Back to Top Skip to main content

Update: Gallbladder Disease and Cholecystectomies, Active Component, U.S. Armed Forces, 2014–2018

Hansen's disease nerve A team of US military medical professionals participate in a cholecystectomy aboard the USNS Comfort in Colon, Honduras, Dec. 10, 2018. The ship’s medical personnel provided care for 5,475 patients including 159 surgeries, 3,338 medical patients, 1, 426 optometry patients and 711 dental patients. (U.S. Army photo by Maria Pinel)

Recommended Content:

Medical Surveillance Monthly Report

ABSTRACT

The term gallbladder disease refers to a variety of conditions of the gallbladder and the biliary tract. The more common of these conditions are cholelithiasis (gallstones) and cholecystitis (inflammation of the gallbladder), and these conditions often are treated with cholecystectomy (gallbladder removal). During the 2014–2018 surveillance period, 8,008 active component service members were identified as incident cases of gallbladder disease. The crude overall incidence rate of gallbladder disease was 1.2 per 1,000 person-years; the crude annual rate decreased very slightly during the period. A total of 6,470 active component service members underwent incident cholecystectomies. Almost all (97.4%) were performed laparoscopically, and the majority were performed in outpatient settings (65.2%). The number of hospital bed days per open cholecystectomy far exceeded those per laparoscopic cholecystectomy. However, the number of hospital bed days per open cholecystectomy markedly decreased throughout the period. Gallbladder disease and cholecystectomies were more common among service members who were female, American Indian/Alaska Native or Hispanic, older, in the Air Force, and in healthcare occupations. Clinicians should continue to advocate for lifestyle changes, such as maintaining a healthy weight and a diet low in fat and cholesterol, that could prevent gallbladder disease. Similarly, continued Department of Defense-wide initiatives to promote healthy lifestyles could also help prevent gallbladder disease and maintain the health of the force.

WHAT ARE THE NEW FINDINGS?    

Annual rates of gallbladder disease in active component service members during the 2014–2018 period declined slightly compared to the 2004–2013 period, when rates increased. About 1,601 new cases of gallbladder disease and 1,294 cholecystectomies occurred annually during the surveillance period. Over 97% of cholecystectomies were performed via laparoscopy, a technique that reduces the duration of recovery compared to an open surgical approach.

WHAT IS THE IMPACT ON READINESS AND FORCE HEALTH PROTECTION?

Gallbladder disease and cholecystectomy are not rare, affecting approximately 1 out of every 1,000 service members per year. Their availability for duty and deployability are adversely impacted during the evaluation, surgical treatment, and convalescence associated with gallbladder disease. Risk factors for such disease that are susceptible to modification include excess body weight, a diet with a high fat or cholesterol content, diabetes, and certain medications.

BACKGROUND

The gallbladder is a small (3-inch long), hollow, pear-shaped organ located in the upper right section of the abdomen, just under the right lobe of the liver. The gallbladder stores bile produced by the liver and releases it into the small intestine after a meal to help dissolve fat. Gallbladder disease, including cholelithiasis (gallstones), is common in the U.S. and often results in cholecystitis (inflammation of the gallbladder). Cholecystitis can result in severe pain in the upper right or center abdomen, pain that spreads in the right shoulder or back, tenderness over the abdomen when touched, nausea, vomiting, or fever, particularly after a large or fatty meal. Although these symptoms may be avoided by reducing the amount of fatty and highly processed foods as well as whole milk dairy products consumed, gallbladder removal (cholecystectomy) is recommended when symptoms become frequent, recurrent, or more severe. Gallbladder removal is typically achieved with the minimally invasive laparoscopic technique, which involves inserting a camera and dissection tools through several small incisions in the abdominal wall.1 Open cholecystectomy, which requires a 4- to 6-inch incision1 and longer hospitalization and convalescence periods, is only used if the laparoscopic method is not possible or cannot be completed safely because the gallbladder is severely inflamed, infected, or scarred from other operations.

