Burden and risk factors for Achilles tendinopathy in the military population from 2006 to 2015. A retrospective cohort study

Abstract

Context: Ankle-foot injuries are ubiquitous in the US military, with Achilles tendinopathy (AT) a common condition that affects function and health-related quality of life. Objective: To evaluate the burden and associated factors of AT. Design: Descriptive Epidemiology Study Setting: The Defense Medical Epidemiological Database was utilized to identify relevant healthcare encounters. Patients or Other Participants: All active duty and reserve military members who served between 2006 to 2015 (officers: n= 2 149 887; enlisted: n= 9 503 995). Main Outcome Measures: Multi-year prevalence of AT care episodes were calculated and compared by year, service branch, and military rank. Unadjusted and adjusted assessment of injury burden were calculated. Results: Officers incurred 37,939 episodes at a prevalence of 17.65 per 1000 servicemembers (male officers: 18.20 per 1000 servicemembers; female officers: 14.80 per 1000 servicemembers). Among enlisted personnel, there were 116,122 episodes of AT that occurred in 12.22 per 1000 servicemembers (male enlisted: 12.07 per 1000 servicemembers; female enlisted: 13.22 per 1000 servicemembers). All officer specialties had significantly higher burden of AT episodes compared to the ground and naval gunfire officers (prevalence ratio [PR]: 1.04-1.43), except for aviation that demonstrated a significantly lower burden (PR: 0.65). Among enlisted occupations, maritime/naval specialties had lower burden of AT compared to infantry (PR: 0.82) and all other specialties, except for aviation, had significantly higher burden (PR: 1.07-1.71). There were multiple associated factors identified, to include sex, age, rank, military occupation, and service branch. Conclusion: AT was ubiquitous in the US military, with a progressive increase in prevalence during the study epoch. There were multiple associated factors identified, to include sex, age, rank, military occupation, and service branch. These findings highlight both the need for prophylactic interventions and identification of the populations with the greatest need.