MSMR最新文献

This report presents the incidence and prevalence of diagnosed female infertility among active component U.S. service women. During 2019-2023, 8,154 active component women of childbearing potential were diagnosed with incident infertility, resulting in an overall incidence of 77.5 cases per 10,000 person-years (p-yrs). Incidence rates were highest among women in their 30s, non-Hispanic Black individuals, those in health care and pilot or air crew occupations, Army soldiers, and those who were married. From 2019 through 2023, the incidence rate of diagnosed female infertility decreased from 89.2 per 10,000 p-yrs to 69.5 per 10,000 p-yrs despite a concurrent increase in the rate of fertility testing. During the surveillance period, the average annual prevalence of diagnosed female infertility was 1.6%. Of the service women diagnosed with infertility for the first time during the surveillance period, 2,005 (24.6%) delivered live births within 2 years following their incident infertility diagnoses. The incidence rate of diagnosed infertility among service women decreased by 22.1% during the surveillance period, coincident with an increase of 74.0% in the rate of fertility testing from 2019 through 2023.

Cervical cancer screening recommendations have evolved in the past 20 years. Several recent studies have reported on practice pattern changes in the U.S. in response to these guideline changes, but practice patterns have not yet been evaluated in the Military Health System (MHS). Data for active component service women were queried from the Defense Medical Surveillance System for relevant inpatient and outpatient encounter codes within the MHS between January 1, 2013 and December 31, 2023 to identify instances of cervical cancer screening and classify each by modality: cytology alone, HPV alone, and co-testing. Trends in the use of each were evaluated within age categories: younger than age 21 years, ages 21-29 years, ages 30-64 years. A total of 378,952 screening events were captured from 2013 through 2023. MHS practice patterns demonstrated a response to national guideline changes, including increased co-testing and evidence of increasing primary HPV screening among women aged 30-64 years. Cervical cancer screening in women younger than age 21 years markedly decreased following recommendations against screening in this age group. The overall trends in the MHS are similar to those reported in the U.S. general population. Trends in use of each screening modality-cytology, primary HPV, and co-testing-for active component service women are shifting in response to changing national guidelines. There is emerging evidence of increasing primary HPV screening in women ages 30-64 years, especially after 2021.

Despite significant efforts to further reduce HIV incidence, including the introduction and scaling of pre-exposure prophylaxis (PrEP) in 2012, the repeal of the "Don't Ask, Don't Tell" (DADT) policy in 2011, and test-and-treat initiatives aligned with the 2019 "Ending the HIV Epidemic" initiative, annual rates of HIV incidence in the U.S. Armed Forces have continued to show little to no annual declines. To better understand the nature of new infections in the U.S. military, this retrospective analysis examined cases and trends in greater depth to 1) identify and describe total HIV antibody seropositivity rates from 1990 to 2024, with stratification by demographic characteristics, and 2) identify and characterize potential shifts in the epidemiological profile of HIV cases during the course of the evolving HIV epidemic. From January 1990 through December 2024, over 46 million U.S. service members in the active component, Guard, and reserve were tested for HIV antibodies, and 11,280 (24.3 per 100,000 persons tested) were diagnosed with HIV. Male service members comprised 96.3% of all HIV infections. The total rate of new HIV diagnoses declined over the period of surveillance, with the steepest decline in the first decade. Overall rates stabilized in 1997, but differences persist between different age and population groups. New HIV diagnoses have risen among male service members under age 30 years, with non-Hispanic Black service members bearing the highest burden and Hispanic service members experiencing the largest relative increases. Since 1997, rates in all racial and ethnic groups have more than doubled for those under age 25 years; for Hispanic service members, the increase was nearly 10-fold.