Gallbladder disease is related to nonmodifiable risk factors, such as being female, being older than 40 years of age, having a family history of gallbladder disease, and being of American Indian or Hispanic descent,2–8 as well as modifiable risk factors, such as being overweight or obese, rapid fluctuations in body weight, a high-fat or high-cholesterol diet, diabetes, and certain medications.2–8 Pregnancy and parity have also been shown to be associated with an increased risk of gallstone formation.2,7,8

It is estimated that over 20 million people in the U.S. have gallstones, and symptoms caused by gallstones are a primary gastrointestinal cause for hospital admissions and healthcare utilization.3,7,9 Furthermore, over 500,000 laparoscopic cholecystectomies are performed annually in the U.S., making it one of the most common abdominal surgeries performed, costing roughly $6.5 billion per year.7,10

A previous MSMR report showed very slight increases in the crude annual incidence rates of gallbladder disease and cholecystectomies among active component members of the U.S. Armed Forces from 2004 through 2013.11 Although outcomes related to laparoscopic cholecystectomy are generally good, an increase in the rates of gallbladder disease could negatively impact the readiness of the force. This report updates the counts and rates of newly diagnosed gallbladder disease and cholecystectomies among U.S. active component service members during 2014–2018.

METHODS

The surveillance period was 01 January 2014 through 31 December 2018. The surveillance population included all active component service members of the Army, Navy, Air Force, and Marine Corps who served at any time during the surveillance period. For the purposes of this report, “gallbladder disease” included not only cholelithiasis and cholecystitis, but also other or unspecified disorders of the gallbladder and other or unspecified disorders of the biliary tract (Table 1). An incident (first-ever) case of gallbladder disease was defined as an inpatient encounter with a case-defining International Classification of Diseases (ICD) code in the primary diagnostic position or 2 outpatient encounters with a relevant ICD code in the primary diagnostic position (Table 1). An individual was considered a case once per lifetime. The type of gallbladder disease was categorized based on the diagnosis specified in the primary diagnostic position for the incident encounter. A prevalent case was defined in the same manner as an incident case, but it occurred before the start of the surveillance period. Individuals with 1 encounter before the start of the surveillance period and 1 after were classified as prevalent cases. Person-time was censored at the incident event and prevalent cases were removed from the study population. Those with diagnoses in non-primary positions were also excluded.

A case of cholecystectomy was defined as an inpatient encounter with a procedure code (PR code) for cholecystectomy in any position or an outpatient encounter with a Current Procedural Terminology (CPT) code for cholecystectomy in any position (Table 1). An individual was considered a case of cholecystectomy only once per lifetime; cholecystectomies were analyzed separately from gallbladder disease cases. For each incident case of cholecystectomy, if an individual had records of multiple procedures performed, inpatient encounters were preferentially selected over outpatient encounters and open cholecystectomies were prioritized over laparoscopic cholecystectomies.

Among the incident gallbladder disease cases that were identified during the surveillance period, the number and percentage of cases with a cholecystectomy encounter whose date was on or after their incident gallbladder disease diagnosis were identified. The average time between incident gallbladder disease diagnosis and first subsequent cholecystectomy encounter was calculated. Similarly, for all individuals with an incident cholecystectomy identified during the surveillance period, the number and percentage of cases with gallbladder disease diagnoses (made in any diagnostic position) during an encounter on or before the date of their incident cholecystectomy were identified. The average time between incident cholecystectomy and first gallbladder disease diagnosis was calculated.

Finally, a burden analysis was performed to identify the morbidity and healthcare burden of gallbladder disease and cholecystectomy during the surveillance period. For this analysis, all inpatient and outpatient encounters with a diagnosis of gallbladder disease in the primary diagnostic position during the study period were included. No more than 1 encounter per person per day was counted. If there were multiple encounters on the same day, inpatient encounters were prioritized over outpatient encounters. The total number of encounters, hospital bed days, and individuals affected were calculated according to standard MSMR burden methodology.12

RESULTS

Gallbladder disease

During the 5-year surveillance period, 8,008 incident diagnoses of gallbladder disease were documented on inpatient or outpatient medical records of active component service members (Table 2). The crude overall rate of incident gallbladder disease diagnoses was 1.2 per 1,000 person-years (p-yrs). A majority of the cases were diagnosed as cholelithiasis (65.8%); cholecystitis was reported among 14.6% of cases, and other/unspecified disorders of the gallbladder/biliary tract were reported among 19.6% (data not shown). Crude annual incidence rates of all gallbladder disease diagnoses (total) decreased very slightly during the surveillance period from 1.3 per 1,000 p-yrs in 2014 to 1.1 per 1,000 p-yrs in 2018 (Figure 1).

