A Longitudinal Study of Prevalence Ratios for Musculoskeletal Back Injury Among U.S. Navy and Marine Corps Personnel, 2009-2015

Abstract

ABSTRACT Introduction Medical readiness to deploy is an increasingly important issue within the military. Musculoskeletal back pain is one of the most common medical problems that affects service members. This study demonstrates the associations between risk factors and the prevalence of musculoskeletal back pain among active duty sailors and Marines within the Department of the Navy (DoN). Materials and Methods Utilizing the Military Health System Data Repository, we conducted a retrospective cross-sectional review of administrative healthcare claim data for all active duty DoN personnel with at least one medical encounter during fiscal years 2009-2015. For each fiscal year, we identified all claims with an ICD-9 code for back pain and calculated prevalence. We compared those with and without back pain across all variables (age, gender, rank, race, body mass index, tobacco use, occupation, and branch of service) using chi-square analysis. Unadjusted and adjusted log-binomial regressions were used to calculate prevalence ratios and examine associated risk factors for back pain. Results The number of active duty subjects per fiscal year ranged from 424,460 to 437,053. The prevalence of back pain showed an upward trend, ranging from 9.99% in 2009 to 12.09% in 2015. Personnel aged 35 years and older had the strongest adjusted prevalence ration (APR) for back pain (APR 2.59; 95% CI, 2.53-2.66). There were also strong associations with obese body mass index (APR 1.76; 95% CI, 1.66-1.86), overweight body mass index (APR 1.29; 95% CI, 1.27-1.32), and tobacco use (APR 1.39; 95% CI, 1.36-1.42). Females were more likely to have back pain than males (APR 1.43; 95% CI, 1.40-1.47) and Marines more likely than sailors (APR 1.39; 95% CI, 1.36-1.42). The occupation with the highest prevalence ratio was healthcare (APR 1.34; 95% CI, 1.29-1.40) when compared to the reference group of combat specialists. Conclusions There was an increasing prevalence of back pain across the DoN from 2009 to 2015. Different occupational categories demonstrate different prevalence of back pain. Surprisingly, combat occupations and aviators were among the groups with the lowest prevalence. Lifestyle factors such as excess body weight and use of tobacco products are clearly associated with increased prevalence. These results could inform military leaders with regard to setting policies that could increase medical readiness.