Back to Top Skip to main content Skip to sub-navigation

Hearing Conservation Measures of Effectiveness Across the Department of Defense

Image of An audiology technician at Naval Branch Health Clinic Jacksonville’s occupational health clinic, conducts a hearing exam with Airman Diosney Moraga. Kori Reese, an audiology technician at Naval Branch Health Clinic Jacksonville’s occupational health clinic, conducts a hearing exam with Airman Diosney Moraga. Naval Hospital Jacksonville and Navy Medical Readiness and Training Command Jacksonville won the Chief of Naval Operation’s Award for Achievement in Ashore Safety (large non-industrial command) for Fiscal Year 2019. (U.S. Navy photo by Jacob Sippel).

Recommended Content:

Medical Surveillance Monthly Report

What are the new findings?

The Department of Defense (DOD) Hearing Conservation Program evaluation has historically been limited to service-specific metrics. This article presents the findings from the first review of data on the Measures of Effectiveness developed by the DOD Hearing Conservation Working Group.

What is the impact on readiness and force health protection?

Hazardous noise exposure is one of the most common occupational hazards within the DOD; such exposure can cause hearing loss or tinnitus that may directly affect a service member's ability to communicate effectively. The data presented here represent a means to evaluate the services’ efforts at hearing s conservation.

Abstract

This article summarizes the findings from the first report of the new, standard Measures of Effectiveness developed by the DOD Hearing Conservation Program Working Group in 2018. When examining periodic hearing test results of DOD personnel, the overall risk of potential hearing injury/illness was stable from 2012 through 2018. The National Guard and Reserve components showed a higher potential risk of hearing loss, possibly related to lower compliance on follow-up tests when a shift in hearing occurred. Finally, the overall percentage of DOD personnel (who received periodic hearing tests) with hearing impairment decreased over the years presented.

Background

Starting in 1949 with the first U.S. Air Force (USAF) regulation on noise,1 Hearing Conservation Programs (HCPs) have been implemented within the military and most commercial occupational settings where hazardous noise is present. These programs protect individuals who are exposed to hazardous noise from developing noise-induced hearing loss or tinnitus, which may result in permanent disability and negatively affect quality of life.2 Basic components of an HCP to mitigate the negative effects of noise on the worker include noise exposure monitoring, engineering and administrative controls (e.g., reducing the noise at the source, limiting personnel work hours around a hazard), audiometric evaluation, use of hearing protection devices, education and motivation, record keeping, and program evaluation.3

The Occupational Safety and Health Administration (OSHA) directs that employers maintain an accurate record of all workers’ noise exposures and audiometric testing information.4 Maintaining accurate and complete records provide evidence of compliance with regulations and are used to evaluate the effectiveness of the program.5 Due to the military’s transient workforce, the DOD uses a system of records that allows for monitoring audiograms of service members and DOD civilian personnel at installations worldwide: the Defense Occupational and Environmental Health Readiness System - Hearing Conservation Data Repository (DOEHRS-HC DR). This system allows for capture, analysis, and storage of hearing test (audiograms) results worldwide for DOD HCPs.

Each DOD component establishes, maintains, and evaluates the effectiveness of its own HCP. At a minimum, hearing test results that document a significant threshold shift (STS) and a permanent threshold shift (PTS), as well as rates of compliance with requirements for hearing tests, are collected, reviewed by program managers, and reported to higher headquarters.6 However, because each service varies in how the metrics are gathered and reported, STS and PTS rates are not always standardized and thus not always comparable. For example, in the Army and Marines Corps, all service members receive hearing tests on at least an annual basis due to the risk of noise-induced hearing loss secondary to exposures to weapon fire noise during required weapon qualification.

Hearing ability is also considered an element of individual readiness due to the need to communicate effectively on the battlefield and its relationship to warfighter lethality and survivability. The Air Force and Navy hearing conservation programs take a risk-based approach in which only members who are exposed to routine hazardous noise are enrolled in an audiometric monitoring program and receive periodic hearing tests. To resolve discrepancies between services, the DOD Hearing Conservation Working Group (HCWG) agreed upon standard HCP Measures of Effectiveness (MOEs) in 2018. These MOEs were then prepared and codified by the U.S. Air Force School of Aerospace Medicine's Epidemiology Consult Service Division and the Armed Forces Health Surveillance Branch Air Force Satellite.