Compared to their respective counterparts, service members who were female, American Indian/Alaska Native or Hispanic, in the Air Force or Army, and in healthcare occupations had higher overall incidence rates of gallbladder disease (Table 2). Overall incidence rates increased approximately linearly with increasing age (Table 2).

Cholecystectomy

From 2014 through 2018, a total of 6,470 active component service members underwent cholecystectomies (Table 2). The overall incidence rate of cholecystectomy was 1.0 per 1,000 p-yrs. Slightly more than three-fifths of all the procedures were performed in the outpatient setting (n=4,220; 65.2%), and the vast majority were performed laparoscopically (n=6,300; 97.4%) (data not shown). There was a small decrease in the annual rate of total cholecystectomy procedures during the surveillance period from 1.1 per 1,000 p-yrs in 2014 to 0.87 per 1,000 p-yrs in 2018, with slight decreases observed in the rates of inpatient and outpatient cholecystectomies as well as open and laparoscopic cholecystectomies (Figure 2).

On average, there were 0.7 hospital bed days per laparoscopic cholecystectomy and 4.8 bed days per open cholecystectomy (data not shown). The number of hospital bed days per laparoscopic cholecystectomy remained under 1 bed day during each year of the surveillance period and was stable throughout the surveillance period (Figure 3). Bed days per open cholecystectomy decreased each year from a high of 6.6 bed days in 2014 to a low of 2.3 bed days in 2018.

Relationship between gallbladder disease diagnoses and cholecystectomy

Of the 8,008 individuals who were identified as incident cases of gallbladder disease, 5,720 (71.4%) were also identified as having a cholecystectomy performed following their first-ever case-defining encounter. Among the gallbladder disease cases who had cholecystectomies, 23.3% had their first-ever gallbladder encounter on record on the same day as the cholecystectomy. The average interval between first-ever gallbladder disease diagnosis and surgery was 44 days (data not shown).

Among the 6,470 service members who were identified as having undergone cholecystectomy, 98.7% (n=6,388) had at least 1 gallbladder disease-related encounter before their cholecystectomy (data not shown). Among the cholecystectomy cases, the average number of days between their first-ever gallbladder disease encounter and cholecystectomy was slightly more than 4 months (123 days).

EDITORIAL COMMENT

The annual rates of gallbladder disease declined very slightly between 2014 and 2018. Gallbladder disease was newly diagnosed in approximately 1,600 active component service members on average each year between 2014 and 2018. A total of 6,470 incident cholecystectomies were performed during this period.

A previously published MSMR report documented a slight overall increase in the annual rates;11 however, data toward the end of the surveillance period may have indicated the beginning of the slight decline documented in this report. It is possible that the increase shown in that 2014 report tracked with the increase in obesity rates,11 as obesity is a known risk factor for gallbladder disease. Indeed, the Millennium Cohort study, MSMR analyses, and the recently published Department of Defense (DoD) Health of the Force have shown that the prevalence of obesity among service members, while still lower than the prevalence among the general U.S. population, has been increasing.13–15 However, the current analysis cannot clarify the reasons for the decreases seen. It should be noted, though, that the increases and decreases documented in both reports represent very slight changes that may not be clinically or epidemiologically meaningful.

Consistent with studies of the prevalence of gallbladder disease in the U.S. and elsewhere, the overall rates of gallbladder disease were highest among females, American Indians/Alaska Natives or Hispanics, and those in the oldest age groups. As indicated in the previous MSMR report, the higher overall rates among those in the Air Force and healthcare occupations may be because those groups have comparatively higher proportions of females and older individuals.11

In line with the slightly declining trend observed in the crude annual rates of gallbladder disease, the rates of both inpatient and outpatient and open and laparoscopic cholecystectomies also decreased slightly. Laparoscopic cholecystectomies performed in the outpatient setting continue to be the standard of care.1 The number of hospital bed days per laparoscopic cholecystectomy stayed under 1 bed day throughout the surveillance period. The number of bed days per open cholecystectomy in particular has shown a steep and steady decline throughout the 5-year surveillance period.

