Back to Top Skip to main content

Hospitalizations, Active Component, U.S. Armed Forces, 2019

Service members assigned to Expeditionary Resuscitative Surgical System 19 prepare medical supplies aboard Royal Fleet Auxiliary ship Cardigan Bay during exercise Azraq Serpent 18. (U.S. Navy photo by Mass Communication Specialist 2nd Class Kevin J. Steinberg) Service members assigned to Expeditionary Resuscitative Surgical System 19 prepare medical supplies aboard Royal Fleet Auxiliary ship Cardigan Bay during exercise Azraq Serpent 18. (U.S. Navy photo by Mass Communication Specialist 2nd Class Kevin J. Steinberg)

Recommended Content:

Medical Surveillance Monthly Report

WHAT ARE THE NEW FINDINGS?

The annual hospitalization rate for any cause in 2019 was unchanged from the rate in 2018 at 50.9 per 1,000 service member person-years. The rates for 2018 and 2019 were the lowest rates in the past 10 years. Rates of hospitalization in most of the ICD-10 major diagnostic categories have declined in recent years, but numbers and rates of hospitalizations for mental health disorders have increased.

WHAT IS THE IMPACT ON READINESS AND FORCE HEALTH PROTECTION?

Declining rates of hospitalization for most categories of illness and injury may reflect the relatively recent decrease in numbers of active duty military personnel involved in peacekeeping and combat operations. The reasons for the increase in mental health disorder-related hospitalizations are not known, but this trend warrants continued research and emphasis on preventive measures for this relatively common category associated with lengthy hospitalizations.

BACKGROUND

This report documents the frequencies, rates, trends, and distributions of hospitalizations of active component members of the U.S. Army, Navy, Air Force, and Marine Corps during calendar year 2019. Summaries are based on standardized records of hospitalizations at U.S. military and non-military (reimbursed care) medical facilities worldwide. For this report, primary (first-listed) discharge diagnoses are considered indicative of the primary reasons for hospitalizations; summaries are based on the first 3 digits of the International Classification of Diseases, 10th Revision (ICD-10) codes used to report primary discharge diagnoses. Hospitalizations not routinely documented with standardized, automated records (e.g., during field training exercises or while shipboard) are not centrally available for health surveillance purposes and thus are not included in this report.

Frequencies, rates, and trends

In 2019, there were 66,989 records of hospitalizations of active component members of the U.S. Army, Navy, Air Force, and Marine Corps (Table 1); 33.0% of the hospitalizations were in non-military facilities (data not shown). The annual hospitalization rate (all causes) for 2019 was 50.9 per 1,000 service member person-years (p-yrs). This rate was unchanged from the rate for 2018 (50.9 per 1,000 p-yrs). The rates for 2018 and 2019 were the lowest rates reported during 2010–2019, the years covered in this report (Figure 1).

Hospitalizations, by illness and injury categories

As in prior years, in 2019, 3 diagnostic categories accounted for three-fifths (60.0%) of all hospitalizations of active component members: mental health disorders (28.1%), pregnancy- and delivery-related conditions (22.5%), and injury/poisoning (9.4%) (Table 1). Similar to 2015 and 2017, in 2019 there were more hospitalizations for mental health disorders than for any other major diagnostic category (per ICD-10); 2008 was the last year in which the number of hospitalizations for pregnancy- and delivery-related conditions exceeded the number for mental health disorders (data not shown).

Comparing 2019 to 2015, numbers of hospitalizations decreased in all major categories of illnesses and injuries except for mental health disorders and respiratory system disorders, which increased 20.9% and 7.1%, respectively (Table 1). The largest drop in the number of hospitalizations during 2015–2019 was seen in the category of “other factors influencing health status and contact with health services” (excluding pregnancy-related) (hospitalization difference, 2015–2019: -1,063; 33.0% decrease).