Methods

DOEHRS-HC DR data were used to generate MOEs at the DOD level and for each individual service. Data were stratified by component (active component [AC], National Guard [NG], reserve component, and civilian) and presented as annual percentages among those who were tested. This report presents findings for calendar years 2012 through 2018. All statistical analyses were performed using SAS/STAT software, version 9.4 (2014, SAS Institute, Cary, NC).

It is important to note that, if an individual’s reference or periodic hearing test reveals a hearing threshold exceeding 25 decibels hearing level (dBHL) in either ear, then that individual is considered to suffer from hearing impairment. A reference test is the initial hearing test received by an individual before exposure to hazardous noise duty. A periodic test is the monitoring hearing test done regularly to detect changes in hearing that may be associated with hearing injury/illness. When compared to the reference test, changes in hearing in the periodic test may initially be characterized as a significant threshold shift (STS). An STS is an average deterioration in hearing threshold of 10 dBHL or more at 2000, 3000, and 4000 Hz in either ear on the monitoring test, when compared to the individual’s reference test. When an STS occurs, follow-up testing is required to confirm whether the shift is temporary or permanent.7,8,9 If the STS has resolved at the time of the follow-up test, it is considered to have been a temporary threshold shift (TTS). Conversely, if an STS is confirmed on follow-up testing, or the member does not return for retesting within the specified timeframe, the STS is considered to represent a permanent threshold shift (PTS). The timeframe for follow-up testing varies from 30 to 90 days from the periodic test depending on service-specific regulations. Hearing is assessed at least annually for individuals and is compared to the most current reference test available. If an individual had more than one periodic or reference test series in a given calendar year, their most recent test series was used in the analysis. Aggregate data for 4 MOEs were compiled across all services and are described in this report.

MOE 1 examines potential hearing illnesses/injuries by calculating the percentages of tested individuals who had results of STS, TTS, and PTS. The percentages of threshold shifts were calculated by taking the number of unique individuals meeting each set of respective criteria on an annual (a type of periodic test) hearing test per calendar year and dividing by the total number of individuals who received an annual hearing test. For example, the number of individuals with a PTS is divided by the number of those who received an annual hearing test in a given time frame and the result is expressed as a percentage.

MOE 2 measures compliance with the requirement for follow-up testing after an STS. This MOE is similar to the DOD Instruction 6055.12 definition of compliance rates, but instead of measuring annual compliance with hearing tests,6 it measures non-compliance when follow-up is required. The rate of non-compliance is calculated by dividing the number of people with an STS who did not receive follow-up testing within the required time frame by the total number of tests indicative of STS per year. The time frame for follow-up testing is based on service-specific requirements.

MOE 3 is a measure of the frequency of hearing impairment (hearing thresholds above 25 dBHL) or the frequency of those with clinically normal hearing (hearing thresholds at 25 dBHL or below) in a population of interest. In this report, MOE 3 focuses on the proportion of hearing impairment counts among individuals who received testing per year. Percentages of hearing impaired were calculated by taking the number of individuals (including enlisted accessions as a separate population) with hearing impairment results on a periodic or reference hearing test per year and dividing by the total number of individuals who received a periodic or reference hearing test in the same year.

MOE 4 calculates the percentages of unique individuals who qualify for Veterans Affairs (VA) claims using counts and criteria as outlined in 38 CFR §3.385, Disability Due to Impaired Hearing.10 Service members meeting these criteria are deemed audiometrically eligible for service-connected disability for hearing impairment; however, there are multiple, additional criteria required before a disability rating for hearing loss is awarded by the VA. The audiometric criteria for MOE 4 are as follows: 1) any threshold greater than or equal to 40 dBHL from 500 to 4000 Hz in either ear, or 2) an average of the 3 highest frequencies between 500 to 4000 Hz greater than 25 dBHL (pure-tone average). The percentage of individuals meeting the VA compensation criteria was defined as the number who met the VA criteria per year divided by the total number of individuals who received a periodic or reference hearing test in that same year.

