Association of Musculoskeletal Injury, Subsequent Mild Traumatic Brain Injury, and Sex Differences Among U.S. Service...

Area of Science:

• Military medicine
• Traumatology
• Epidemiology

Background:

• Mild traumatic brain injury (mTBI) and musculoskeletal injuries (MSKI) are prevalent among U.S. service members.
• Women exhibit higher incidence rates for both mTBI and MSKI.
• The impact of MSKI on subsequent mTBI risk, particularly sex-based differences, remains under-investigated.

Purpose of the Study:

• To determine if a history of MSKI is associated with an increased risk of subsequent mTBI.
• To investigate whether this association differs between male and female U.S. service members.

Main Methods:

• A retrospective cohort study of 776,822 U.S. service members enlisted between 2016 and 2020.
• Follow-up data collected through 2023.
• Multivariable logistic regression and sex-stratified analyses were employed to assess the association between MSKI and subsequent mTBI, accounting for potential confounders and interaction effects.

Main Results:

• Overall, 19% of the cohort were female, and mTBI occurred in 2.46% of participants.
• MSKI was significantly associated with a higher odds of subsequent mTBI (OR=1.06).
• While males had higher odds of mTBI following MSKI compared to females (OR=1.06 vs. OR=1.01), a significant interaction term (p<0.01) indicated a sex-based difference in the association.

Conclusions:

• A history of MSKI is linked to an increased risk of developing mTBI in U.S. service members.
• The association between MSKI and subsequent mTBI is more pronounced in males than females.
• Findings underscore the need for sex-specific considerations in mTBI and MSKI prevention and management strategies within the military population.