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ABSTRACT: Objectives
To determine the probability of discharge from military service among soldiers following an incident diagnosis of ankylosing spondylitis (AS), rheumatoid arthritis (RA), psoriasis or systemic lupus erythematous.Methods
All soldiers on active duty in the US Army between January 2014 and June 2017 were included in a retrospective cohort analysis. Termination from service was ascertained using personnel records. Diagnostic codes were used to identify incident cases of the four musculoskeletal and skin diseases and, for comparison, diabetes mellitus (DM). Time to discharge was modelled using sex stratified multivariate survival analysis.Results
The analysis included 657 417 individuals with a total of 1.2 million person-years of observation. An elevated risk of discharge was observed in association with each of the five chronic conditions studied. The increase in adjusted risk of discharge was highest among soldiers with AS (men, HR=2.5, 95% CI 2.1 to 3.0; women, HR=2.1, 95% CI 1.4 to 3.2) and with DM (men, HR=2.4, 95% CI 2.2 to 2.7; women, HR=2.2, 95% CI 1.8 to 2.5), followed by those with RA (men, HR=1.8, 95% CI 1.5 to 2.2; women, HR=1.8, 95% CI 1.4 to 2.4).Conclusions
Military discharges are consequential for the service and the service member. The doubling in risk of discharge for those with AS or RA was comparable to that for personnel with DM. Conditions that affect the spine and peripheral joints may often be incompatible with military readiness. Nevertheless, a substantial fraction of service members with these diagnoses continued in service.
SUBMITTER: Nelson DA
PROVIDER: S-EPMC9577895 | biostudies-literature | 2022 Oct
REPOSITORIES: biostudies-literature

Nelson D Alan DA Kaplan Robert M RM Weisman Michael H MH Kurina Lianne M LM
BMJ open 20221014 10
<h4>Objectives</h4>To determine the probability of discharge from military service among soldiers following an incident diagnosis of ankylosing spondylitis (AS), rheumatoid arthritis (RA), psoriasis or systemic lupus erythematous.<h4>Methods</h4>All soldiers on active duty in the US Army between January 2014 and June 2017 were included in a retrospective cohort analysis. Termination from service was ascertained using personnel records. Diagnostic codes were used to identify incident cases of the ...[more]