Results

Service representation in the data used for this analysis was approximately 60% Army, 14% Navy, 14% Marines, and 12% Air Force.11 Figures 1a and 1b show results for MOE 1. Overall, from 2012 through 2018, percentages of potential hearing injury/illness (MOE 1) exhibited a stable pattern or steady decline during the period for AC and civilians, and essentially a stable pattern for NG and reserve members after 2014. Annual percentages of STS and PTS were consistently higher in NG (STS range: 15.1 – 16.3%, PTS range: 12.8 – 14.9%) and reserve members (STS range: 13.7 – 18.4%, PTS range: 11.8 – 17.2%) when compared to AC members (STS range: 8.1 – 11.0%, PTS range: 4.8 – 7.2%). Over the course of the 7-year period, civilian percentages of STS (range: 13.6 – 16.2%) were broadly similar to that of reserve and NG members. Annual percentages of PTS in civilians (range: 9.4 – 10.5%) were higher than those among AC members, but lower than percentages among reserve and NG members (Figures 1a, 1b).

The frequency of non-compliance with follow-up testing (MOE 2) demonstrated a downward trend from 2012 through 2017 among AC, NG, and civilians. Overall, non-compliance among reserve members trended upward during the 7-year study period. In general, non-compliance was substantially lower among AC members (range: 28.2 – 55.0%) and civilians (range: 27.6 – 54.9%) when compared to reserve (range: 78.5 – 93.9%) and NG members (range: 82.0 – 95.5%) (Figure 2).

The percentages of those with hearing test results indicative of hearing impairment (MOE 3) decreased slightly but steadily from 2012 through 2018 for all service members and civilians (Figure 3). A stable, but slightly downward trend was also noted for DOD enlisted accessions. The percentages of those tested who met the VA compensation criteria (MOE 4) decreased steadily over the 7-year period for all components and the DOD overall (Figure 4). This downward trend appeared to occur equally across all service components.

Editorial Comment

MOE 1 results show that DOD civilian personnel have generally maintained a stable risk of hearing injury/illness from 2012 through 2018. The goal for this MOE was to detect potential hearing injuries/illnesses due to hazardous noise exposure; therefore, only the periodic annual tests were used to better reflect the personnel who are more routinely exposed. However, because only periodic annual tests were used in computing this measure, it is not recommended to compare MOE 1 STS, PTS, and/ or TTS outcomes to similar metrics found in DOEHRS-HC DR aggregate reports, or in other surveillance or research projects. Additionally, not all services are evenly represented within the DOEHRS-HC DR since each branch has its own criteria for enrolling members onto the program as previously stated.

Examination of MOE 1 results across components revealed that AC members had the lowest STS and PTS percentages, and the highest TTS percentages compared to reserve, and NG members. This trend in reserve and NG members may be the result of high non-compliance on follow-up tests as evident in the pattern of MOE 2 results. When an individual does not comply with the required follow-up test to verify a shift in hearing on the periodic annual hearing test within the required time frame, then a TTS automatically becomes a PTS in the DOERH-HC DR until the individual takes the next year’s hearing test. Therefore, an accurate analysis of permanent hearing injury/illness in these 2 populations is not possible until the differences in the proportions of non-compliance are addressed.

The explanation for the elevated proportions of STS, TTS, and PTS among DOD civilian personnel is unknown; however, the results for this population may reflect differences in age and/or years of noise exposure compared to service member populations (as the effects of noise on the auditory system are cumulative over time), as well as non-compliance with follow- up testing when an STS is captured. Overall, the comparisons between these 4 groups should be undertaken with care due to the differences in their contributions to the dataset (AC 63%; reserve 12%; NG 18%; DoD civilian personnel 7%). In other words, although AC accounts for the largest percentage of test results represented in the DOEHRS-HC DR data, the rules of surveillance are quite different between services and in comparison to reserve, NG or DOD civilian populations. In addition, there are significant age and sex differences between the DOD civilian population and the other populations. Furthermore, there may be additional exposures for the reserves and NG; for example a traditional guardsman only on orders 1 weekend a month could have a concurrent full-time civilian position with hazardous noise exposure.

