Abstract

Examination of rotator cuff injury incidence rates among active-duty Soldiers from 2016 to 2021

Soothesuk Kusumpa, MPA, MPH¹, Kathryn M. Taylor, ScD², LTC Jason L. Judkins, PhD, DSc, SP USA² (1)Oak Ridge Institute for Science and Education, (2)United States Army Research Institute of Environmental Medicine (Disclaimer: The Views Expressed in this Presentation are Those of the Authors and Do Not Reflect the Official Policy of the Department of Army, Department of Defense, or the U.S. Government)

APHA 2022 Annual Meeting and Expo

Background: The new Army combat fitness test (ACFT) requires more upper body strength than the former Army Physical Fitness Test. Heightened physical demands of the ACFT may increase shoulder injury risk, including developing impingement syndrome. Shoulder impingement may progress into rotator cuff tears, an injury with long-term performance implications. Our objective is to determine if U.S. Army Soldiers with shoulder impingement syndrome are at increased risk of developing rotator cuff tears.

Methods: This is a nested matched, case-control study with data from all Soldiers from 2016-2021 (N= 869,651). Cases were matched to four controls without a prior rotator cuff tear by age, sex, date entered into study and service time. International Classification of Diseases 10th Revision Codes were used to define shoulder impingement and rotator cuff tears. We used Poisson regression to determine incident rates and Cox models to estimate hazards ratios.

Results: The incidence of shoulder impingement syndrome and rotator cuff tears was 2.24 (CI: 2.10-2.39) and 0.94 (0.86-1.03) per 1,000 person-years, respectively. Soldiers with no prior history of shoulder impingement had a lower hazard rate for developing a rotator cuff tear (HRR: 0.34, CI: 0.32-0.37) compared to Soldiers with impingement syndrome.

Conclusion: Shoulder impingement syndrome increases the risk for rotator cuff tears by 190%. As training for the ACFT intensifies, increases in overuse injuries of the upper extremities are a concern for Army leadership. Developing progressive strength-training regimes that promote shoulder muscle strength may be key for prevention of new impingement injuries and subsequent rotator cuff tears.

Abstract

National Age and Gender Disparities in Traumatic Brain Injury-Hospitalizations and Centers for Disease Control and Prevention’s Investment in Prevention

Alexis Peterson, Karen Thomas, Hong Zhou Centers for Disease Control- National Center for Injury Prevention and Control

APHA 2022 Annual Meeting and Expo

Background: Nationally, age and sex disparities persist in estimates of nonfatal traumatic brain injury (TBI). Multiple mechanisms of injury (MOI) can result in a new case of TBI, an injury that can disrupt normal brain function. The purpose of this presentation is to describe recent data on TBI-related disparities, discuss effective ways to prevent TBI, and CDC’s initiatives supporting communities to enhance injury prevention efforts.

Methods: CDC analyzed 2019 Healthcare Cost and Utilization Project National Inpatient Sample data to calculate rates of TBI-related hospitalizations by age, sex, MOI, and injury intent. Cases were included if the primary diagnosis was an injury, and a TBI-related diagnosis code was present in any diagnosis field. Hospitalizations were weighted and 95% confidence intervals were calculated using complex survey procedures in SAS. All hospitalization rates were age-adjusted (except age-specific hospitalization rates) to the U.S. 2000 population and presented per 100,000 population.

Results: In 2019 there were an estimated 223,135 TBI-related hospitalizations; 32% of these cases occurred among adults aged ≥75 years. The rate of TBI-related hospitalizations among persons aged ≥75 years was nearly 3x higher than among those aged 65–74 years, and the age-adjusted rate among males was nearly double that among females for all ages. Unintentional falls and motor vehicle crashes (MVCs) were leading MOIs for TBI-related hospitalizations. Rates for fall-related TBIs were highest among adults aged ≥75 years; persons aged 15–24 and 25–34 years displayed the highest rates of TBI-related hospitalizations due to MVCs. Among the MOIs examined that contributed to a TBI-related hospitalization (e.g., MVCs, falls, being struck by or against an object), higher total estimates and age-adjusted rates were observed among males compared with females for all MOI.

Conclusions: Findings highlight national health disparities in nonfatal TBI, particularly among adults aged ≥75 years and males. CDC’s Still Going Strong campaign, focused on raising older adult awareness of preventing injuries that can cause a TBI will be highlighted including strategies for home safety (e.g., removing tripping hazards). Utilizing linked data (e.g., police, emergency medical services, hospital), states can identify risk factors (e.g., age, speeding) for MVCs and measure their impact on TBIs. Best practices (e.g., developing a business model/policies) for state expansion of data linkage programs from CDC’s latest resource, the Linking Information for Nonfatal Crash Surveillance (LINCS) Guide, will be highlighted. CDC’s Still Going Strong campaign and LINCS Guide are initiatives supporting communities to enhance injury prevention efforts.

