TABLE 4-11 Musculoskeletal Diseases

Study

Design

Population

Outcomes

Results

Adjustments

Comments

Eisen et al., 2005 (Vol. 4)

Population-based, cross-sectional, prevalence, medical evaluation

1061 deployed vs 1128 nondeployed

Persistent and clinically significant bone or joint symptoms with or without joint effusion, and treatment with anti-inflammatory agents, narcotic pain medications, or nonnarcotic pain medications

Prevalence: 6.4% vs 6.8% (OR 1.15, 95% CI 0.70-1.89)

Age, sex, race, years of education, smoking, duty type, service branch, rank

Low participation rates, especially among nondeployed

Gray et al., 1996 (Update)

Retrospective cohort, hospitalizations from August 1991 through September 1993

547,076 active-duty GWVs, 618,335 NDVs

Hospital-discharge diagnoses of musculoskeletal system diseases in DoD hospital system

Exact values not given 1991: OR < 1.0 (95% CI < 1.0); 1992: OR < 1.0 (95% CI < 1.0) 1993, OR about 1.01 (95% CI 0.9-1.15)

Prewar hospitalization, sex, age, race, service branch, marital status, rank, length of service, salary, occupation

Short follow-up period; no outpatient data; restriction to DoD hospitals, and thus to persons remaining on active duty after the war; no adjustment for other potential confounders

Gray et al., 2000 (Update)

Retrospective cohort, hospitalizations from August 1991 through December 1994

652,979 GWVs, 652,922 randomly selected NDVs 182,164 DoD hospitalizations; 16,030 VA hospitalizations; 5185 COSHPD hospitalizations

Hospital-discharge diagnoses of musculoskeletal system diseases in DoD, VA, and COSHPD hospital systems

DoD PMR 1.01 (95% CI 0.99-1.02) VA PMR 0.86 (95% CI 0.81-0.91) COSHPD PMR 0.79 (95% CI 0.64-0.93)

Age, sex, race (only for DoD PMR)

Able to assess only illnesses that resulted in hospitalization; possible undetected confounders PMR has lower sensitivity than a comparison of hospitalization rates would have



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