The trend seen in MOE 3 of fewer individuals presenting with a hearing impairment over the past 6 years could be the result of multiple factors, such as effective hearing conservation prevention efforts, employee turnover, a reduction in noise exposure due to an overall decrease in combat operations, and/or force reduction efforts (e.g., reduction in force by medical requirement enforcement, or decrease in waivers for hearing issues identified at accession). Additionally, the DOD civilian population had a higher percentage meeting the hearing impairment criteria. As with the MOE 1 results for civilians, this observation may have been due to differences in age and/or years of noise exposure for this population compared to service member populations. Alternatively, this trend could also have been the result of less comprehensive efforts in hearing conservation for non-military individuals within DOD. As the DOD continues to emphasize noise-induced hearing loss prevention and to monitor metrics like the MOEs, the downward trend of members meeting MOE 4 VA Criteria indicates fewer individuals are meeting audiometric hearing impairment criteria. There are additional criteria that need to be met before a final service-connected disability rating can be obtained for hearing loss such as speech recognition scores below a specified cut-off and medical professional concurrence.

A limitation of the DOEHRS-HC DR data, particularly for more recent years in this report, is the real-time nature of the system in which hearing tests are continuously being imported/exported, edited, and corrected at installations and service levels; decidedly, the data become more stable over time. Therefore, there is less confidence in some data trends until they are shown to be stable in subsequent years; MOE 3 and 4 results show recent shifts in their respective trends between 2017 and 2018, for example.

The MOEs methods and data sets will continually be reviewed by the DOD HCWG and adjusted as needed based on the ever changing mission sets and hazardous noise environments. Upon the request of the DOD HCWG, the Air Force Hearing Conservation Program Office at USAFSAM is evaluating early warning shifts (greater than or equal to 15dB shift at 1,000, 2,000, 3,000 or 4,000 Hz on periodic hearing tests compared to reference hearing test for an individual) for use as a more sensitive indicator for potential hearing injury/illness. These shifts are also flagged in the DOERHS-HC DR data and are very similar to the NIOSH recommended STS criteria.12 Preliminary data show that early warning shifts have a high positive predictive value in identifying those service members who will present with an STS on their periodic hearing test. Additionally, for the last several years, the Army has taken the STS reporting a step further by creating a “new case of STS” metric, due to the STS’s dependence on follow-up test compliance. This metric only counts a new STS; it does not count a repeat STS that was noted the year before. A repeat STS can happen when the member does not complete the required follow up during the year prior; therefore, the reference was never re-established and the member presents with another shift. This metric helps the Army better understand the incidence of hearing injury and STS within their members. The addition of these 2 metrics could give the individual services the ability to better evaluate the effectiveness of their programs and make real-time recommendations, making these metrics good candidates for inclusion as an MOE in the future.

Author affiliations: U.S. Air Force School of Aerospace Medicine, Epidemiology Consult Service, Wright-Patterson AFB, OH (Mr. Wolff, Maj Batchelor, Dr. McKenna); U.S. Army Medical Material Development Activity, Warfighter Expeditionary Medicine and Treatment Project Management Office, Fort Detrick, MD (Maj Williams).

Acknowledgements: James D. Escobar, MPH; Deborah C. Lake, AuD; Theodore Mason; Joel R. Bealer, MA (CDR, USN); John A. Merkley, AuD (LTC, USA); Martin B. Robinette, AuD (LTC, USA).

References

1. Department of the Air Force. Air Force Regulation No. 160-3. 31 August 1949.

2. American National Standards Institute (ANSI). ANSI Technical Report, Evaluating the Effectiveness of Hearing Conservation Programs through Audiometric Data Base Analysis. ANSI S12.13 TR- 2002 (R-2011).

