In 2014, three of the 25 major disease and injury categories accounted for most (57 percent) of the medical encounters among active component service members in the U.S. Armed Forces, according to newly released health surveillance reports in the April issue of the MSMR published by the Armed Forces Health Surveillance Center (AFHSC). The categories that accounted for the most medical encounters were injuries (e.g., arm/shoulder, knee, foot/ankle), mental disorders (e.g., anxiety, mood, adjustment disorders), and musculoskeletal diseases (e.g., other back problems) (Table 1, Figure 2) .
In 2014, the largest numbers of service members received medical care for the following specific conditions: musculoskeletal disorders (other back problems and other musculoskeletal diseases), upper respiratory infections, injuries of the arm/shoulder, knee, and foot/ankle, other skin diseases, and eye disorders of refraction and accommodation (Table 1).
“These studies document a pattern of a few illnesses and injuries accounting for most of the morbidity and healthcare burdens that affect U.S. military service members,” said Army Captain Michael R. Bell, director of the AFHSC. “As a result, the analyses suggest priorities for preventive measures and research to reduce the impact of these burdens on the health of the force and on the Military Health System.”
In 2014, mood disorders and substance abuse accounted for more than one-quarter (26.0 percent) of all hospital bed days among active component service members. Four mental disorders (mood, substance abuse, anxiety, and adjustment) and one maternal condition (delivery) accounted for half (50 percent) of all hospital bed days (Table 1, Figure3). About one-ninth (11.1 percent) of all hospital bed days were attributable to injuries and poisonings.
No single condition accounted for more than 7 percent of all lost work time (Figure 4) . Four conditions (substance abuse disorders, other back problems, upper respiratory infections, and mood disorders) combined to account for 24.8 percent of all lost work time.
Hospitalization rates for all causes among active component members decreased in 2014 to the lowest rates in the past decade. In 2014, three diagnostic categories accounted for more than half (53.7 percent) of all hospitalizations of active component members: mental disorders (21.9 percent), pregnancy- and delivery-related conditions (21.7 percent), and injuries and poisonings (10.1 percent)(Table 1).
Similar to 2010 and 2012, in 2014 there were more hospitalizations for mental disorders than for any other major diagnostic category (per the ICD-9-CM). The last year in which the number of hospitalizations for pregnancy and delivery-related conditions exceeded the number for mental disorders was 2008 (data not shown).In 2014, adjustment reactions (including post-traumatic stress disorder) and mood disorders were among the leading causes of hospitalizations of both male and female service members.
In the past five years, the distribution of illness- and injury-related ambulatory visits among active component service members in relation to their reported primary causes has remained fairly stable. However, during 2010–2014, the numbers of visits that were documented with diagnostic codes referring to mental disorders or the musculoskeletal system increased by 14.3 percent and 17 percent respectively.
In 2014, musculoskeletal system and mental disorders accounted for nearly one-half (47.6%) of all illness and injury-related diagnoses documented on standardized records of ambulatory encounters. It should be noted, however, that the annual numbers of visits for these two major categories peaked in 2012 and have declined slightly since then.
For the second straight year, the MSMR has published a report that quantified the health care for illnesses and injuries among non-service members through the MHS.In 2014, a large majority of the healthcare services for current illness and injury (excluding encounters with diagnoses identified by V-codes) that are provided through the MHS to non-service member beneficiaries are delivered in non-military medical facilities (i.e., outsourced [purchased] care). Most medical encounters (88.8 percent) among non-service member beneficiaries were in non-military medical facilities (“outsourced care”) (Table 1).
Of all beneficiaries with any illness or injury-related encounters during the year, many more received exclusively outsourced care (n=4,566,448; 68.6 percent) than either military medical (direct) care only (n=906,452; 13.6 percent) or both outsourced and direct care (n=1,184,125; 17.8 percent). By far, most inpatient care (90.4 percent of all bed days) was received in non-military facilities (outsourced).
In 2014, mental disorders accounted for the largest proportions of the morbidity and healthcare burdens that affected the pediatric (0–17 years) and young adult (18–44 years) beneficiary age groups. Among pediatric beneficiaries, 61.7 percent of medical encounters for mental disorders were attributable to autistic disorders, attention deficit disorders, and developmental speech/language disorders.
The highest numbers and proportion of hospital bed days among 18- to 44-year-olds were for maternal conditions because this age group encompasses nearly all women of childbearing age.
Among older adults (aged 44–65 years), musculoskeletal diseases were the greatest contributors to morbidity and healthcare burdens; and among adults aged 65 years or older, cardiovascular diseases were the major morbidity and healthcare burdens.
Click here to read all the reports. The MSMR is the flagship publication for the AFHSC, featuring articles on evidence-based estimates of the incidence, distribution, impact, and trends of illness in service members and associated populations.
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