COVID-19 Cases, Hospitalizations, and Deaths Among American Indian or Alaska Native Persons - Alaska, 2020-2021.

American Indian or Alaska Native (AI/AN) persons across the United States face substantial health disparities, including a disproportionately higher incidence of COVID-19 (1,2). AI/AN persons living in Alaska also face serious health and health care challenges, including access to care because 90% of the state's land area is inaccessible by road (3), and approximately one half of the state's AI/AN population (AI/AN race alone or in combination with another race) live in remote rural areas (4). To examine the extent of COVID-19-associated disparities among AI/AN persons living in Alaska, a retrospective analysis of COVID-19 cases reported to the Alaska Department of Health and Social Services (AKDHSS) during March 12, 2020-December 31, 2021, was conducted. The age-adjusted COVID-19 incidence among AI/AN persons was 26,583 per 100,000 standard population, approximately twice the rate among White persons living in Alaska (11,935). The age-adjusted COVID-19-associated hospitalization rate among AI/AN persons was 742 per 100,000, nearly three times the rate among White persons (273) (rate ratio [RR] = 2.72). The age-adjusted COVID-19-related mortality rate among AI/AN persons was 297 per 100,000, approximately three times that among White persons (104; RR = 2.86). Culturally competent public health efforts that are designed in collaboration with AI/AN persons and communities, including support for vaccination and other proven COVID-19 prevention strategies, are critical to reducing COVID-19-associated disparities among AI/AN persons in Alaska.

The Alaska Native Tumour Registry: fifty years of cancer surveillance data for Alaska Native people.

Like other Indigenous Circumpolar populations, Alaska Native (AN) people experience different patterns of cancer than their non-Indigenous counterparts. Every 5 years, the Alaska Native Tumour Registry releases a comprehensive report on cancer among AN people; this study provides 50 years of cancer surveillance data. Five-year annual-average age-adjusted incidence rates were calculated for time-periods ranging 1969-2018. AN data were compared with data for US whites (SEER 9). Mortality rates were calculated for 1994-2018 using data from the National Center for Health Statistics. During 2014-2018, there were 2,401 cases of invasive cancer among AN people. Among these, the most commonly diagnosed cancers were colorectal (405 cases, 17% of all cancers), lung and bronchus (373 cases, 16% of all cancers), and female breast (340 cases, 14% of all cancers). Lung cancer was the leading cause of cancer death, followed by colorectal and female breast cancers. These leading cancers are screenable, and preventable through lifestyle modifications including tobacco cessation, healthy eating and engaging in physical activity. These data provide important information to support cancer prevention and control among AN people. Cancer surveillance has been a valuable tool throughout the Circumpolar North to support reducing the burden of cancer among Indigenous populations.Abbreviations: ANAI: Alaska Native/American Indian; AN: Alaska Native; USW: U.S. White(s); ANMC: Alaska Native Medical Center; ANTR: Alaska Native Tumour Registry; IR: Incidence Rate; CI: Confidence Interval; RR: Rate Ratio; ICD-O-3: International Classification of Diseases for Oncology - Third Edition; SEER: Surveillance, Epidemiology and End Results.

Characteristics of colorectal cancers among Alaska Native people before and after implementing programs to promote screening.

