Evaluation of ICD-10-CM-based case definitions of ambulatory encounters for COVID-19 among Department of Defense health care beneficiaries.

SARS-CoV-2 ICD-10-CM-based case definitions are lacking in the literature. This analysis was conducted to evaluate the performance metrics of 3 COVID-19 case definitions among Department of Defense (DoD) beneficiaries. SARS-CoV-2 tested specimens collected from 1 March 2020 to 28 February 2021 were matched to ambulatory medical encounters (68% match). The COVID-19 case definition (ICD-10-CM: U07.1) had high specificity (99%) and positive predictive value (PPV) (94%) but low to moderate (29%-66%) sensitivity. The COVID-specific case definition (10 additional codes added), had moderate to high specificity (82-93%), moderate sensitivity (65-75%), and low to moderate PPV (23%-77%). The COVID-like illness case definition (19 additional codes added to the COVID-specific definition), had moderate specificity (65%-86%), moderate sensitivity (76%-79%), and low to moderate PPV (15%-62%). Regardless of the case definition, all metrics improved over the surveillance period. The COVID-19 case definition is ideal for studies that need to ensure all cases are true positives. However, for broad surveillance efforts, the COVID-specific case definition may be the best to maximize specificity without a large decrease in sensitivity and PPV.

Disparities in COVID-19 Vaccine Initiation and Completion Among Active Component Service Members and Health Care Personnel, 11 December 2020-12 March 2021.

The objective of this study was to assess overall vaccine initiation and completion in the active component U.S. military, with a focus on racial/ethnic disparities. From 11 December 2020 through 12 March 2021, a total of 361,538 service members (27.2%) initiated a COVID-19 mRNA vaccine. Non-Hispanic Blacks were 28% less likely to initiate vaccination (95% confidence interval: 25%-29%) in comparison to non-Hispanic Whites, after adjusting for potential confounders. Increasing age, higher education levels, higher rank, and Asian/Pacific Islander race/ethnicity were also associated with increasing incidence of initiation after adjustment. When the analysis was restricted to active component health care personnel, similar patterns were seen. Overall, 93.8% of those who initiated the vaccine series completed it during the study period, and only minor differences in completion rates were noted among the demographic subgroups. This study suggests additional factors, such as vaccine hesitancy, influence COVID-19 vaccination choices in the U.S. military. Military leadership and vaccine planners should be knowledgeable about and aware of the disparities in vaccine series initiation.

Fibromyalgia: Prevalence and Burden of Disease Among Active Component Service Members, U.S. Armed Forces, 2018.

This report uses routinely collected data in the Defense Medical Surveillance System (DMSS) to characterize the prevalence and burden of fibromyalgia (FM) among members of the active component of the U.S. Armed Forces between 1 Jan 2018 and 31 Dec 2018. During the study period, the prevalence of FM was 0.15%. There was a trend of increasing prevalence with increasing age. Prevalence was highest among women (0.59%), those in the oldest age group (0.52%), non-Hispanic blacks (0.25%), those in the Air Force (0.21%),those in a healthcare occupation (0.36%), senior enlisted (0.24%) and warrant officers (0.24%). The prevalence of FM was approximately twice as high among non-Hispanic blacks compared to non-Hispanic whites. The average number of medical encounters per FM patient per year was 57 (median 38, LQ=21, UQ=66, range=1-263) compared to an average of 13 in the total patient population. The groups of conditions most commonly associated with an FM diagnosis were musculoskeletal and mental health conditions.The burden of FM disease poses clear readiness and retention concerns.

Increased risk for stress fractures and delayed healing with NSAID receipt, U.S. Armed Forces, 2014-2018.

Previous studies have suggested that the use of nonsteroidal antiinflammatory drugs (NSAIDs) is associated with an increased risk of stress fractures due to their inhibitory effect on bone formation. The current study evaluated the relative risk of stress fractures in active duty service members with and without previous receipt of NSAIDs. A total of 7,036 cases of stress fracture and 28,141 matched controls were identified between June 2014 and December 2018 and included in the analysis. A subset of cases were evaluated for delayed healing diagnoses within 90 days following incident case diagnosis using International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes. Prior receipt of NSAIDs was associated with an increased incidence of stress fractures (adjusted incidence rate ratio=1.70; 95% confidence interval [CI]:1.58-1.82; p<.0001). Among stress fracture cases, prior receipt of NSAIDs was associated with increased diagnosis of delayed healing (adjusted odds ratio=1.41; 95% CI: 1.12-1.77; p=.004). These findings may have significant implications for military readiness because NSAIDs are used extensively and stress fractures are already a major contributor to the burden of healthcare encounters and lost duty time.

Carbon monoxide poisoning, active and reserve component service members and non-service member beneficiaries of the Military Health System, U.S. Armed Forces, July 2009-June 2019.

Morbidity and mortality from carbon monoxide (CO) poisoning are important public health problems, but their full impact is difficult to estimate. The current analysis used the 2018 Council of State and Territorial Epidemiologist criteria and International Classification of Diseases (ICD) codebased data to classify CO poisoning cases by intent, source of exposure, and degree of certainty that poisoning was CO related. During July 2009-June 2019, there were 1,288 CO poisoning cases classified as confirmed/probable among active component service members, 366 among reserve component members, and 4,754 among non-service member beneficiaries. Service members working in repair/engineering occupations accounted for the greatest proportion of confirmed CO poisoning cases among active component members and the second greatest proportion among reserve component members. Compared to suspected cases, confirmed/probable cases were more often associated with intentional self-harm and undetermined causes of injury, whereas suspected cases were more often coded as unintentional. Confirmed/probable active component and non-service member beneficiary cases were more likely than their respective suspected case counterparts to receive care in inpatient settings. The need for improvements in ICD coding to reduce the percentage of CO poisoning cases coded with unknown injury intent and/or unknown CO poisoning source is discussed.

Update: Gallbladder disease and cholecystectomies, active component, U.S. Armed Forces, 2014-2018.

The term gallbladder disease refers to a variety of conditions of the gallbladder and the biliary tract. The more common of these conditions are cholelithiasis (gallstones) and cholecystitis (inflammation of the gallbladder), and these conditions often are treated with cholecystectomy (gallbladder removal). During the 2014-2018 surveillance period, 8,008 active component service members were identified as incident cases of gallbladder disease. The crude overall incidence rate of gallbladder disease was 1.2 per 1,000 person-years; the crude annual rate decreased very slightly during the period. A total of 6,470 active component service members underwent incident cholecystectomies. Almost all (97.4%) were performed laparoscopically, and the majority were performed in outpatient settings (65.2%). The number of hospital bed days per open cholecystectomy far exceeded those per laparoscopic cholecystectomy. However, the number of hospital bed days per open cholecystectomy markedly decreased throughout the period. Gallbladder disease and cholecystectomies were more common among service members who were female, American Indian/Alaska Native or Hispanic, older, in the Air Force, and in healthcare occupations. Clinicians should continue to advocate for lifestyle changes, such as maintaining a healthy weight and a diet low in fat and cholesterol, that could prevent gallbladder disease. Similarly, continued Department of Defense-wide initiatives to promote healthy lifestyles could also help prevent gallbladder disease and maintain the health of the force.