unit records. Chi-squared tests were used to assess differences in injury risk by fitness level and cigarette smoking. Relative risk values were calculated with 95% confidence intervals. RESULTS: The primary findings showed that smokers experienced 20%-30% higher risk of injury than nonsmokers. In addition, higher aerobic and muscular fitness was generally not protective against injury between least fit and more fit smokers. However, higher fitness was protective against injury between least and more fit nonsmokers, with least fit nonsmokers being 30%-50% more likely to experience an injury than fit nonsmokers. CONCLUSION: This study revealed that higher aerobic and muscular fitness was not protective against injury among smokers; however, it was protective against injury among nonsmokers. Further implementation of smoking cessation programs may be beneficial for military and civilian personnel who are required to be physically fit in order to carry out their job responsibilities. IMPLICATIONS: Male and female smokers experienced significantly higher risk of injury than nonsmokers. Although higher fitness is protective against injury in nonsmokers, the protective effect of fitness is lost among smokers. In an attempt to reduce injury risk among military and emergency personnel, smoking cessation programs should be further implemented among both more fit and less fit smokers.

Risk Factors for Sprains and Strains Among Physically Active Young Men: A US Army Study.

This investigation aimed to identify risk factors for lower extremity sprain/strain injuries in physically active men. Lower extremity (LE) sprain/strain injuries are a significant source of morbidity among physically active populations. Data on and risk factors for injuries, including personal characteristics, and physical training and fitness were obtained from male Soldiers in an operational US Army division (N=6,865) by survey. Injury risks, risk ratios (RR), odds ratios (OR), and 95% confidence intervals (95% CI) were calculated. Multivariate analysis utilized logistic regression. Self-reported injury incidence for the prior 12 months was 43% (n=2,939), with 30% (n=878) of injuries attributed to LE sprains/strains. Lower extremity sprain/strain injuries were most commonly caused by falls, jumps, trips, or slips (49.4%), occurred while running (30.6%), and often resulted in limited duty profiles (64%). Higher risk of LE sprain/strain injury was independently associated with higher body mass index (ORoverweight/normal=1.2, 95% CI: 1.0-1.5), (ORobese/normal=1.4, 95% CI: 1.1-1.9), lower aerobic endurance (from 2-mile run time) (ORQuartile 2 (Q2)/Quartile 4 (Q4)=1.4, 95% CI: 1.0-1.8), (ORQuartile 1 (Q1)/Q4=1.6, 95% CI: 1.3-2.1), and lower core strength (sit-up repetitions) (ORQ1/Q4=1.4, 95% CI: 1.1-1.8). Lower risk of LE sprain/strain injury was associated with performing unit resistance training 3 or more times per week (OR3 times/none=0.5, 95% CI: 0.3-0.8). LE sprain/strain injuries contribute a significant portion of injuries among US Army Soldiers. Emphasis on aerobic fitness, core strength, and resistance training may help reduce the risk of LE sprain/strain injury among physically active men.

Sex and age differences in physical performance: A comparison of Army basic training and operational populations.

OBJECTIVES: To determine the age- and sex-specific differences of physical fitness performances and Body Mass Index (BMI) in basic training and the operational Army. DESIGN: Cross-sectional Study. METHODS: This secondary analysis utilizes retrospective surveys of U.S. Army Soldiers in Basic Combat Training (BCT) and operational units to compare physical performances between men and women as measured by the Army Physical Readiness Test (APFT). An ANOVA was used to compare mean differences in APFT results and BMI within sex-specific populations. A post hoc Tukey test identified specific mean differences. Adjusting for age, an ANCOVA was used to compare sex and occupation (infantry and non-infantry) differences in APFT results. RESULTS: Surveyed populations consisted of 2216 BCT Soldiers (1573 men and 643 women) and 5515 Operational Soldiers (4987 men and 528 women). Male and female operational Soldiers had greater muscular performance (79%-125% higher APFT push-ups, 66%-85% higher APFT sit-ups) and cardiorespiratory performance (22%-24% faster APFT 2-mile run times) than BCT Soldiers. Male BCT and operational Soldiers outperform their female counterparts on tests of muscular and cardiorespiratory endurance. Sex differences in physical performances attenuated among female Soldiers in operational units compared to BCT. Among male operational Soldiers, infantry Soldiers exhibited greater cardiorespiratory and muscular performance than non-infantry Soldiers. Higher BMI was associated with higher age groups, except for female BCT Soldiers. CONCLUSIONS: Gaps in cardiorespiratory and muscular performances between men and women should be addressed through targeted physical training programs that aim to minimize physiological differences.

