Bedno Sheryl A, Gardiner Bradley, Li Yuanzhang, Wiesen Andrew R, Firestone Jordan A, Niebuhr David W
Department of Epidemiology, Walter Reed Army Institute of Research, 503 Robert Grant Road, Silver Spring, MD 20910,USA
Mil Med. 2011 May;176(5):519-23. doi: 10.7205/milmed-d-10-00282.
Selective accession waivers for medically disqualifying conditions like spinal curvature are one way the military meets its manpower needs. We evaluated retention patterns during the first 2 years of service of a cohort of military recruits with waivers for pathological curvature of the spine (spinal curvature). Recruits waived for spinal curvature (n = 417), who accessed from 1998 to 2005 were identified and matched with 3 qualified recruits. Kaplan-Meier survival analysis and Cox proportional hazards model were used to compare survival patterns and adjusted attrition hazard estimates. Waived recruits experienced significantly increased risk of "all cause" discharge (relative risk = 1.3; 95% confidence interval: 1.1, 1.5) and "existing prior to service" discharge (relative risk = 2.4; confidence interval: 1.6, 3.5). Despite the increased risk of discharge, current waiver criteria allowed a majority with spinal curvature to complete at least 2 years of service. Policy makers must consider risks and benefits before modifying the current accession standard for spinal curvature.
针对脊柱侧弯等医学上不合格情况的选择性入伍豁免是军队满足其人力需求的一种方式。我们评估了一组因脊柱病理性侧弯（脊柱侧弯）获得豁免的新兵在服役头两年的留队模式。确定了1998年至2005年期间因脊柱侧弯获得豁免的新兵（n = 417），并与3名合格新兵进行匹配。采用Kaplan-Meier生存分析和Cox比例风险模型比较生存模式并调整损耗风险估计值。获得豁免的新兵出现“全因”退伍的风险显著增加（相对风险 = 1.3；95%置信区间：1.1, 1.5）以及“服役前就已存在”退伍的风险显著增加（相对风险 = 2.4；置信区间：1.6, 3.5）。尽管退伍风险增加，但当前的豁免标准仍使大多数脊柱侧弯患者能够完成至少两年的服役期。政策制定者在修改当前脊柱侧弯入伍标准之前必须考虑风险和益处。