BACKGROUND: Alaska Native (AN) people have the highest rates of colorectal cancer (CRC) globally. Increasing CRC screening has been effective in reducing CRC-related morbidity and mortality in other populations. OBJECTIVE: To examine recent descriptive epidemiology and longer-term CRC trends among AN people. To determine any changes in the descriptive epidemiology of CRC among AN people concurrent with increases in screening prevalence. METHODS: We estimated age-specific CRC incidence and mortality rates 2000-2017. To examine longer-term trends in incidence and mortality 1990-2017, we conducted Joinpoint regression analyses of three-year rolling average incidence and mortality rates. We calculated descriptive statistics for two time-periods: 2000-2008, and 2009-2017. Finally, we examined five-year survival probability. RESULTS: CRC incidence increased over time (1990-2017) among AN people aged less than 50 years, while there were modest declines in AN people older than 50 years old since 2000. Overall, AN CRC mortality rates declined between 1990 and 2004, but have been increasing steadily since that time. Comparing 2000-2008 with 2009-2017 we observed no difference in CRC incidence and mortality, age at diagnosis, tumor size, tumor location, or stage distribution. Survival analyses indicated no change in hazard of death between 2004-2008 and 2009-2017 (HR 1.02, 95 % CI: 0.74, 1.38, P = 0.93). CONCLUSIONS: Colorectal cancer prevention and control efforts across the Alaska Tribal Health System have not yet resulted in reduced mortality rates, or induced earlier stage migration. POLICY SUMMARY STATEMENT: Intensified efforts will be necessary to reduce the burden of CRC among this high-risk population. Continued and increased focus on primary and secondary prevention efforts is warranted.

Medevac Utilization and Patient Characteristics in Rural Alaska 2010 to 2018.

OBJECTIVE: Little is known about medevac utilization in remote, rural Alaska where there is no road access and communities are reliant on medevacs for emergency care. With high financial costs and risks to flight crews, there is an urgent need to understand medevac utilization in rural Alaska. This article aimed to describe medevac utilization and patient characteristics over 9 years in the remote, air transport dependent in Alaska. METHODS: Deidentified data (2010-2018) were obtained for all medevacs originating within the Yukon-Kuskokwim Delta. Descriptive statistics were calculated, and chi-square tests of independence were conducted to identify differences. RESULTS: Four thousand nine hundred ninety-one medevacs were performed, averaging 555 (standard deviation = 67.7) per year. Medevacs for respiratory complaints were predominant for children, whereas trauma predominated for adults 18 to 40 years old. Traumatic injury was more common in males than females aged < 65 years but was more common in females than males aged ≥ 65 years. Significant variability occurred in medevacs based on the community and the hour of the day. CONCLUSION: Medevacs are a critical part of health care in rural, remote Alaska but appear subject to clinical and nonclinical determinants. These baseline data provide a foundation for future studies aiming to increase medevac safety and provide decision-making support.

Norovirus outbreak at a wildland fire base camp ignites investigation of restaurant inspection policies.

Norovirus outbreaks occur worldwide and have been associated with congregate settings (e.g., military and recreational camps). Investigation of a norovirus outbreak at a wildland fire base camp identified 49 (27%) illnesses among approximately 180 responders. Epidemiologic evidence implicated a restaurant as the infection source. Eight (89%) of nine wildland fire responder groups who ate at the restaurant had ill members; no groups who ate elsewhere reported ill members. An environmental health specialist restaurant inspection identified lack of managerial knowledge to protect against foodborne disease one year after the restaurant's opening; earlier inspection after opening might have led to earlier intervention. States were surveyed to determine existence of any policy or rule for food establishment inspection after opening and inspection timing. Among 18 states, five had no state rule or policy; nine had a policy in place; and four required postopening inspection by rule. Further research is needed to evaluate post-opening inspection efficacy and timing.

Anterior cruciate ligament tunnel placement.