Hospitalizations, by sex

In 2019, the hospitalization rate (all causes) among females was more than 3 times that of males (120.2 per 1,000 p-yrs vs. 36.9 per 1,000 p-yrs, respectively). Excluding pregnancy and delivery, the rate of hospitalizations among females (52.0 per 1,000 p-yrs) was 40.9% higher than among males (data not shown).

Overall hospitalization rates were higher (i.e., the rate difference [RD] was greater than 1.0 per 1,000 p-yrs) among females than males for mental health disorders (female:male, RD: 7.7 per 1,000 p-yrs); genitourinary disorders (RD: 3.6 per 1,000 p-yrs); and neoplasms (RD: 1.6 per 1,000 p-yrs) (data not shown). With the exception of pregnancy- and delivery-related conditions, hospitalization rates were relatively similar among males and females for the remaining 13 major disease-specific categories (data not shown).

Relationships between age and hospitalization rates varied considerably across illness- and injury-specific categories. For example, among both males and females, hospitalization rates generally increased with age for musculoskeletal system/connective tissue disorders, neoplasms, and circulatory, genitourinary, digestive, nervous, and endocrine/nutrition/immunity disorders (Figure 2). Among service members aged 30 years or older, there was a pronounced difference by sex in the slopes of the rates of neoplasms, with the rates among females notably higher than among males in the same age groups. Rates decreased with age for mental health disorders but were relatively stable across age groups for injury/poisoning, signs/symptoms/ill-defined conditions, and infectious/parasitic diseases.

Most frequent diagnoses

In 2019, adjustment disorder was the most frequent discharge diagnosis among males (n=4,473) (Table 2). Alcohol dependence (n=2,207), major depressive disorder [single episode, unspecified] (n=1,255), acute appendicitis (n=1,196), major depressive disorder [recurrent, severe without psychotic features] (n=1,123), other symptoms and signs involving emotional state (n=605), and post-traumatic stress disorder (PTSD) (n=581) were the next 6 most frequent diagnoses in males (Table 2).

In 2019, pregnancy- and delivery-related conditions represented 4 of the top 5 leading causes of hospitalizations among females, and this category alone accounted for 56.9% of all hospitalizations of females (Table 3). The top 5 discharge diagnoses in this condition category included post-term (late) pregnancy (n=1,183), abnormality in fetal heart rate and rhythm (n=1,013), premature rupture of membranes [onset of labor within 24 hours of rupture] (n=936), maternal care due to uterine scar from previous surgery (n=840), and second degree laceration during delivery (n=759). Other than pregnancy- and delivery-related diagnoses, leading causes of hospitalizations among females were adjustment disorder (n=1,305), recurrent major depressive disorder without psychotic features (n=532), major depressive disorder [single episode, unspecified] (n=436), PTSD (n=421), and alcohol dependence (n=267). Combined, mental health disorder diagnoses accounted for one-sixth (17.3%) of all hospitalizations of females.

Injury/poisoning

As in the past, in 2019, injury/poisoning was the third leading cause of hospitalizations of U.S. military members (Table 1). Of all injury/poisoning-related hospitalizations in U.S. military medical facilities (n=3,798), more than half (58.6%) had a missing or invalid NATO Standardization Agreement (STANAG) code (Table 4). Nearly one-third (31.9%) of all “unintentional” injury/poisoning-related hospitalizations in U.S. military facilities (n=1,425) were considered caused by falls and miscellaneous (n=455), while land transport (n=320) accounted for 22.5% of “unintentional” injury/poisoning-related hospitalizations (Table 4).

Among males, injury/poisoning-related hospitalizations were most often related to infection following a procedure, concussion, fracture of the tibial shaft, or fracture of the mandible (Table 2). Among females, injury/poisoning-related hospitalizations were most often related to poisoning by/adverse effect of/underdosing of other and unspecified antidepressants, infection following a procedure, poisoning by/adverse effect of acetaminophen derivatives, or other fractures of the lower leg (Table 3).