The mean number of days between the incident gallbladder disease encounter and cholecystectomy among service members with gallbladder disease was 44 days (range = 0 days–4.8 years), which suggests that clinicians and affected individuals are not waiting long before gallbladder removal. This may be related to a variety of factors, including surgical options with a very short recovery period, access to free health care, and the military’s need to maintain a fit and ready force. On the other hand, the mean number of days between incident gallbladder disease encounter and cholecystectomy among all those who had a cholecystectomy (123 days; range = 0 days–18.7 years) increased slightly from the previous MSMR report (82 days; range = 0 days–14.8 years).

The number of cholecystectomy cases exceeded the number of incident gallbladder disease cases who underwent cholecystectomy because some individuals did not have gallbladder disease case-qualifying encounters (e.g., the individual had only 1 outpatient encounter or had a case-defining diagnosis reported in a non-primary diagnostic position) and were not counted in this report. Furthermore, other gallbladder encounters may have occurred before entrance into military service, before the surveillance period, or in healthcare settings outside the Military Health System (MHS).

Interpretation of the findings in this report should be done with consideration of some limitations. This report likely underestimates the rates of cholecystectomy after a gallbladder disease diagnosis, as some service members may have left military service or were lost to follow-up before surgery. Moreover, the surveillance period may have ended before some of the cases that were identified later in the period underwent surgery. Another limitation of the current analysis is related to the implementation of MHS GENESIS, the new electronic health record for the MHS. For 2017–2018, medical data from sites that were using MHS GENESIS are not available in the Defense Medical Surveillance System. These sites include Naval Hospital Oak Harbor, Naval Hospital Bremerton, Air Force Medical Services Fairchild, and Madigan Army Medical Center. Therefore, medical encounter and person-time data for individuals seeking care at any of these facilities during 2017–2018 were not included in the analysis.

Although the rates of gallbladder disease and cholecystectomies declined slightly among all active component service members during the study period, gallbladder disease and cholecystectomies are not rare and the rates are higher among those with identified risk factors for gallstone formation. Clinicians should continue to advocate for lifestyle changes, such as maintaining a healthy weight and a diet low in fat and cholesterol, that could prevent gallbladder disease. Similarly, continued DoD-wide initiatives to promote healthy lifestyles could also help prevent gallbladder disease and maintain the health of the force.

 

REFERENCES

1. Johns Hopkins University. Cholecystectomy. http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/cholecystectomy_92,P07689/. Accessed 19 June 2019.

2. Mayo Clinic. Diseases and conditions: gallstones. http://www.mayoclinic.org/diseases-conditions/gallstones/basics/definition/con-20020461. Accessed 19 June 2019.

3. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172–187.

4. Nakeeb A, Comuzzie AG, Martin L, et al. Gallstones: genetics versus environment. Ann Surg. 2002;235(6):842–849.

5. Arevalo JA, Wollitzer AO, Corporon MB, Larios M, Huante D, Ortiz MT. Ethnic variability in cholelithiasis—an autopsy study. West J Med. 1987;147;44–47.

6. Miquel JF, Covarrubias C, Villaroel L, et al. Genetic epidemiology of cholesterol cholelithiasis among Chilean Hispanics, Amerindians, and Maoris. Gastroenterol. 1998;115(4):937–946.

7. Figueiredo JC, Haiman C, Porcel J, et al. Sex and ethnic/racial-specific risk factors for gallbladder disease. BMC Gastroenterol. 2017;17(1):153.

8. Grodstein F, Colditz GA, Hunter DJ, Manson JE, Willett WC, Stampfer MJ. A prospective study of symptomatic gallstones in women; relation with oral contraceptives and other risk factors. Obstet Gynecol. 1994;84(2):207–214.

