Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Department of Psychology, Texas State University, San Marcos, TX 78666, USA.
Mil Med. 2024 Aug 19;189(Suppl 3):21-30. doi: 10.1093/milmed/usae033.
Disease and non-battle injury (DNBI) has historically been the leading casualty type among service members in warfare and a leading health problem confronting military personnel, resulting in significant loss of manpower. Studies show a significant increase in disease burden for DNBI when compared to combat-related injuries. Understanding the causes of and trends in DNBI may help guide efforts to develop preventive measures and help increase medical readiness and resiliency. However, despite its significant disease burden within the military population, DNBI remains less studied than battle injury. In this review, we aimed to evaluate the recently published literature on DNBI and to describe the characteristics of these recently published studies.
This systematic review is reported in the Prospective Register of Systematic Reviews database. The systematic search for published articles was conducted through July 21, 2022, in Cumulative Index of Nursing and Allied Health, Cochrane Library, Defense Technical Information Center, Embase, and PubMed. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses, the investigators independently screened the reference lists on the Covidence website (covidence.org). An article was excluded if it met any of the following criteria: (1) Published not in English; (2) published before 2010; (3) data used before 2001; (4) case reports, commentaries, and editorial letters; (5) systematic reviews or narrative reviews; (6) used animal models; (7) mechanical or biomechanical studies; (8) outcome was combat injury or non-specified; (9) sample was veterans, DoD civilians, contractors, local nationals, foreign military, and others; (10) sample was U.S. Military academy; (11) sample was non-deployed; (12) bioterrorism study; (13) qualitative study. The full-text review of 2 independent investigators reached 96% overall agreement (166 of 173 articles; κ = 0.89). Disagreements were resolved by a third reviewer. Study characteristics and outcomes were extracted from each article. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis of pooled estimates of incidence rates for disease (D), non-battle injury (NBI), and combined DNBI was created using random-effects models.
Of the 3,401 articles, 173 were included for the full review and 29 (16.8%) met all inclusion criteria. Of the 29 studies included, 21 (72.4%) were retrospective designs, 5 (17.2%) were prospective designs, and 3 (10.3%) were surveys. Across all studies, the median number of total cases reported was 1,626 (interquartile range: 619.5-10,203). The results of meta-analyses for 8 studies with reported incidence rates (per 1,000 person-years) for D (n = 3), NBI (n = 7), and DNBI (n = 5) showed pooled incidence rates of 22.18 per 1,000 person-years for D, 19.86 per 1,000 person-years for NBI, and 50.97 per 1,000 person-years for combined DNBI. Among 3 studies with incidence rates for D, NBI, and battle injury, the incidence rates were 20.32 per 1,000 person-years for D, 6.88 per 1,000 person-years for NBI, and 6.83 per 1,000 person-years for battle injury.
DNBI remains the leading cause of morbidity in conflicts involving the U.S. Military over the last 20 years. More research with stronger designs and consistent measurement is needed to improve medical readiness and maintain force lethality.
Systematic Review and Meta-Analysis, Level III.
在战争中，疾病和非战斗性损伤（DNBI）一直是现役军人的主要伤亡类型，也是军事人员面临的主要健康问题，导致大量人力损失。研究表明，与战斗相关的伤害相比，DNBI 的疾病负担显著增加。了解 DNBI 的病因和趋势可能有助于指导制定预防措施，并有助于提高医疗准备和恢复能力。然而，尽管其在军队人群中的疾病负担很大，但与战斗伤害相比，DNBI 的研究仍然较少。在本综述中，我们旨在评估最近发表的关于 DNBI 的文献，并描述这些最近发表的研究的特征。
本系统评价在系统评价注册库中进行。通过 2022 年 7 月 21 日在 Cumulative Index of Nursing and Allied Health、Cochrane Library、Defense Technical Information Center、Embase 和 PubMed 中的检索，对已发表文章进行了系统搜索。在 Covidence 网站（covidence.org）上的参考文献列表中，由两位独立的研究人员进行筛选，指导我们的是系统评价和荟萃分析的首选报告项目。如果符合以下任何标准，则排除一篇文章：（1）未以英文发表；（2）发表时间早于 2010 年；（3）数据使用时间早于 2001 年；（4）病例报告、评论和社论；（5）系统评价或叙述性评论；（6）使用动物模型；（7）机械或生物力学研究；（8）结果是战斗伤害或未指定；（9）样本是退伍军人、国防部平民、承包商、当地国民、外国军队等；（10）样本是美国军事学院；（11）样本是非部署的；（12）生物恐怖主义研究；（13）定性研究。2 位独立研究人员对 2 篇全文的审查总体一致率达到 96%（173 篇文章中的 166 篇；κ=0.89）。分歧由第三位审稿人解决。从每篇文章中提取研究特征和结果。使用纽卡斯尔-渥太华量表评估偏倚风险。使用随机效应模型对疾病（D）、非战斗性损伤（NBI）和合并的 DNBI 的发病率进行汇总估计的 meta 分析。
在 3401 篇文章中，有 173 篇被纳入全文审查，其中 29 篇（16.8%）符合所有纳入标准。在 29 项研究中，21 项（72.4%）为回顾性设计，5 项（17.2%）为前瞻性设计，3 项（10.3%）为调查。在所有研究中，报告的总病例数中位数为 1626 例（四分位距：619.5-10203）。对 8 项报告发病率（每 1000 人年）的研究进行 meta 分析，发病率分别为每 1000 人年 22.18 例（D）、19.86 例（NBI）和 50.97 例（DNBI）。在 3 项报告 D、NBI 和战斗伤害发病率的研究中，发病率分别为每 1000 人年 20.32 例（D）、每 1000 人年 6.88 例（NBI）和每 1000 人年 6.83 例（战斗伤害）。
在过去 20 年的美国军事冲突中，DNBI 仍然是主要的发病原因。需要更多具有更强设计和一致测量的研究来提高医疗准备和保持部队杀伤力。
系统评价和荟萃分析，三级。