Durations of hospitalizations

During 2010–2019, the median duration of hospital stays (all causes) remained stable at 3 days (Figure 3). As in previous years, medians and ranges of durations of hospitalizations varied considerably across major diagnostic categories. For example, median lengths of hospitalizations varied from 2 days (e.g., musculoskeletal system disorders; genitourinary system disorders; signs, symptoms, and ill-defined conditions) to 6 days (mental health disorders). For most diagnostic categories, less than 5% of hospitalizations exceeded 12 days, but for 6 categories, 5% of hospitalizations had longer durations: nervous system/sense organ disorders (13 days), hematologic disorders (13.5 days), injury/poisoning (18 days), neoplasms (20 days), other nonpregnancy-related factors influencing health status and contact with health services (primarily orthopedic aftercare and rehabilitation following a previous illness or injury) (27 days), and mental health disorders (30 days) (Figure 4).

Hospitalizations, by service

Among active component members of the Navy and Air Force, pregnancy- and delivery-related conditions accounted for more hospitalizations than any other category of illnesses or injuries; however, among active component members of the Army and Marine Corps, mental health disorders were the leading cause of hospitalizations (Table 5). The crude hospitalization rate for mental health disorders among active component Army members (16.6 per 1,000 p-yrs) was higher than among members of all other services.

Injury/poisoning was the third leading cause of hospitalizations in the Army and the Marine Corps, fourth in the Navy, and fifth in the Air Force (Table 5). The hospitalization rate for injury/poisoning was highest among Army (6.6 per 1,000 p-yrs) and Marines Corps members (5.8 per 1,000 p-yrs) and lowest among Air Force members (3.0 per 1,000 p-yrs).

EDITORIAL COMMENT

The hospitalization rates for all causes among active component members in 2018 and 2019 were the lowest rates seen in the past 10 years. As in past years, in 2019, mental health disorders, pregnancy- and delivery-related conditions, and injury/poisoning accounted for more than half of all hospitalizations of active component members. Adjustment and mood disorders were among the leading causes of hospitalizations among both male and female service members. In recent years, attention at the highest levels of the U.S. military and significant resources have focused on detecting, diagnosing, and treating mental health disorders—especially those related to long and repeated deployments and combat stress. Annual numbers and crude rates of hospitalizations for mental health disorders increased between 2015 and 2017 and remained relatively stable between 2017 and 2019; the number of mental health disorder-related hospitalizations in 2019 was more than 3,000 greater than in 2015 and the crude rate was 19.6% higher.

The reasons for the recent downturn in the trends for annual numbers of hospitalizations overall and for the slight increase in mental health disorder-related hospitalizations in particular are not clear. It is conceivable that there has been a decline in the impact of combat and peacekeeping operations on overall morbidity among service members since the withdrawal of U.S. forces from Iraq and the official end to combat operations in Afghanistan. Continued monitoring of hospitalizations and all other healthcare encounters over time may permit elucidation of the possible reasons for the recent trends in hospitalization.

This summary has certain limitations that should be considered when interpreting the results. For example, the scope of this report is limited to members of the active components of the U.S. Armed Forces. Many reserve component members were hospitalized for illnesses and injuries while serving on active duty in 2019; however, these hospitalizations are not accounted for in this report. In addition, many injury/poisoning-related hospitalizations occur in nonmilitary hospitals. If there are significant differences between the causes of injuries and poisonings that resulted in hospitalizations in U.S. military and non-military hospitals, the summary of external causes of injuries requiring hospital treatment reported here (Table 4) could be misleading. Also, this summary is based on primary (first-listed) discharge diagnoses only; however, in many hospitalized cases, there are multiple underlying conditions. For example, military members who are wounded in combat or injured in motor vehicle accidents may have multiple injuries and complex medical and psychological complications. In such cases, only the first-listed discharge diagnosis would be accounted for in this report. Finally, the new electronic health record for the Military Health System, MHS GENESIS, was implemented at 4 military treatment facilities in the state of Washington in 2017 (Naval Hospital Oak Harbor, Naval Hospital Bremerton, Air Force Medical Services Fairchild, and Madigan Army Medical Center). Implementation of the second wave of MHS GENESIS sites began in 2019 and included 3 facilities in California (Travis Air Force Base [AFB], the Presidio of Monterey, and Naval Air Station Lemoore) and 1 in Idaho (Mountain Home AFB). Medical data from facilities using MHS GENESIS are not available in the Defense Medical Surveillance System. Therefore, medical encounter data for individuals seeking care at any of these facilities after their conversion to MHS GENESIS were not included in the current analysis. Even with these limitations, this report provides useful and informative insights regarding the natures, rates, and distributions of the most serious illnesses and injuries that affect active component military members.