9. Afdhal NH, Zakko SF. Gallstones: epidemiology, risk factors and prevention. UpToDate. https://www.uptodate.com/contents/gallstones-epidemiology-risk-factors-and-prevention?search=cholelithiasis&topicRef=654&source=see_link. Accessed 19 June 2019.

10. Kapoor T, Wrenn SM, Callas PW, Abu-Jaish W. Cost analysis and supply utilization of laparoscopic cholecystectomy. Minim Invasive Surg. 2018;Dec:7838103.

11. Armed Forces Health Surveillance Branch. Gallbladder disease and cholecystectomies, active component, U.S. Armed Forces, 2004–2013. MSMR. 2014;21(6):8–11.

12. Armed Forces Health Surveillance Branch. Absolute and relative morbidity burdens attributable to various illnesses and injuries, active component, U.S. Armed Forces, 2018. MSMR. 2019;26(5):2–10.

13. Clark LL, Stephen TB. Update: Diagnosis of overweight and obesity, active component, U.S. Armed Forces, 2011–2015. MSMR. 2016;23(9):9–13.

14. Rush T, LeardMann CA, Crum-Cianflone NF. Obesity and associated adverse health outcomes among US military members and veterans: findings from the Millennium Cohort Study. Obesity. 2016;24(7):1582–1589.

15. Armed Forces Health Surveillance Branch. DoD Health of the Force 2018. Falls Church, VA: Defense Health Agency; 2019.

Incidence rates of gallbladder disease diagnoses by type, active component, U.S. Armed Forces, 2014–2018

Incidence rates of cholecystectomy by type, active component, U.S. Armed Forces, 2014–2018

Ratio of bed days per cholecystectomy by year and type, active component, U.S. Armed Forces, 2014–2018

Gallbladder disease case-defining ICD-9/ICD-10 codes and cholecystectomy PR codes

Demographic and military characteristics of service members with gallbladder disease and cholecystectomies, active component, U.S. Armed Forces, 2014–2018

You also may be interested in...

Absolute and relative morbidity burdens attributable to various illnesses and injuries, active component, U.S. Armed Forces, 2018

Article
5/1/2019
A U.S. naval officer listens through his stethoscope to hear his patient’s lungs at Camp Schwab in Okinawa, Japan in 2018. (Photo courtesy of U.S. Marine Corps) photo by Lance Cpl. Cameron Parks)

In 2018, mental health disorders accounted for the largest proportions of the morbidity and healthcare burdens that affected the pediatric and younger adult beneficiary age groups. Among adults aged 45–64 years, musculoskeletal diseases accounted for the most morbidity and healthcare burdens, and among adults aged 65 years or older, cardiovascular diseases accounted for the most.

Recommended Content:

Medical Surveillance Monthly Report

Heat Illness

Infographic
4/1/2019
Heat Illness

This report summarizes reportable medical events of heat illness as well as heat illness-related hospitalizations and ambulatory visits among active component service members during 2018 and compares them to the previous 4 years. Episodes of heat stroke and heat exhaustion are summarized separately.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Exertional Rhabdomyolysis

Infographic
4/1/2019
Exertional Rhabdomyolysis

Each year, the MSMR summarizes the numbers, rates, trends, risk factors, and locations of occurrences of exertional heat injuries, including exertional rhabdomyolysis. This report includes the data for 2014–2018.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Exertional Hyponatremia

Infographic
4/1/2019
Exertional Hyponatremia

Each year, the MSMR summarizes the numbers, rates, trends, risk factors, and locations of occurrences of exertional heat injuries, including exertional rhabdomyolysis. This report includes the data for 2014–2018.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Lyme Disease

Infographic
4/1/2019
Lyme Disease

Each year, the MSMR summarizes the numbers, rates, trends, risk factors, and locations of occurrences of exertional heat injuries, including exertional rhabdomyolysis. This report includes the data for 2014–2018.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Update: Heat Illness, Active Component, U.S. Armed Forces, 2018

Article
4/1/2019
Drink water the day before and during physical activity or if heat is going to become a factor. (Photo Courtesy: U.S. Air Force)