3. Centers for Disease Control and Prevention. In: Franks JR, Stephenson MR, Merry CJ, eds. Preventing Occupational Hearing Loss: A Practical Guide. Cincinnati, OH: National Institute for Occupational Safety and Health; 1996.

4. Council for Accreditation in Occupational Hearing Conservation. In: Hutchison T, Schulz T, eds. Hearing Conservation Manual. 5th ed. Milwaukee, WI: Council for Accreditation in Occupational Hearing Conservation; 2014:13–18.

5. Occupational Safety and Health Administration. 29 CFR 1910.95, Occupational noise exposure. 23 June 2008.

6. Office of the Under Secretary of Defense for Personnel and Readiness. Department of Defense Instruction 6055.12. Hearing Conservation Program. 14 August 2019.

7. Office of the Secretary of the Air Force. Air Force Instruction 48-127. Occupational Noise and Hearing Conservation Program. 26 February 2016.

8. Headquarters, Department of the Army. Pamphlet 40-501. Army Hearing Program. 8 January 2015.

9. Navy and Marine Corps Public Health Center. Navy Medical Department Hearing Conservation Proram Procedures. TM 6260.51.99-2. 15 September 2008.

10. 38 CFR §3.385. Disability due to impaired hearing. 59 FR 60560. 25 November 1994.

11. DOD Hearing Conservation Working Group and DOD Hearing Center of Excellence. Hearing Health Surveillance Data Review Military Hearing Conservation–CY18. https://hearing.health.mil/Resources/ News-and-Events/Hearing-Health-Review. Accessed 01 October 2019.

12. National Institute for Occupational Safety and Health. Criteria for a Recommended Standard, Occupation Noise Exposure, Revised Criteria 1998. Publication No. 98-126. June 1998.

FIGURE 1a. MOE 1: Percentages of STS, TTS, and PTS, U.S. active component service members and DoD civilians, 2012–2018

FIGURE 1b. MOE 1: Percentages of STS, TTS, and PTS, reserve component, U.S. Armed Forces, 2012–2018

FIGURE 2. MOE 2: Percentages of non-compliance with follow-up testing, by service component and DoD civilians, 2012–2018

FIGURE 3. MOE 3: Percentage hearing impaired by service component, DoD civilians, and enlisted accessions, 2012–2018

FIGURE 4. MOE 4: Percentages meeting VA criteria by service component, 2012–2018

You also may be interested in...

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

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

Brief Report: Male Infertility, Active Component, U.S. Armed Forces, 2013–2017

Article
3/1/2019
Sperm is the male reproductive cell  Photo: iStock

Infertility, defined as the inability to achieve a successful pregnancy after 1 year or more of unprotected sexual intercourse or therapeutic donor insemination, affects approximately 15% of all couples. Male infertility is diagnosed when, after testing both partners, reproductive problems have been found in the male. A male factor contributes in part or whole to about 50% of cases of infertility. However, determining the true prevalence of male infertility remains elusive, as most estimates are derived from couples seeking assistive reproductive technology in tertiary care or referral centers, population-based surveys, or high-risk occupational cohorts, all of which are likely to underestimate the prevalence of the condition in the general U.S. population.

Recommended Content:

Medical Surveillance Monthly Report

Sexually Transmitted Infections, Active Component, U.S. Armed Forces, 2010–2018

Article
3/1/2019
Anopheles merus

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. Infections with chlamydia were the most common, followed in decreasing order of frequency by infections with genital human papillomavirus (HPV), gonorrhea, genital herpes simplex virus (HSV), and syphilis. Compared to men, women had higher rates of all STIs except for syphilis. In general, compared to their respective counterparts, younger service members, non-Hispanic blacks, soldiers, and enlisted members had higher incidence rates of STIs. During the latter half of the surveillance period, the incidence of chlamydia and gonorrhea increased among both male and female service members. Rates of syphilis increased for male service members but remained relatively stable among female service members. In contrast, the incidence of genital HPV and HSV decreased among both male and female service members. Similarities to and differences from the findings of the last MSMR update on STIs are discussed.