FIGURE 1. Rates of hospitalization, by year, active component, U.S. Armed Forces, 2010–2019

FIGURE 2. Ratesa of hospitalization, by ICD-10 major diagnostic category, age group, and sex, active component, U.S. Armed Forces, 2019

Length of hospital stay, active component, U.S. Armed Forces, 2010–2019

Length of hospital stay, by ICD-10 major diagnostic category, active component, U.S. Armed Forces, 2010–2019

 Numbers, rates,a and ranksb of hospitalizations, by ICD-9/ICD-10 major diagnostic category, active component, U.S. Armed Forces, 2015, 2017, and 2019

Numbers and percentages of the most frequent diagnoses during hospitalization, by ICD-10 major diagnostic category, males, active component, U.S. Armed Forces, 2019

Numbers and percentages of most frequent diagnoses during hospitalization, by ICD-10 major diagnostic category, females, active component, U.S. Armed Forces, 2019

 Numbers and percentages of injury-related hospitalizations,a by causal agent,b active component, U.S. Armed Forces, 2019

TABLE 5. Numbers and rates of hospitalizations, by service and ICD-10 major diagnostic category, active component, U.S. Armed Forces, 2019

 

You also may be interested in...

Attrition Rates and Incidence of Mental Health Disorders in an Attention-Deficit/Hyperactivity Disorder (ADHD) Cohort, Active Component, U.S. Armed Forces, 2014–2018

Article
1/1/2021
Capt. Michelle Tsai, the behavioral health officer for the 4th Brigade, 2nd Infantry Division, reviews medical information in her office at the Joint Readiness Training Center June 17. Tsai, an Alexandria, Va., native, is here with the Raider Brigade in support of training operations for the unit's upcoming deployment to Iraq. (Photo by Pfc. Luke Rollins)

Recommended Content:

Medical Surveillance Monthly Report

Exertional Rhabdomyolysis and Sickle Cell Trait Status in the U.S. Air Force, January 2009–December 2018

Article
1/1/2021
JOINT BASE SAN ANTONIO, Texas - Master Sgt. Daniel Bedford, Air Force Recruiting Service National Events program manager, prepares to pump up a gold medal lift in the bench press during the USPA (United State Powerlifting Association) 2020 Texas State Bench Press Championship. Senior Master Sgt. Michael Lear, AFRS Strategic Marketing Division superintendent, prepares to spot Bedford. Lear and Bedford are Total Force recruiting partners who train together and motivate one another at work and in the gym. (Courtesy photo) (Photo By: babin.)

Recommended Content:

Medical Surveillance Monthly Report

The Prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) and ADHD Medication Treatment in Active Component Service Members, U.S. Armed Forces, 2014–2018

Article
1/1/2021
New Recruits with Golf Company, 2nd Recruit Training Battalion, are screened after arriving at Marine Corps Recruit Depot, San Diego, Dec. 28, 2020. As recruits arrive to the depot in the future, they will enter a staging period of 14 days during which they will be medically screened, monitored, and provided classes to prepare and orient them to begin recruit training. All of this will occur before they step onto our iconic yellow footprints and make that memorable move toward earning the title Marine. Current planning and execution remain fluid as the situation continues to evolve. The health and well-being of our recruits, recruiting and training personnel, and their families remain our primary concerns. All recruits will be screened and tested for COVID-19 prior to beginning recruit training. (U.S. Marine Corps photo by Lance Cpl. Grace J. Kindred)

Recommended Content:

