美国军队中患有特定肌肉骨骼和皮肤疾病的军人的退役情况：一项回顾性队列研究。
Service discharges among US Army personnel with selected musculoskeletal and skin conditions: a retrospective cohort study.
机构信息
Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA.
Department of Medicine, Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California, USA.
出版信息
BMJ Open. 2022 Oct 14;12(10):e063371. doi: 10.1136/bmjopen-2022-063371.
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.
目的
确定患有强直性脊柱炎（AS）、类风湿关节炎（RA）、银屑病或系统性红斑狼疮（SLE）等疾病的士兵退伍的概率。
方法
本研究采用回顾性队列分析，纳入 2014 年 1 月至 2017 年 6 月期间在美国陆军服役的所有现役士兵。通过人员记录确定退伍情况。使用诊断代码识别上述四种肌肉骨骼和皮肤病以及糖尿病（DM）的新发病例。采用性别分层多变量生存分析来建模退伍时间。
结果
分析共纳入 657417 人，总观察人数为 120 万人年。研究的五种慢性疾病均与退伍风险升高有关。与 AS（男性，HR=2.5，95%CI 2.1 至 3.0；女性，HR=2.1，95%CI 1.4 至 3.2）和 DM（男性，HR=2.4，95%CI 2.2 至 2.7；女性，HR=2.2，95%CI 1.8 至 2.5）相比，退伍风险增加幅度最大，其次是 RA（男性，HR=1.8，95%CI 1.5 至 2.2；女性，HR=1.8，95%CI 1.4 至 2.4）。
结论
退伍对军队和军人来说都有影响。患有 AS 或 RA 的士兵退伍风险增加了一倍，与患有 DM 的士兵相当。影响脊柱和外周关节的疾病通常可能使士兵无法胜任战备工作。尽管如此，仍有相当一部分患有这些疾病的士兵继续服役。
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