Abstract

Comparing finger, hand, and wrist injuries in the U.S. Air Force personnel to the U.S. workforce

Authors: Melody Gwilliam¹, Scott Hendricks¹, Christina Socias-Morales¹, Bruce Burnham², Harold Gomes¹, Audrey Reichard¹, Heidi Stallings² Author Affiliations: 1: NIOSH Division of Safety Research (DSR), 2: U.S. Air Force Safety Center (AFSEC). The presenter Melody Gwilliam is a PhD candidate at West Virginia University, School of Public Health in the Department of Epidemiology and Biostatistics. Also, she is an epidemiologist with the National Institute for Occupational Safety and Health, in the Division of Safety Research, in the Analysis & Field Evaluations Branch, she has been working with this branch for 8 years. She also worked as an Epidemiologist for the State of West Virginia for 5 years. The presentation on “Comparing finger, hand, and wrist injuries in the U.S. Air Force personnel to the U.S. workforce” explores the collaborative research project between the National Institute for Occupational Safety and Health and the U.S Air Force. Other areas of her research include occupational safety among law enforcement, fire fighters, building cleaners, USAF personnel, Department of Navy personnel, and occupational injuries from forklifts.

APHA 2022 Annual Meeting and Expo

Background: This study compared finger, hand, and wrist (FHW) injuries among U.S. Air Force (USAF) personnel to all workers in the U.S. workforce. FHWs are the most injured body parts in work-related injuries, but little is known about the comparative differences of these injuries.
Objective: Determine if rates of FHW injuries are higher in the USAF than the U.S. workforce.
Methods: All work-related, non-combat FHW injuries requiring at least one day way from work among USAF personnel and the U.S. workforce were analyzed from 2008 through 2018. USAF injury and demographic data were obtained from the Air Force Safety Automated System and the Interactive Demographic Analysis System. U.S. workforce estimates of FHW injuries were obtained from the Bureau of Labor Statistics, Survey of Occupational Injuries and Illnesses and population estimates from the Current Population Survey. USAF FHW injury rates were age-adjusted to the U.S. workforce.
Results: FHW injuries were higher among the U.S. workforce and among males (rates per 10,000 workers,95% CI: U.S. males 18.35 CI:17.32-19.38, females 12.47 CI:11.96-12.99; USAF males 3.14 CI:2.81-3.46, females 2.53 CI:2.14-2.92). FHW injuries from falls were higher among females and increased with age among both populations. All FHW injuries from contact with objects and equipment were higher among those aged 16-24. The leading nature of FHW injuries was open wounds for the U.S. workforce and fractures for USAF personnel.
Conclusion: Given the difference in the nature of FHW injuries between the two populations, efforts should focus on understanding risk factors and sharing successful prevention activities.

Abstract

Epidemiology of musculoskeletal injuries among women and men during Marine Corps Officer Candidate School

Mita Lovalekar, MBBS, PhD, MPH, Matthew Bird, MS, Kristen Koltun, PhD, Jennifer Forse, MS, Debora Cruz, MSc, Elizabeth Steele, Brian Martin, PhD, Qi Mi, PhD, Bradley Nindl, PhD University of Pittsburgh

APHA 2022 Annual Meeting and Expo

Background: Marine Corps Officer Candidates (MOCs) undergo 10 weeks of arduous physical training during Officer Candidate School (OCS) and are susceptible to musculoskeletal injuries (MSIs).

Objectives(s): Describe the incidence and patterns of MSIs and associated healthcare utilization during OCS.

Methods: MSI self-reports were obtained from a sample of 448 MOCs (81 women: age 25.1±3.5 years, 367 men: age 25.0±3.1 years). MSIs during OCS were described and classified according to their cumulative incidence, anatomic location, MSI type and cause, activity during MSI, and whether medical care was sought. Fisher’s exact test was utilized to compare MSI incidence between sexes.

Results: The incidence of MSIs was significantly higher in women (71.6% of MOCs) as compared to men (54.2%; p=0.004). The most common anatomic location was the lower extremity (women: 84.0% of MSIs; men: 83.6%). Frequent anatomic sub-locations were the ankle (women: 21.7%; men: 26.4%), followed by knee (women: 20.8%; men: 24.5%). Common MSI types reported were pain/spasm/ache (women: 39.6%, men: 30.0%), and sprain (women: 18.9%, men: 24.8%). Running was the most frequent cause of MSIs (women: 45.3%, men: 47.9%), and MOCs were engaged in physical training during the occurrence of most MSIs (women: 78.3%, men: 70.3%). MOCs reported not seeking medical care for a large percentage of MSIs (women: 57.5% of MSIs, men: 69.1%).

Conclusion: MSIs affecting the ankle and knee cause considerable morbidity among MOCs. There is a need to investigate potential prevention strategies for MSIs among MOCs, especially among women and occurring during physical training, in this population.