Affiliations: Center for Injury Research and Policy, Department of
Health Policy and Management, The Johns Hopkins University Bloomberg School of
Public Health, Baltimore, MD, USA | US Army Research Institute of Environmental Medicine,
Natick, MA, USA | Social Sectors Development Strategies, Inc., Natick,
MA and the Boston University School of Public Health, Boston, MA, USA
Note: [] Address for correspondence: Andrew E. Lincoln, ScD, The Johns
Hopkins Center for Injury Research and Policy, 624 N. Broadway, #512,
Baltimore, MD 21205, USA. Tel.: +1 410 614 4023; Fax: +1 707 897 1950; E-mail:
[email protected]
Abstract: We describe the natural history of 13 musculoskeletal conditions
requiring hospitalization and identify demographic, behavioral, psychosocial,
occupational, and clinical characteristics most strongly associated with
disability discharge from the Army. Subjects included 15,268 active-duty
personnel hospitalized for a common musculoskeletal condition between the years
1989--1996 who were retrospectively followed through 1997. Back conditions had
the greatest 5-year cumulative risk of disability (21%, for intervertebral disc
displacement, intervertebral disc degeneration, and nonspecific low back pain,
respectively). Cox proportional hazards models identified the following risk
factors for disability among males: lower pay grade, musculoskeletal diagnosis,
shorter length of service, older age, occupational category, lower job
satisfaction, recurrent musculoskeletal hospitalizations, more cigarette
smoking, greater work stress, and heavier physical demands. Among females,
fewer covariates reached statistical significance, although lower education
level was significant in more than one model. Modifiable risk factors related
to work (job satisfaction, work stress, physical demands, occupation) and
health behaviors (smoking) suggest possible targets for intervention.
