We describe the natural history of 13 musculoskeletal conditions requiring hospitalization and identify demographic, behavioral, psychosocial, occupational, and clinical characteristics most strongly associated with disability discharge from the Army. Subjects included 15,268 active-duty personnel hospitalized for a common musculoskeletal condition between the years 1989-1996 who were retrospectively followed through 1997. Back conditions had the greatest 5-year cumulative risk of disability (21%, 19%, and 17% for intervertebral disc displacement, intervertebral disc degeneration, and nonspecific low back pain, respectively). Cox proportional hazards models identified the following risk factors for disability among males: lower pay grade, musculoskeletal diagnosis, shorter length of service, older age, occupational category, lower job satisfaction, recurrent musculoskeletal hospitalizations, more cigarette smoking, greater work stress, and heavier physical demands. Among females, fewer covariates reached statistical significance, although lower education level was significant in more than one model. Modifiable risk factors related to work (job satisfaction, work stress, physical demands, occupation) and health behaviors (smoking) suggest possible targets for intervention.
Musculoskeletal system disorders; Military personnel; Disabled workers; Risk analysis; Risk factors; Medical treatment; Back injuries; Men; Sociological factors; Cigarette smoking; Smoking; Employee health; Demographic characteristics; Job stress; Women; Education; Physical capacity; Behavior; Psychological factors; Injuries; Epidemology;
Author Keywords: Musculoskeletal conditions; natural history; disability; epidemiology; occupation; military personnel; injury
Andrew E. Lincoln, ScD, The Johns Hopkins Center for Injury Research and Policy, 624 N. Broadway, #512, Baltimore, MD 21205, USA