In 2018, there were 578 incident diagnoses of heat stroke and 2,214 incident diagnoses of heat exhaustion among active component service members. The overall crude incidence rates of heat stroke and heat exhaustion diagnoses were 0.45 cases and 1.71 cases per 1,000 person-years, respectively. In 2018, subgroup-specific rates of incident heat stroke diagnoses were highest among males and service members less than 20 years old, Asian/Pacific Islanders, Marine Corps and Army members, recruit trainees, and those in combat-specific occupations. Subgroup-specific incidence rates of heat exhaustion diagnoses in 2018 were notably higher among service members less than 20 years old, Asian/Pacific Islanders, Army and Marine Corps members, recruit trainees, and service members in combat-specific occupations. During 2014–2018, a total of 325 heat illnesses were documented among service members in Iraq and Afghanistan; 8.6% (n=28) 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.

Recommended Content:

Medical Surveillance Monthly Report

Update: Exertional Rhabdomyolysis, Active Component, U.S. Armed Forces, 2014–2018

Article
4/1/2019
U.S. Marines sprint uphill during a field training exercise at Marine Corps Air Station Miramar, California. to maintain contact with an aviation combat element, teaching and sustaining their proficiency in setting up and maintaining communication equipment.  (Photo Courtesy: U.S. Marine Corps)

Among active component service members in 2018, there were 545 incident diagnoses of rhabdomyolysis likely due to exertional rhabdomyolysis, for an unadjusted incidence rate of 42.0 cases per 100,000 person-years. Subgroup-specific rates in 2018 were highest among males, those less than 20 years old, Asian/Pacific Islander service members, Marine Corps and Army members, and those in combat-specific or “other/unknown” occupations. During 2014–2018, crude rates of exertional rhabdomyolysis increased steadily from 2014 through 2016 after which rates declined slightly in 2017 before increasing again in 2018. Compared to service members in other race/ethnicity groups, the overall rate of exertional rhabdomyolysis was highest among non-Hispanic blacks in every year except 2018. Overall and annual rates were highest among Marine Corps members, intermediate among those in the Army, and lowest among those in the Air Force and Navy. Most cases of exertional rhabdomyolysis were diagnosed at installations that support basic combat/recruit training or major ground combat units of the Army or the Marine Corps. Medical care providers should consider exertional rhabdomyolysis in the differential diagnosis when service members (particularly recruits) present with muscular pain or swelling, limited range of motion, or the excretion of dark urine (possibly due to myoglobinuria) after strenuous physical activity, particularly in hot, humid weather.

Recommended Content:

Medical Surveillance Monthly Report

Modeling Lyme Disease Host Animal Habitat Suitability, West Point, New York

Article
4/1/2019
A deer basks in the morning sun at Joint Base San Antonio-Fort Sam Houston, Texas.  (Photo Courtesy: U.S. Air Force)

As the most frequently reported vector-borne disease among active component U.S. service members, with an incidence rate of 16 cases per 100,000 person-years in 2011, Lyme disease poses both a challenge to healthcare providers in the Military Health System and a threat to military readiness. Spread through the bite of an infected blacklegged tick, infection with the bacterial cause of Lyme disease can have lasting effects that may lead to medical discharge from the military. The U.S. Military Academy at West Point is situated in a highly endemic area in New York State. To identify probable areas where West Point cadets as well as active duty service members stationed at West Point and their families might contract Lyme disease, this study used Geographic Information System mapping methods and remote sensing data to replicate an established spatial model to identify the likely habitat of a key host animal—the white-tailed deer.

Recommended Content:

Medical Surveillance Monthly Report

Incidence, Timing, and Seasonal Patterns of Heat Illnesses During U.S. Army Basic Combat Training, 2014–2018

Article
4/1/2019
U.S. Marines participate in morning physical training during a field exercise at Marine Corps Base Camp Pendleton, California. (Photo Courtesy: U.S. Marine Corps)

