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Knowledge of injury causes is essential for prevention. To investigate cause coding in service members' electronic medical records, injury encounters from 2016 to 2019 containing at least 1 external cause code were analyzed. Approximately 10% of incident injury encounters contained at least 1 cause code describing the mechanism, activity, or place of occurrence. Less than 2% of overuse injury encounters had a cause code each year, compared to 36.4-44.0% of acute injuries occurring from 2016 to 2019. Cause coding occurred more frequently in records from military facilities compared to outsourced care (p<0.001). Inpatient records were more likely to be cause-coded than outpatient records (p<0.001). More injury encounters in emergency clinics were cause coded (>50%), compared to approximately 7% of primary care and 2% of specialist encounters. In 2019, the leading mechanism was overexertion (19.9%), followed by falls, slips, or trips (18.7%). The primary activity associated with injuries was running (21.1%). Military training ground was the leading place of occurrence (13.0%). Improvements to the quality and quantity of external cause coding in the medical records would provide critical details to inform military injury prevention. From 2016 through 2019, approximately 10% of 1.5 million annual U.S. service member incident injury medical encounters contained external cause codes. Acute injuries were approximately 20 times more likely to receive a cause code than overuse injuries. Causes were less likely to be recorded in outpatient care records and at non-military health care facilities.

Historically, disease and illness (D&I) surveillance on U.S. Navy vessels relied on weekly data updates and required manual data processing. Established surveillance approaches for fixed military hospitals and clinics were not designed to be applied to the highly mobile populations aboard ships. This paper describes the development of a new surveillance capability through utilization of the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE). The pilot program successfully instituted a near real-time D&I surveillance system defined for shipboard operations. Following initial data and system assessment, an operational surveillance strategy was developed and implemented at the Navy's 4 regional Navy Environmental and Preventive Medicine Units responsible for global fleet assets. Despite early implementation challenges, preventive medicine users reported that the fleet ESSENCE system was effective in identifying potential outbreaks, with sufficient efficiency for daily surveillance. This new capability using in-theater data in ESSENCE enables unprecedented, near real-time D&I surveillance for the U.S. Navy fleet. While currently targeting gastrointestinal and respiratory illness trends, the infrastructure has flexibility to add new modules in response to fleet and preventive medicine requirements.

This retrospective cohort study examined ovarian dysfunction diagnosis incidence among female active component service members in the U.S. military from 2014 to 2023 using medical encounter data from the Defense Medical Surveillance System. Ovarian dysfunction diagnosis incidence gradually increased during this period, driven almost entirely by polycystic ovary syndrome (PCOS), of which the incidence increased from 32.0 cases per 10,000 person-years in 2014 to 60.3 cases per 10,000 person-years in 2023. Increases occurred among all demographic subcategories. This study also assessed independent association between ovarian dysfunction and socio-demographic and medical covariates, including COVID-19 infection and vaccination status. History of obesity had the strongest association with PCOS incidence, with an adjusted incident rate ratio (aIRR) of 2.5 and 95% confidence interval (CI) of 2.3-2.6. COVID-19 infection was modestly associated with PCOS incidence (aIRR 1.2; 95% CI, 1.1-1.3). COVID-19 vaccination status was not independently associated with increased PCOS incidence. A potential contributing factor of increased PCOS diagnosis incidence is that recent updates to the diagnostic criteria enabled more clinical and telehealth diagnoses. The increased incidence may also reflect the increasing rate of obesity and other related health burdens in the U.S. military. Incidence of diagnosis of ovarian dysfunction, driven almost entirely by PCOS, increased steadily among female active component service members from 2014 to 2023. This increase in incidence was observed in all demographic subgroups and had the strongest independent association with pre-existing obesity.

Traumatic brain injury (TBI) has been a major source of morbidity within military forces during the last 2 decades, but research on the relationship between TBI and medical readiness is limited. This study population included 41,442 service members from the U.S. Navy and Marine Corps who completed a Post-Deployment Health Assessment (PDHA) and a Periodic Health Assessment (PHA). Presence of TBI was ascertained from a screening instrument on the PDHA, and provider determination of medical readiness was abstracted from the PHA. Multivariable logistic regression assessed the association between probable TBI and 'not medically ready' (NMR) service member disposition while adjusting for covariates. Overall, 1.8% of the study population screened positive for TBI, and individuals with TBI had a significantly higher prevalence of NMR disposition (7.8%) than those without (3.7%). After adjusting for all covariates, TBI was associated with higher odds of post-deployment NMR disposition (odds ratio 1.5; 95% confidence interval, 1.2-2.0). Deployment-related TBI is associated with medical readiness. Future studies are needed to elucidate the TBI sequelae that may lead to NMR disposition as well as the impact of repeated TBIs. This study identified 54% increased odds of NMR disposition for military personnel with probable TBI following deployment, after adjusting for post-traumatic stress disorder and other covariates.

