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Nontraumatic deaths during U.S. Armed Forces basic training, 1977-2001
Stephanie L Scoville1, John W Gardner, Alan J Magill
1U.S. Army Center for Health Promotion and Preventive Medicine, Directorate of Epidemiology and Disease Surveillance, Aberdeen Proving Ground, Maryland, USA. Stephanie.Scoville@na.amedd.army.mil
Insights
Military recruit deaths are lower than civilian rates, but exercise-related deaths, particularly cardiac events and heat stress, are a concern. Focusing on heat stress prevention may reduce these fatalities during training.
Area of Science:
- Military Medicine
- Public Health Surveillance
- Epidemiology
Background:
- Established a Recruit Mortality Registry linked to the Department of Defense Medical Mortality Registry.
- Aimed to provide comprehensive medical surveillance for deaths during enlisted basic military training.
Purpose of the Study:
- To analyze mortality trends and causes of death among military recruits from 1977 to 2001.
- To compare recruit mortality rates with the same-age U.S. civilian population.
Main Methods:
- Identified and confirmed recruit deaths (1977-2001) using redundant sources.
- Collected demographic, circumstantial, and medical data for each case.
- Calculated mortality rates per 100,000 recruit-years using accession data.
Main Results:
- 276 recruit deaths occurred; mortality rates were less than half of U.S. civilian rates.
- 72% of deaths were nontraumatic, with 70% linked to exercise (59% cardiac, 33% heat stress).
- Nontraumatic death rates increased with age and were higher in African American recruits.
Conclusions:
- While overall recruit mortality is low, exercise-related deaths, especially from heat stress, warrant preventive measures.
- 25 years of data allow ongoing evaluation of trends, preventive measure effectiveness, and emerging threats.
Background:
A Recruit Mortality Registry, linked to the Department of Defense Medical Mortality Registry, was created to provide comprehensive medical surveillance data for deaths occurring during enlisted basic military training.
Methods:
Recruit deaths from 1977 through 2001 were identified and confirmed through redundant sources. Complete demographic, circumstantial, and medical information was sought for each case and recorded on an abstraction form. Mortality rates per 100,000 recruit-years were calculated by using recruit accession data from the Defense Manpower Data Center.
Results:
There were 276 recruit deaths from 1977 through 2001 and age-specific recruit mortality rates were less than half of same-age U.S. civilian mortality rates. The majority (72%) of recruit deaths were classified as nontraumatic and 70% of these deaths (139 of 199) were related to exercise. Of the exercise-related deaths, 59 (42%) were cardiac deaths, and heat stress was a primary or contributory cause in at least 46 (33%). Infectious agents accounted for only 49 (25%) of the nontraumatic deaths. Nontraumatic death rates increased with age (rate ratio is 2.5 for 25+ v <25 years; p<0.001). The age- and gender-adjusted nontraumatic death rates were 2.6 times higher for African American than non-African American recruits (p<0.001).
Conclusions:
Although recruit mortality rates are lower than the same-age U.S. civilian population, preventive measures focused on reducing heat stress during exercise might be effective in decreasing the high proportion of exercise-related death. The availability of 25 years of comprehensive recruit mortality data will permit the ongoing evaluation of cause-of-death trends, effectiveness of preventive measures, and identification of emerging threats during basic military training.
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