Risk factors for heat illnesses (HIs) among new soldiers include exercise intensity, environmental conditions at the time of exercise, a high body mass index, and conducting initial entry training during hot and humid weather when recruits are not yet acclimated to physical exertion in heat. This study used data from the Defense Health Agency’s–Weather-Related Injury Repository to calculate rates and to describe the incidence, timing, and geographic distribution of HIs among soldiers during U.S. Army basic combat training (BCT). From 2014 through 2018, HI events occurred in 1,210 trainees during BCT, resulting in an overall rate of 3.6 per 10,000 BCT person-weeks (p-wks) (95% CI: 3.4–3.8). HI rates (cases per 10,000 BCT p-wks) varied among the 4 Army BCT sites: Fort Benning, GA (6.8); Fort Jackson, SC (4.4); Fort Sill, OK (1.8); and Fort Leonard Wood, MO (1.7). Although the highest rates ofHIs occurred at Fort Benning, recruits in all geographic areas were at risk. The highest rates of HI occurred during the peak training months of June through September, and over half of all HI cases affected soldiers during the first 3 weeks of BCT. Prevention of HI among BCT soldiers requires relevant training of both recruits and cadre as well as the implementation of effective preventive measures.

Recommended Content:

Medical Surveillance Monthly Report

Update: Exertional Hyponatremia, Active Component, U.S. Armed Forces, 2003–2018

Article
4/1/2019
Drink water the day before and during physical activity or if heat is going to become a factor. (Photo Courtesy: U.S. Air Force)

From 2003 through 2018, there were 1,579 incident diagnoses of exertional hyponatremia among active component service members, for a crude overall incidence rate of 7.2 cases per 100,000 person-years (p-yrs). Compared to their respective counterparts, females, those less than 20 years old, and recruit trainees had higher overall incidence rates of exertional hyponatremia diagnoses. The overall incidence rate during the 16-year period was highest in the Marine Corps, intermediate in the Army and Air Force, and lowest in the Navy. Overall rates during the surveillance period were highest among Asian/Pacific Islander and non-Hispanic white service members and lowest among non-Hispanic black service members. Between 2003 and 2018, crude annual incidence rates of exertional hyponatremia peaked in 2010 (12.7 per 100,000 p-yrs) and then decreased to 5.3 cases per 100,000 p-yrs in 2013 before increasing in 2014 and 2015. The crude annual rate in 2018 (6.3 per 100,000 p-yrs) represented a decrease of 26.5% from 2015. Service members and their supervisors must be knowledgeable of the dangers of excessive water consumption and the prescribed limits for water intake during prolonged physical activity (e.g., field training exercises, personal fitness training, and recreational activities) in hot, humid weather.

Recommended Content:

Medical Surveillance Monthly Report

Testosterone Replacement Therapy

Infographic
3/20/2019
Testosterone Replacement Therapy

With the increasing number of testosterone deficiency diagnoses and potential health risks associated with initiation of TRT, it is important to understand the epidemiology of which U.S. service men are receiving TRT and whether these individuals have an indication for receiving treatment.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Sexually Transmitted Infections

Infographic
3/20/2019
Sexually Transmitted Infections

This report summarizes incidence rates of the 5 most common sexually transmitted infections (STIs) among active component service members of the U.S. Armed Forces during 2010–2018.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Male Infertility

Infographic
3/20/2019
Male Infertility

The current report updates and expands on the findings of the previous MSMR analysis of infertility among active component service men. Specifically, the current report summarizes the frequencies, rates, temporal trends, types of infertility, and demographic and military characteristics of infertility among active component service men during 2013–2017.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Vasectomy

Infographic
3/20/2019
Vasectomy

There are few published studies of vasectomy and vasectomy reversal among the U.S. military population. To address these gaps, the current analysis describes the overall and annual incidence rates of vasectomy among active component service men during 2000–2017 by demographic and military characteristics and by type of surgical vas isolation procedure used. In addition, the median age at incident vasectomy and the time between incident vasectomy and first vasectomy reversal are described.

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Adenovirus

Infographic
3/1/2019
Adenovirus

During August–September 2016, U.S. Naval Academy clinical staff noted an increase in students presenting with acute respiratory illness (ARI). An investigation was conducted to determine the extent and cause of the outbreak.

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health
<< < ... 6 7 8 9 10  ... > >> 
Showing results 76 - 90 Page 6 of 11

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.