Belding Jennifer N, Bonkowski James, Englert Robyn
Naval Health Research Center, San Diego, CA, United States.
Leidos, Inc., San Diego, CA, United States.
Front Neurol. 2024 Apr 16;15:1389757. doi: 10.3389/fneur.2024.1389757. eCollection 2024.
Although traumatic brain injury (TBI) has been linked with adverse long-term health, less research has examined whether TBI is linked with non-clinical outcomes including involuntary job loss. Symptoms associated with TBI may influence one's ability to maintain gainful employment including employment in the U.S. military. That influence may impact military service members with exposure to repetitive low-level blast (LLB). Understanding the association between TBI and involuntary job loss outcomes among military populations is particularly important as it may be associated with differences in eligibility for post-service benefits. The purpose of the present research was to determine whether (1) TBI and related conditions are associated with involuntary job loss (i.e., medical and administrative separations from service) among military personnel, and (2) occupational risk of LLB is associated with involuntary job loss in both the presence and absence of clinical diagnoses of TBI and related conditions.
This research leveraged population-level data from the Career History Archival Medical and Personnel System for enlisted personnel who served on active duty between 2005-2015. Risk of LLB exposure was categorized using military occupational specialty as a proxy. Medical diagnoses were identified using ICD-9 codes. Separations for medical and administrative reasons were identified.
Risk for administrative separation differed across medical diagnoses of interest, but those who worked in high-risk occupations were more likely to be administratively separated than those working in low-risk occupations. Risk for medical separation was associated with occupational risk of LLB and each of the diagnoses of interest, though significant interactions suggested that the effects of certain diagnoses of interest (e.g., concussion, cognitive problems, postconcussive syndrome, migraines) on medical separations was greater among those working in high-risk occupations.
Taken together, the present research suggests that TBI and associated medical conditions, as well as occupational risk of LLB, are associated with long-term involuntary job loss for medical reasons. This study is the first to demonstrate involuntary military job loss outcomes associated with TBI, mental health conditions, and conditions associated with blast exposure using both inpatient and outpatient population-level data and may have important implications for civilian employment and post-service benefits.
尽管创伤性脑损伤（TBI）与长期不良健康状况有关，但较少有研究探讨TBI是否与包括非自愿失业在内的非临床结果相关。与TBI相关的症状可能会影响一个人维持有收益工作的能力，包括在美国军队中的工作。这种影响可能会对暴露于重复性低强度爆炸（LLB）的军人产生影响。了解军事人群中TBI与非自愿失业结果之间的关联尤为重要，因为这可能与退役后福利资格的差异有关。本研究的目的是确定：（1）TBI及相关病症是否与军事人员的非自愿失业（即因医疗和行政原因退役）相关；（2）在有和没有TBI及相关病症临床诊断的情况下，LLB的职业风险是否与非自愿失业相关。
本研究利用了职业历史档案医疗和人事系统中的人群水平数据，这些数据来自2005年至2015年期间服现役的 enlisted人员。使用军事职业专长作为代理对LLB暴露风险进行分类。使用国际疾病分类第九版（ICD-9）编码识别医疗诊断。识别因医疗和行政原因导致的退役情况。
行政退役风险在感兴趣的医疗诊断中存在差异，但从事高风险职业的人员比从事低风险职业的人员更有可能被行政退役。医疗退役风险与LLB的职业风险以及每个感兴趣的诊断相关，尽管显著的相互作用表明，某些感兴趣的诊断（如脑震荡、认知问题、脑震荡后综合征、偏头痛）对医疗退役的影响在从事高风险职业的人员中更大。
综合来看，本研究表明TBI及相关医疗病症以及LLB的职业风险与因医疗原因导致的长期非自愿失业相关。本研究首次使用住院和门诊人群水平数据证明了与TBI、心理健康状况以及与爆炸暴露相关病症相关的非自愿军事失业结果，这可能对平民就业和退役后福利具有重要意义。