The purpose of this cadaveric study was to analyze variation in anterior cruciate ligament (ACL) tunnel placement between surgeons and the influence of preferred surgical technique and surgeon experience level using three-dimensional (3D) computed tomography (CT). In this study, 12 surgeons drilled ACL tunnels on six cadaveric knees each. Surgeons were divided by experience level and preferred surgical technique (two-incision [TI], medial portal [MP], and transtibial [TT]). ACL tunnel aperture locations were analyzed using 3D CT scans and compared with radiographic ACL footprint criteria. The femoral tunnel location from front to back within the notch demonstrated a range of means of 16% with the TI tunnels the furthest back. A range of means of only 5% was found for femoral tunnel low to high positions by technique. The anterior to posterior tibial tunnel measure demonstrated wider variation than the medial to lateral position. The mean tibial tunnel location drilled by TT surgeons was more posterior than surgeons using the other techniques. Overall, 82% of femoral tunnels and 78% of tibial tunnels met all radiographic measurement criteria. Slight (1-7%) differences in mean tunnel placement on the femur and tibia were found between experienced and new surgeons. The location of the femoral tunnel aperture in the front to back plane relative to the notch roof and the anterior to posterior position on the tibia were the most variable measures. Surgeon experience level did not appear to significantly affect tunnel location. This study provides background information that may be beneficial when evaluating multisurgeon and multicenter collaborative ACL studies.

How orthopaedic residents perceive educational resources.

INTRODUCTION: The educational paradigm for orthopaedic surgeons is shifting from a strictly Operating Room based approach to the addition of simulator- and lab-based models. This study aims to assess resident views on the relative value of orthopaedic educational resources and the value of a cadaver-based arthroscopy skills laboratory. METHOD: A questionnaire assessing beliefs about various orthopaedic educational resources for overall orthopaedic education and surgical skills education was given to all residents in one orthopaedic residency program with a new arthroscopic skills laboratory during a three year period. Forty-one orthopaedic residents from years PGY1 through PGY5 participated. RESULTS: Observation and participation in the OR was the highest ranked learning activity for both overall and surgical skills education. Sessions in the skills lab ranked second for surgical skills education and fourth for overall orthopaedic education. The arthroscopic skills lab was most highly valued for practicing 3-D use of instruments and developing familiarity with equipment. CONCLUSIONS: Orthopaedic trainees highly value operating room experience as the primary resource for education during residency. Orthopaedic trainees have found the addition of a surgical skills training lab for teaching arthroscopic skills a significant benefit to both their overall education and to surgical skills training.

Risk of injury by job assignment among federal wildland firefighters, United States, 2003-2007.

BACKGROUND: Wildland fires cost billions of dollars annually and expose thousands of firefighters to a variety of occupational hazards. Little is known about injury patterns among wildland firefighters. METHODS: We examined non-fatal firefighter injuries among federal wildland firefighters reported to the US Department of the Interior for the years 2003-2007. The risk of disabling injury by job assignment, controlling for demographic and temporal variables, was assessed with logistic regression. RESULTS: Of the 1301 non-fatal injuries, slips, trips, and falls were the most frequent injury types and sprains/strains were the most common injury. Engine crew workers suffered a third of all injuries. Handcrews and helitak/smokejumper assignments had increased odds of sprains and strains, which were the most common injury overall. CONCLUSIONS: While some injuries are equally prevalent by job assignment, others vary. Identifying hazards leading to these injuries will be essential to develop prevention strategies.

Epidemiology of injuries to wildland firefighters.

INTRODUCTION: Wildland fires have significant ecologic and economic impact in the United States. Despite the number of firefighters involved in controlling them, little is known about the injuries that they sustain. We hypothesized that the mechanism of injury would predict injury characteristics and severity of fire-related injuries. METHODS: We examined firefighter injuries reported to the US Department of the Interior from the years 2003 to 2007. Associations between the injury mechanism and the injury diagnosis and body part were assessed. A logistic regression model was used to evaluate the odds of disabling injury associated with mechanism of injury after controlling for demographic and temporal variables. RESULTS: A total of 1301 nonfatal injuries to wildland firefighters were reported during the 5-year period. Mechanism of injury was significantly associated with the type of injury and injured body part (P ≤ .001). The most common injury mechanism was slips/trips/falls followed by equipment/tools/machinery. Injuries from poisoning or environmental exposure were less likely to lead to severe injury than slips, trips, or falls (odds ratio, 0.45; 95% confidence interval, 0.21-0.95). Compared with injuries in the early and peak season, those in the late season had more than twice the odds of being severe (odds ratio, 2.24; 95% confidence interval, 1.23-4.10). DISCUSSION: This study contributes important knowledge for implementing evidence-based injury prevention programs, for planning emergency medical responses on fire incidents and for provoking further inquiry into occupational risk factors affecting this high-risk occupational group.