The Role of Gender and Physical Performance on Injuries: An Army Study.

INTRODUCTION: In basic combat training, women experience twice as many injuries as men; however, evidence at the operational Army level is limited. This study aims to investigate the association between gender and injury likelihood while controlling for certain confounding factors in the operational Army. METHODS: Data were analyzed in 2015 from a cross-sectional study utilizing data from a 2010-2011 survey of light infantry Army Soldiers. Gender, age, body fat, tobacco use, Army Physical Fitness Test (2-mile run, push-ups, and sit-ups), occupational physical demand, and injury data were obtained via paper survey. ORs and 95% CIs from a multivariable analysis were calculated. RESULTS: Surveys were completed by 4,384 male and 363 female Soldiers. Injury incidence was 42% for men and 53% for women. After adjusting for the aforementioned variables, injury likelihood was higher in Soldiers aged ≥27 years (OR [age 27-29/22-26 years]=1.26, 95% CI=1.07, 1.48; OR [age ≥30/22-26 years]=1.28, 95% CI=1.08, 1.51), Soldiers with body fat ≥23.38% (OR [body fat ≥23.38%/≤19.28%]=1.30, 95% CI=1.08, 1.57), and Soldiers with the slowest 2-mile run times (OR [≥15.68/≤14.13 minutes]=1.53, 95% CI=1.26, 1.85). Women were no more likely than men to sustain an injury. CONCLUSIONS: When accounting for age, body fat, physical performance, and occupational physical demand, there was no gender difference in the likelihood of injury among Soldiers. Although women, on average, have lower aerobic and muscular performance than men, results suggest men and women of similar physical performance experience similar injury likelihood.

Mental health risk factors for suicides in the US Army, 2007--8.

OBJECTIVE: Suicides among active duty US Army personnel have been increasing since 2004, surpassing comparable civilian rates in 2008. This analysis uses US military data to assess suicide rates for the 2-year period 2007--8, and examines relative risks (RR) of suicide associated with mental health disorders. METHODS: Historical trends of US Army suicides were assessed using 1977--2008 data from Army G-1 (Personnel). Suicide rates, RR and the 2000--8 trends of mental health disorders were calculated using data from the Defense Casualty Information Processing System and Defense Medical Surveillance System. RESULTS: A total of 255 soldiers committed suicide in 2007--8 (2008 rate 20.2 per 100 000). Factors associated with higher suicide risk included male gender, lower enlisted rank and mental health disorders treated on an outpatient basis (RR 3.9), as well as a number of mental health disorders (mood disorders, anxiety disorders, post-traumatic stress disorder, personality/psychotic disorders, substance-related disorders and adjustment disorder; RR range 4.7--24.5). Analysis of historical trends suggested that 25--50% of the suicides that occurred in 2008 might have been related to the major commitment of troops to combat beginning in 2003. CONCLUSIONS: The recent increase in suicides parallels an increase in the prevalence of mental disorders across the army. This finding suggests that increasing rates of clinically treated psychopathology are associated with increasing rates of suicides; these rates probably serve as sentinels for suicide risk in this population. Soldiers seeking treatment for mental disorders and substance abuse should be a focus for suicide prevention.