Recommended Content:

Medical Surveillance Monthly Report

Vasectomy and Vasectomy Reversals, Active Component, U.S. Armed Forces, 2000–2017

Article
3/1/2019
Sperm is the male reproductive cell  Photo: iStock

During 2000–2017, a total of 170,878 active component service members underwent a first-occurring vasectomy, for a crude overall incidence rate of 8.6 cases per 1,000 person-years (p-yrs). Among the men who underwent incident vasectomy, 2.2% had another vasectomy performed during the surveillance period. Compared to their respective counterparts, the overall rates of vasectomy were highest among service men aged 30–39 years, non-Hispanic whites, married men, and those in pilot/air crew occupations. Male Air Force members had the highest overall incidence of vasectomy and men in the Marine Corps, the lowest. Crude annual vasectomy rates among service men increased slightly between 2000 and 2017. The largest increases in rates over the 18-year period occurred among service men aged 35–49 years and among men working as pilots/air crew. Among those who underwent vasectomy, 1.8% also had at least 1 vasectomy reversal during the surveillance period. The likelihood of vasectomy reversal decreased with advancing age. Non-Hispanic black and Hispanic service men were more likely than those of other race/ethnicity groups to undergo vasectomy reversals.

Recommended Content:

Medical Surveillance Monthly Report

Testosterone Replacement Therapy Use Among Active Component Service Men, 2017

Article
3/1/2019
Image of Marines carrying a wooden log for physical fitness. Click to open a larger version of the image.

This analysis summarizes the prevalence of testosterone replacement therapy (TRT) during 2017 among active component service men by demographic and military characteristics. This analysis also determines the percentage of those receiving TRT in 2017 who had an indication for receiving TRT using the 2018 American Urological Association (AUA) clinical practice guidelines. In 2017, 5,093 of 1,076,633 active component service men filled a prescription for TRT, for a period prevalence of 4.7 per 1,000 male service members. After adjustment for covariates, the prevalence of TRT use remained highest among Army members, senior enlisted members, warrant officers, non-Hispanic whites, American Indians/Alaska Natives, those in combat arms occupations, healthcare workers, those who were married, and those with other/unknown marital status. Among active component male service members who received TRT in 2017, only 44.5% met the 2018 AUA clinical practice guidelines for receiving TRT.

Recommended Content:

Medical Surveillance Monthly Report

Outbreak of Acute Respiratory Illness Associated with Adenovirus Type 4 at the U.S. Naval Academy, 2016

Article
2/1/2019
Malaria case definition

Human adenoviruses (HAdVs) are known to cause respiratory illness outbreaks at basic military training (BMT) sites. HAdV type-4 and -7 vaccines are routinely administered at enlisted BMT sites, but not at military academies. 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. During 22 August–11 September 2016, 652 clinic visits for ARI were identified using electronic health records. HAdV-4 was confirmed by real-time polymerase chain reaction assay in 18 out of 33 patient specimens collected and 1 additional HAdV case was detected from hospital records. Two HAdV-4 positive patients were treated for pneumonia including 1 hospitalized patient. Molecular analysis of 4 HAdV-4 isolates identified genome type 4a1, which is considered vaccine-preventable. Understanding the impact of HAdV in congregate settings other than enlisted BMT sites is necessary to inform discussions regarding future HAdV vaccine strategy.

Recommended Content:

Medical Surveillance Monthly Report

Update: Malaria, U.S. Armed Forces, 2018

Article
2/1/2019
Anopheles merus

Malaria infection remains an important health threat to U.S. service mem­bers who are located in endemic areas because of long-term duty assign­ments, participation in shorter-term contingency operations, or personal travel. In 2018, a total of 58 service members were diagnosed with or reported to have malaria. This represents a 65.7% increase from the 35 cases identi­fied in 2017. The relatively low numbers of cases during 2012–2018 mainly reflect decreases in cases acquired in Afghanistan, a reduction due largely to the progressive withdrawal of U.S. forces from that country. The percentage of cases of malaria caused by unspecified agents (63.8%; n=37) in 2018 was the highest during any given year of the surveillance period. The percent­age of cases identified as having been caused by Plasmodium vivax (10.3%; n=6) in 2018 was the lowest observed during the 10-year surveillance period. The percentage of malaria cases attributed to P. falciparum (25.9 %) in 2018 was similar to that observed in 2017 (25.7%), although the number of cases increased. Malaria was diagnosed at or reported from 31 different medical facilities in the U.S., Afghanistan, Italy, Germany, Djibouti, and Korea. Pro­viders of medical care to military members should be knowledgeable of and vigilant for clinical manifestations of malaria outside of endemic areas.