Fire characteristics associated with firefighter injury on large federal wildland fires.

PURPOSE: Wildland fires present many injury hazards to firefighters. We estimate injury rates and identify fire-related factors associated with injury. METHODS: Data from the National Interagency Fire Center from 2003 to 2007 provided the number of injuries in which the firefighter could not return to his or her job assignment, person-days worked, and fire characteristics (year, region, season, cause, fuel type, resistance to control, and structures destroyed). We assessed fire-level risk factors of having at least one reported injury using logistic regression. Negative binomial regression was used to examine incidence rate ratios associated with fire-level risk factors. RESULTS: Of 867 fires, 9.5% required the most complex management and 24.7% required the next-highest level of management. Fires most often occurred in the western United States (82.8%), during the summer (69.6%), caused by lightening (54.9%). Timber was the most frequent fuel source (40.2%). Peak incident management level, person-days of exposure, and the fire's resistance to control were significantly related to the odds of a fire having at least one reported injury. However, the most complex fires had a lower injury incidence rate than less complex fires. CONCLUSIONS: Although fire complexity and the number of firefighters were associated with the risk for at least one reported injury, the more experienced and specialized firefighting teams had lower injury incidence.

Arthroscopic agreement among surgeons on anterior cruciate ligament tunnel placement.

BACKGROUND: Little is known about surgeon agreement and accuracy using arthroscopic evaluation of anterior cruciate ligament (ACL) tunnel positioning. PURPOSE: To investigate agreement on ACL tunnel position evaluated arthroscopically between operating surgeons and reviewing surgeons. We hypothesized that operating and evaluating surgeons would characterize tunnel positions significantly differently. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve surgeons drilled ACL tunnels on 72 cadaveric knees using transtibial (TT), medial portal (MP), or 2-incision (TI) techniques and then completed a detailed assessment form on tunnel positioning. Then, 3 independent blinded surgeon reviewers each arthroscopically evaluated tunnel position and completed the assessment form. Statistical comparisons of tunnel position evaluation between operating and reviewing surgeons were completed. Three-dimensional (3D) computed tomography (CT) scans were performed and compared with arthroscopic assessments. Arthroscopic assessments were compared with CT tunnel location criteria. RESULTS: Operating surgeons were significantly more likely to evaluate femoral tunnel position (92.6% vs 69.2%; P = .0054) and femoral back wall thickness as "ideal" compared with reviewing surgeons. Tunnels were judged ideal by reviewing surgeons more often when the TI technique was used compared with the MP and TT techniques. Operating surgeons were more likely to evaluate tibial tunnel position as ideal (95.5% vs 57.1%; P < .0001) and "acceptable" compared with reviewers. The ACL tunnels drilled using the TT technique were least likely to be judged as ideal on the tibia and the femur. Agreement among surgeons and observers was poor for all parameters (κ = -0.0053 to 0.2457). By 3D CT criteria, 88% of femoral tunnels and 78% of tibial tunnels were placed within applied criteria. CONCLUSION: Operating surgeons are more likely to judge their tunnels favorably than observers. However, independent surgeon reviewers appear to be more critical than results of 3D CT imaging measures. When subjectively evaluated arthroscopically, the TT technique yields more subjectively poorly positioned tunnels than the TI and MP techniques. Surgeons do not agree on the ideal placement for single-bundle ACL tunnels. CLINICAL RELEVANCE: This study demonstrates that surgeons do not currently uniformly agree on ideal single-bundle tunnel placement and that the TT technique may yield more poorly placed tunnels.