Medical Surveillance Monthly Report

Cases of Coronavirus Disease 2019 and Comorbidities Among Military Health System Beneficiaries, 1 January 2020 through 30 September 2020

Article
12/1/2020
1-6179898: A U.S. Army nurse paratrooper assigned to the 173rd Brigade Support Battalion, 173rd Airborne Brigade provides patient care in support of preventative efforts against COVID-19 on Caserma Del Din, Italy, April 20, 2020. The 173rd Airborne Brigade is the U.S. Army's Contingency Response Force in Europe, providing rapidly deployable forces to the United States Europe, Africa and Central Command areas of responsibility. Forward deployed across Italy and Germany, the brigade routinely trains alongside NATO allies and partners to build partnerships and strengthen the alliance. (U.S. Army photo by Spc. Ryan Lucas)

Recommended Content:

Medical Surveillance Monthly Report

SARS-CoV-2 and Influenza Coinfection in a Deployed Military Setting—Two Case Reports

Article
12/1/2020
4-2871: This illustration, created at the Centers for Disease Control and Prevention (CDC), reveals ultrastructural morphology exhibited by coronaviruses. Note the spikes that adorn the outer surface of the virus, which impart the look of a corona surrounding the virion, when viewed electron microscopically. A novel coronavirus, named Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), was identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China in 2019. The illness caused by this virus has been named coronavirus disease 2019 (COVID-19). (Credit: Alissa Eckert, MSMI; Dan Higgins, MAMS)

Recommended Content:

Medical Surveillance Monthly Report

Air Evacuation of Service Members for COVID-19 in U.S. Central Command and U.S. European Command From 11 March 2020 Through 30 September 2020

Article
12/1/2020
3-3D_Influenza_blue_no_key_pieslice_med: This illustration provides a 3D graphical representation of a generic Influenza virion’s ultrastructure, and is not specific to a seasonal, avian or 2009 H1N1 virus. (Credit: CDC/ Douglas Jordan)

Recommended Content:

Medical Surveillance Monthly Report

Characteristics of U.S. Army Beneficiary Cases of COVID-19 in Europe, 12 March 2020–17 April 2020

Article
12/1/2020
2-200410-F-BT441-2099: Three U.S. Air Force medical Airmen exit a C-17 Globemaster III aircraft following the first-ever operational use of the Transport Isolation System at Ramstein Air Base, Germany, April 10, 2020. The TIS is an infectious disease containment unit designed to minimize contamination risk to aircrew and medical attendants, while allowing in-flight medical care for patients afflicted by a disease--in this case, COVID-19. (U.S. Air Force photo by Staff Sgt. Devin Nothstine)

Recommended Content:

Medical Surveillance Monthly Report

Update: Cold Weather Injuries, Active and Reserve Components, U.S. Armed Forces, July 2015–June 2020

Article
11/1/2020
Chill factor, improper warm up, and inadequate clothing can contribute to the risk for cold injuries. Experts encourage everyone, whether acclimated to cold weather or not, to protect against cold temperature injuries this winter. (U.S. Marine Corps photo by Lance Cpl. Cody Rowe)

Update: Cold Weather Injuries, Active and Reserve Components, U.S. Armed Forces, July 2015–June 2020

Recommended Content:

Medical Surveillance Monthly Report

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

Article
11/1/2020
Back pain. Credit: iStock.com/Albina Gavrilovic

Recommended Content:

Medical Surveillance Monthly Report

Acute Respiratory Infections Among Active Component Service Members Who Use Combustible Tobacco Products and/or E-cigarette/Vaping Products, U.S. Armed Forces, 2018–2019

Article
11/1/2020
A Team Offutt Airman vapes in an authorized smoking area during a break Nov. 7. As of Oct. 29, 2019, over 1,800 lung injury cases and 37 deaths have been reported to the Centers for Disease Control and Prevention and the only commonality among all cases is the patient’s use of e-cigarette or vaping products. Offutt Airmen looking for support quitting can schedule an appointment with a behavioral health consultant or primary care manager by calling 402-232-2273. To schedule a unit briefing on the dangers of vaping and options for quitting, call 402-294-5977. Outside assistance, including text-message support, is available by visiting www.smokefree.gov, www.thetruth.com or www.ycq2.org.