Recommended Content:

Medical Surveillance Monthly Report

Update: Incidence of Glaucoma Diagnoses, Active Component, U.S. Armed Forces, 2013–2017

Article
2/1/2019
Glaucoma

Glaucoma is an eye disease that involves progressive optic nerve damage and vision loss, leading to blindness if undetected or untreated. This report describes an analysis using the Defense Medical Surveillance System to identify all active component service members with an incident diagnosis of glaucoma during the period between 2013 and 2017. The analysis identified 37,718 incident cases of glaucoma and an overall incidence rate of 5.9 cases per 1,000 person-years (p-yrs). The majority of cases (97.6%) were diagnosed at an early stage as borderline glaucoma; of these borderline cases, 2.2% progressed to open-angle glaucoma during the study period. No incident cases of absolute glaucoma, or total blindness, were identified. Rates of glaucoma were higher among non-Hispanic black (11.0 per 1,000 p-yrs), Asian/Pacific Islander (9.5), and Hispanic (6.9) service members, compared with non-Hispanic white (4.0) service members. Rates among female service members (6.6 per 1,000 p-yrs) were higher than those among male service members (5.8). Between 2013 and 2017, incidence rates of glaucoma diagnoses increased by 75.4% among all service members.

Recommended Content:

Medical Surveillance Monthly Report

Re-evaluation of the MSMR Case Definition for Incident Cases of Malaria

Article
2/1/2019
Anopheles merus

The MSMR has been publishing the results of surveillance studies of malaria since 1995. The standard MSMR case definition uses Medical Event Reports and records of hospitalizations in counting cases of malaria. This report summarizes the performance of the standard MSMR case definition in estimating incident cases of malaria from 2015 through 2017. Also explored was the potential surveillance value of including outpatient encounters with diagnoses of malaria or positive laboratory tests for malaria in the case definition. The study corroborated the relative accuracy of the MSMR case definition in estimating malaria incidence and provided the basis for updating the case definition in 2019 to include positive laboratory tests for malaria antigen within 30 days of an outpatient diagnosis.

Recommended Content:

Medical Surveillance Monthly Report

Adrenal Gland Disorders, Active Component, U.S. Armed Forces, 2002–2017

Article
12/1/2018

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 androgenital 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 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.

Recommended Content:

Medical Surveillance Monthly Report

Incidence and Prevalence of the Metabolic Syndrome Using ICD-9 and ICD-10 Diagnostic Codes, Active Component, U.S. Armed Forces, 2002–2017

Article
12/1/2018

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.

Recommended Content:

Medical Surveillance Monthly Report

Thyroid Disorders, Active Component, U.S. Armed Forces, 2008–2017

Article
12/1/2018

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.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.

Recommended Content:

Medical Surveillance Monthly Report

2018 #ColdReadiness Twitter chat recap: Preventing cold weather injuries for service members and their families

Fact Sheet
2/5/2018

To help protect U.S. armed forces, the Armed Forces Health Surveillance Branch (AFHSB) hosted a live #ColdReadiness Twitter chat on Wednesday, January 24th, 12-1:30 pm EST to discuss what service members and their families need to know about winter safety and preventing cold weather injuries as the temperatures drop. This fact sheet documents highlights from the Twitter chat.

Recommended Content:

Medical Surveillance Monthly Report | Winter Safety | Medical and Dental Preventive Care Fitness | Health Readiness & Combat Support
<< < ... 11 12 13 > >> 
Showing results 166 - 180 Page 12 of 13
Refine your search
Last Updated: August 05, 2022

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.