Radiographic sizing for meniscal transplantation using 3-D CT reconstruction.

In meniscus transplantation, allograft size mismatch causes increased contact pressures and early degeneration of the knee. The purpose of this study is to compare the accuracy and reliability of sizing the tibial plateau using three-dimensional (3-D) computed tomography (CT) scans versus plain radiographs (XR). Anteroposterior (AP) and lateral XR as well as CT with 3-D reconstructions were performed on 16 cadaveric knees. Sagittal and coronal dimensions of the hemiplateaus were measured on each imaging modality and then on the disarticulated specimens. CT estimates of plateau size were closer to anatomic measurements compared with radiographic estimates in all dimensions and these differences were statistically significant (p < 0.0001). CT scan fell within 5 mm of anatomic measurements 100% of the time versus 76.5% for XR and within 2 mm 71.9% of the time versus 34.4%. The proportion of CT measurements within 2 mm of actual values was significantly higher for CT for the lateral meniscus on AP (p = 0.0011) and lateral (p = 0.0039) views. 3-D CT has less error in measurement of the tibial plateau than XR and estimates were more likely to be within 2 and 5 mm of actual size. This may decrease the likelihood of allograft size mismatch.

Reliability of tunnel measurements and the quadrant method using fluoroscopic radiographs after anterior cruciate ligament reconstruction.

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction tunnel placement is often evaluated by radiographs. This study examines the interobserver reliability of various radiographic measurements of ACL tunnels. HYPOTHESIS: When ideal radiographic views are obtained, the interobserver reliability of the measurements among experienced surgeons would be good to excellent. STUDY DESIGN: Descriptive laboratory study. METHODS: Tunnels for single-bundle ACL reconstruction were drilled and filled with metal interference screws or a tibial reamer on 73 cadaveric knees. Ideal fluoroscopic radiographs were obtained. Three independent reviewers performed 18 measurements including a modification of the grid method. For the grid method analysis, reviewers fit a 16 × 12 grid to the lateral knee radiograph, and the center of the femoral tunnel was marked. Interobserver reliability of the measurements was performed using intraclass correlation coefficients (ICCs). A precision grouping analysis was performed for the grid measurements to calculate the mean radius and standard deviation grouping distances. RESULTS: The ICCs were excellent (>.75) for the tibial tunnel angles and tunnel measurements, the clock face measurement, and the Aglietti et al and Jonsson et al measurements. The ICCs were good (.4-.75) for an estimation of graft impingement, Harner et al measurements, and notch height. The mean radius for grid measurements was 0.6 ± 0.4 units (range, 0-2.36 units), with each unit being 1 box in the 16 × 12 grid. When a circle was constructed with a 1.3-unit radius, 95% of the 3 surgeons' measurements would be included in the area of that circle. CONCLUSION: Reliability of ACL tunnel measurements was good to excellent under ideal circumstances for the majority of measurements. The modified grid method demonstrated very acceptable reliability. CLINICAL RELEVANCE: Measurements with good to excellent reliability can be used to evaluate ACL tunnel placement when ideal radiographic views are obtained.

Surgically oriented measurements for three-dimensional characterization of tunnel placement in anterior cruciate ligament reconstruction.