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Influenza Immunization Among U.S. Armed Forces Healthcare Workers, August 2015–April 2020

Article
10/1/2020
NORFOLK (Oct. 15, 2019) Lt. Sipriano Marte administers an influenza vaccination to Airman Tyler French in the intensive care unit aboard the Wasp-class amphibious assault ship USS Kearsarge (LHD 3). Kearsarge is underway conducting routine training. (U.S. Navy photo by Mass Communication Specialist Petty Officer 3rd Class Jacob Vermeulen/Released)

Surveillance Snapshot: Influenza Immunization Among U.S. Armed Forces Healthcare Workers, August 2015–April 2020

Recommended Content:

Medical Surveillance Monthly Report

Acute and Chronic Pancreatitis, Active Component, U.S. Armed Forces, 2004–2018

Article
10/1/2020
Istock 916163392 3D illustration of human body organs (pancreas).

Acute and Chronic Pancreatitis, Active Component, U.S. Armed Forces, 2004–2018

Recommended Content:

Medical Surveillance Monthly Report

Characterizing the Contribution of Chronic Pain Diagnoses to the Neurologic Burden of Disease, Active Component, U.S. Armed Forces, 2009–2018

Article
10/1/2020
Belgian Medical Component 1st Lt. Olivier, a physical therapist, adjusts the neck of a pilot from the 332nd Air Expeditionary Wing, June 22, 2017, in Southwest Asia. Aircrew from the 332nd AEW received treatment for pains associated with flying high performance aircraft through a partnership program with the Belgian Medical Component. (U.S. Air Force photo/Senior Airman Damon Kasberg)

Recommended Content:

Medical Surveillance Monthly Report

Update: Surveillance of Spotted Fever Rickettsioses at Army Installations in the U.S. Central and Atlantic Regions, 2012–2018

Article
9/1/2020
This photograph depicts a dorsal view of a female Gulf Coast tick, Amblyomma maculatum. This tick species is a known vector for Rickettsial organisms, Rickettsia parkeri, and Ehrlichia ruminantium, formerly Cowdria ruminantium. R. parkeri is a member of the spotted fever group of rickettsial diseases affecting humans, while E. ruminantium causes heartwater disease, an infectious, noncontagious, tick-borne disease of domestic, and wild ruminants, including cattle, sheep, goats, antelope, and buffalo. Note the considerably smaller scutum, or shield covering only a small region of its dorsal abdomen, unlike its male counterpart, an example of which can be seen in PHIL 10877, and 10878, which sports a scutum covering its entire dorsal abdomen. The smaller scutum in the female enables its abdomen to expand considerably, leading to an engorged appearance after ingesting its host blood meal. (Content provider: CDC/ Dr. Christopher Paddock)

Recommended Content:

Medical Surveillance Monthly Report

Update: Routine Screening for Antibodies to Human Immunodeficiency Virus, Civilian Applicants for U.S. Military Service and U.S. Armed Forces, Active and Reserve Components, January 2015–June 2020

Article
9/1/2020
Spc. Jayson Sanchez of the Army Reserve’s 77th Sustainment Brigade receives a blood draw from phlebotomist Nikole Horrell during the mass medical-readiness event hosted Aug. 8-9, 2015 by the Army Reserve’s 99th Regional Support Command at Joint Base McGuire-Dix-Lakehurst, N.J., in an effort to increase Soldier readiness throughout the northeastern United States. More than 300 Army Reserve and Army National Guard Soldiers had the opportunity to take care of their Periodic Health Assessments, dental exams, vision screenings, HIV blood draws, immunizations, hearing tests, LOD processing and temporary/permanent profiles during the event. (U.S. Army photo by Sgt. Salvatore Ottaviano, 99th Readiness Division)

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 13

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.