The Armed Forces Health Surveillance Division (AFHSD) uses a surveillance case definition to identify malignant brain tumors among U.S. active service members. This case definition was applied to the dependent pediatric population of the active component of the Department of the Air Force, which identified 179 malignant brain cancer cases. Those identified pediatric cases were reviewed using multiple data sources. The positive predictive value (PPV) of the AFHSD case definition was found to be 64.5% (95% confidence interval [CI], 55.9-72.5%). In 2019, Webber et al. reported a PPV of 84.3% for brain and other nervous system cancers among U.S. active component officers. The current pediatric study's lower PPV suggests the case definition may be less effective for pediatric populations, indicating a need for refining surveillance methods for dependent populations. The AFHSD case definition was less effective at identifying malignant brain tumors in the active component Air Force pediatric dependent population, with a lower PPV compared to previous studies of the active component Air Force adult population. In addition, several cases were missed by the AFHSD rules. The PPV of the AFHSD case definition was lower when applied to the Air Force pediatric dependent population (64.5%; 95% CI, 55.9-72.5%) compared to the previously published PPV in the adult population (84.3%). There were an additional 16 cases of malignant brain tumors missed by initial screening utilizing AFHSD incidence rules.

This report presents the rates of maternal syphilis among pregnant women and congenital syphilis among newborns in the Military Health System (MHS) beneficiary population from 2012 to 2022. Medical encounter data from military hospitals and clinics as well as civilian health care facilities were obtained from the Defense Medical Surveillance System (DMSS) to determine pregnancies, live births, and confirmed diagnoses of maternal and congenital syphilis. The rate of maternal syphilis in female MHS beneficiaries increased by 233% between 2012 (n=123, 66.0 per 100,000 births) and 2022 (n=169, 219.8 per 100,000 births), while the rate of congenital syphilis in newborn MHS beneficiaries increased by 355% (n=9 to n=32, 6.8 to 30.8 per 100,000 live births). Pregnant active component service members generally evinced higher rates of maternal syphilis than pregnant non-service member MHS beneficiaries during the reporting period. Additionally, the positive predictive value of maternal syphilis cases in the MHS was found to be low (59%). Future studies could focus on potential misclassification of maternal syphilis cases as well as syphilis screening compliance and treatment during pregnancy for all pregnant MHS beneficiaries. The rate of diagnosed maternal syphilis among pregnant female active component service members exceeded previously reported rates of syphilis among all female active component service members annually between 2015 and 2022, likely due to increased screening.

Early evidence suggests that COVID-19 is linked to kidney-related events in older and hospitalized patients. This link has not, however, been explored among a younger, healthy population such as U.S. active component service members (ACSMs). This retrospective cohort study assessed the incidence of post-acute sequelae of SARS-CoV-2 (PASC) and kidney events between March 1, 2020 and September 30, 2022 in ACSMs with no prior history of kidney events. Among the study population (n=831,780), 1,975 (0.2%) kidney events were reported between 31 days and 6 months after COVID-19 test dates. The incidence rate of any kidney event was slightly higher among ACSMs who tested negative for COVID-19 (10.6 per 10,000 person-years) compared to ACSMs who tested positive (9.8 per 10,000 person-years). In adjusted models of incidence rate ratios (IRRs), older ACSMs evinced significantly higher rates of kidney events compared to younger ACSMs, and COVID-19 vaccination had a protective effect; this was true in both the COVID-19-positive and -negative groups, although the IRR magnitude was stronger in the COVID-19-positive group. PASC did not lead to an increased incidence of kidney events compared to the COVID-19-negative group among ACSMs, an overall young and healthy population. PASC-related kidney events were rare among a young, healthy population of ACSMs without prior history of kidney events. The incidence of kidney events among ACSMs was not higher in the COVID-positive group compared to the group that tested negative for COVID.

Mental health disorders have historically accounted for significant morbidity, health care provision, disability, and attrition from military service. From 2019 through 2023, a total of 541,672 active component service members of the U.S. Armed Forces were diagnosed with at least 1 mental health disorder. Crude annual incidence rates of at least 1 mental health disorder decreased from 2019 to 2020, but then increased continually from 2021 until 2023. Most incident mental health disorder diagnoses during the study period were attributable to adjustment disorders, anxiety disorders, depressive disorders, 'other' mental health disorders, and alcohol-related disorders. Efforts to assist and treat service members should continue to promote help-seeking behavior to improve their psychological and emotional well-being and reduce the burden of mental health disorders, especially as rates have been increasing since the COVID-19 pandemic. Annual incidence rates for service members diagnosed with at least 1 mental health disorder increased from 2021 through 2023, coincident with the COVID-19 pandemic. Incidence rates for anxiety disorder and post-traumatic stress disorder increased substantially from 2019 to 2023, nearly doubling during that period.

Over the 5-year surveillance period, from July 2019 through June 2024, the crude incidence rate of any cold weather injury was 31.1 per 100,000 person-years (p-yrs) for the active component and 6.4 per 100,000 persons for the reserve component of the U.S. Armed Forces. From July 2023 through June 2024, a total of 456 members of the active (n=403) and reserve (n=53) components of the U.S. Armed Forces had at least 1 cold weather injury. During the 2023-2024 cold season, the rates of any cold weather injury increased slightly for the active (31.1 per 100,000 p-yrs) and reserve (6.4 per 100,000 persons) components compared to the previous cold season. The rate of any cold weather injury varied among the services for the 2023-2024 cold season, with higher rates observed in the Army and the Marine Corps. Over the entire surveillance period, active component service member cold weather injury rates were higher among males, non-Hispanic Black or African Americans, and those under 20 years old.