OBJECTIVE: To develop and evaluate the feasibility and reliability of an alternative three-dimensional (3D) measurement system capable of characterizing tunnel position and orientation in ACL reconstructed knees. METHODS: We developed a surgically oriented 3D measurement system for characterizing femoral and tibial drill tunnels from ACL reconstructions. This is accomplished by simulating the positioning of the drill bit originally used to create the tunnels within the bone, which allows for angular and spatial descriptions along defined axes that are established with respect to previously described anatomic landmarks and radiographic views. Computer-generated digital phantoms composed of simplified geometries were used to verify proper calculation of angular and spatial measurements. We also evaluated the inter-observer reliability of the measurements using 10 surfaces generated from cadaveric knees in which ACL tunnels were drilled. The reliability of the measurements was evaluated by intraclass correlation coefficients. RESULTS: The digital phantom evaluation verified the measurement methods by computing angular and spatial values that matched the known values in all cases. The intraclass correlation coefficient was calculated for four users and was found to range from 0.95 to 0.99 for the femoral and tibial measurements, demonstrating near-perfect agreement. CONCLUSIONS: The characterization of ACL tunnels has historically concentrated on two-dimensional (2D) measurements; however, it can be difficult to define ACL tunnel placement using 2D methods. We have presented novel techniques for defining graft tunnel placement from 3D surface representations of the ACL reconstructed knee. These measurements provide exact tunnel location spatially and along axes that offer the potential to comparatively analyze ACL reconstructions post-operatively using advanced imaging. These methods are reliable, and have been demonstrated to be applicable to multiple single-bundle techniques for ACL reconstruction.

Reliability of early postoperative radiographic assessment of tunnel placement after anterior cruciate ligament reconstruction.

PURPOSE: To evaluate the interobserver and intraobserver reliability of radiographic assessment of tunnel placement in anterior cruciate ligament reconstruction. METHODS: Seven sports fellowship-trained orthopaedic surgeons in the Multicenter Orthopaedic Outcomes Network (MOON) group participated in the study. We prospectively enrolled 54 consecutive patients after primary anterior cruciate ligament reconstruction. Postoperative plain radiographs were obtained including a full-extension anteroposterior view of the knee, a lateral view of the knee in full extension, and a notch view at 45° of flexion (Rosenberg view). Three blinded reviewers performed 8 different radiographic measurements including those of Harner and Aglietti/Jonsson. Intraclass correlation coefficients were used to determine reliability of the measurements. Intrarater reliability was assessed by repeated measurements of a subset of 20 patient images from 1 institution, and inter-rater reliability was assessed by use of all 54 sets of films from a total of 4 institutions. RESULTS: Intraobserver reliability for femoral measures ranged from none to substantial, with notch height having the worst results. Intraobserver reliability was moderate to almost perfect for tibial measures. Interobserver reliability ranged from slight to moderate for femoral measures. The Harner method for determining tunnel depth was more reliable than the Aglietti/Jonsson method. Interobserver reliability for tibial measures ranged from fair to substantial. The presence of metal interference screws did not improve reliability of measurements. CONCLUSIONS: Postoperative radiographs are easily obtained, but our results show that radiographic measurements are of quite variable reliability, with most of the results falling into the fair to moderate categories.

Agreement in the classification and treatment of the superior labrum.

BACKGROUND: The Snyder classification scheme is the most commonly used system for classifying superior labral injuries. Although this scheme is intended to be used for arthroscopic visual classification only, it is thought that other nonarthroscopic historical variables also influence the classification. PURPOSE: This study was conducted to evaluate the intrasurgeon and intersurgeon agreement in classifying variable presentations of the superior labrum and to evaluate the influence of clinical variables on the classification and treatment choices of surgeons. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: A group of arthroscopic shoulder surgeons were asked to rank in order of importance clinical variables considered in diagnosing and treating the superior labrum. The surgeons then watched 50 arthroscopic videos of the superior labrum, ranging from normal to pathologic, on 3 different occasions. The first and third viewings were accompanied by no clinical information. The second viewing was accompanied by a detailed clinical vignette for each video. The surgeons selected a classification and treatment for each video. RESULTS: A patient's job/sport, age, and physical examination findings were considered the most important clinical variables surgeons consider during management of the superior labrum. Comparing the 2 viewings without clinical information, surgeons selected a different classification 28.5% of the time from the first to the second time. A different classification was chosen 71.5% of the time when the surgeon was supplied a clinical vignette at the subsequent viewing. Similarly, the treatment selected changed in 36% and 69.1% of cases when viewed again without vignettes and with vignettes, respectively. Intersurgeon agreement was moderate without clinical vignettes and fair with vignettes. Historical, physical examination, and surgical observations were found to influence the odds of change of classification. CONCLUSION: There is significant intrasurgeon and intersurgeon variability in classification and treatment of the superior labrum. Clinical historical, examination, and surgical findings influence classification and treatment choices.

Teenage driver crash incidence and factors influencing crash injury by rurality.

BACKGROUND: Previous research has identified teenage drivers as having an increased risk for motor-vehicle crash injury compared with older drivers, and rural roads as having increased crash severity compared with urban roads. Few studies have examined incidence and characteristics of teen driver-involved crashes on rural and urban roads. METHODS: All crashes involving a driver aged 10 through 18 were identified from the Iowa Department of Transportation crash data from 2002 through 2008. Rates of overall crashes and fatal or severe injury crashes were calculated for urban, suburban, rural, and remote rural areas. The distribution of driver and crash characteristics were compared between rural and urban crashes. Logistic regression was used to identify driver and crash characteristics associated with increased odds of fatal or severe injury among urban and rural crashes. RESULTS: For younger teen drivers (age 10 through 15), overall crash rates were higher for more rural areas, although for older teen drivers (age 16 through 18) the overall crash rates were lower for rural areas. Rural teen crashes were nearly five times more likely to lead to a fatal or severe injury crash than urban teen crashes. Rural crashes were more likely to involve single vehicles, be late at night, involve a failure to yield the right-of-way and crossing the center divider. CONCLUSIONS: Intervention programs to increase safe teen driving in rural areas need to address specific risk factors associated with rural roadways. IMPACT ON INDUSTRY: Teen crashes cause lost work time for teen workers as well as their parents. Industries such as safety, health care, and insurance have a vested interest in enhanced vehicle safety, and these efforts should address risks and injury differentials in urban and rural roadways.

Injury patterns in Division I collegiate swimming.

BACKGROUND: In the last 25 years, it is estimated that over 42,000 male and female swimmers have competed at the National Collegiate Athletic Association (NCAA) Division I-A level. Despite the magnitude of these numbers, little is known about the epidemiology of collegiate swimming injuries. Purpose To describe the pattern of injuries incurred for one NCAA Division I collegiate men's and women's swimming team over 5 seasons. STUDY DESIGN: Descriptive epidemiology study. METHODS: Musculoskeletal and head injuries reported in the Sports Injury Management System for a Division I swimming team from 2002-2007 were identified. Gender, body part, year of eligibility, position, stroke specialty, scholarship status, and team activity during which the injury occurred and lost time were recorded. Risk of injury was assessed relative to gender, stroke specialty, and year of eligibility. RESULTS: From 2002-2007, 44 male and 50 female athletes competed for the University of Iowa swimming and diving team. The overall injury rates were estimated as 4.00 injuries per 1000 exposures for men and 3.78 injuries per 1000 exposures for women. Thirty-seven percent of injuries resulted in missed time. The shoulder/upper arm was the most frequently injured body part followed by the neck/back. Freshman swimmers suffered the most injuries as well as the highest mean number of injuries per swimmer. A significant pattern of fewer injuries in later years of eligibility was also demonstrated. The relative risk (RR) for injury was higher among nonfreestyle stroke specialties (RR, 1.33 [1.00-1.77]). Injury most often occurred as a result of, or during, practice for all swimmers. However, 38% of injuries were the result of team activities outside of practice or competition, such as strength training. No significant relationship was found between occurrence of injury and gender or scholarship status. There was no significant relationship between body part injured and stroke specialty. An increased number of total injuries and an increased risk of injuries in freshman collegiate swimmers were found. CONCLUSION: Particular attention should be given to swimmers making the transition into collegiate level swimming. These data also suggest that injury surveillance and potential prevention strategies should focus on the shoulder for in-pool activities and the axial spine for cross-training activities.