Back to Top Skip to main content Skip to sub-navigation

Hospitalizations, Active Component, U.S. Armed Forces, 2020

Image of Army Medicine surgeons in the operating room. Ensuring trained and ready medical forces, particularly combat trauma surgeons, is critical to support our Soldiers and other service personnel in combat. Army Medicine is using individual critical task lists, centrally managing trauma surgery personnel and assets, and building military-civilian partnerships with civilian level I trauma centers to ensure Army Medicine surgeons are getting the experience needed for battlefield surgery.





Recommended Content:

Medical Surveillance Monthly Report

WHAT ARE THE NEW FINDINGS?

The hospitalization rate in 2020 was 47.1 per 1,000 person-years, the lowest rate of the most recent 10 years, during which period annual rates steadily declined. As in prior years, the majority (70.9%) of hospitalizations were associated with diagnoses in the categories of mental health disorders, pregnancy-related conditions, injury/poisoning, and digestive system disorders.

WHAT IS THE IMPACT ON READINESS AND FORCE HEALTH PROTECTION? 

Not only are mental health disorders the most common diagnoses associated with hospitalizations, they are associated with the longest median hospital stay (6 days). Moreover, 5% of hospitalizations for mental health disorders had durations of stay greater than 30 days. Prolonged hospitalizations, subsequent aftercare, and early attrition because of such common disorders can have a negative impact on individual and unit operational readiness.

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 2020. 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, 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 2020, there were 62,459 records of hospitalizations of active component members of the U.S. Army, Navy, Air Force, and Marine Corps (Table 1); 33.7% of the hospitalizations were in non-military facilities (data not shown). The annual hospitalization rate (all causes) for 2020 was 47.1 per 1,000 service member person-years (p-yrs). This rate was the lowest of the years covered in this report (2011–2020), during which rates fell steadily each year until 2019 when the rate (52.2 per 1,000 p-yrs) exceeded that of 2018 (51.0 per 1,000 p-yrs) (Figure 1)

Hospitalizations, by illness and injury categories 

In 2020, 4 diagnostic categories accounted for 70.9% of all hospitalizations of active component members: mental health disorders (28.7%), pregnancy- and delivery-related conditions (25.1%), injury/poisoning (8.8%), and digestive system disorders (8.3%) (Table 1). Similar to 2016 and 2018, in 2020 there were more hospitalizations for mental health disorders than for any other major diagnostic category (per ICD-10); 2009 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 2020 to 2016, numbers of hospitalizations decreased in all major categories of illnesses and injuries except for mental health disorders, pregnancy and delivery, and hematologic and immune disorders, which increased 7.2%, 1.1%, and 9.2%, respectively (Table 1). The largest drop in the number of hospitalizations during 2016–2020 was seen in the category of “musculoskeletal system and connective system disorders” (hospitalization difference, 2016–2020: -2,081; 34.7% decrease).

Hospitalizations, by sex

In 2020, the hospitalization rate (all causes) among females was more than 3 times that of males (114.8 per 1,000 p-yrs vs. 32.6 per 1,000 p-yrs, respectively). Excluding pregnancy and delivery, the rate of hospitalizations among females (46.1 per 1,000 p-yrs) was 41.6% 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: 7.4 per 1,000 p-yrs); genitourinary disorders (RD: 2.9 per 1,000 p-yrs); and neoplasms (RD: 1.4 per 1,000 p-yrs) (data not shown). With the exception of pregnancy- and delivery-related conditions, hospitalization rates were 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 2020, adjustment disorder was the most frequent discharge diagnosis among males (n=4,433) (Table 2). Alcohol dependence (n=2,303), acute appendicitis (n=1,197), major depressive disorder [recurrent, severe without psychotic features] (n=1,104), major depressive disorder [single episode, unspecified] (n=1,087), other symptoms and signs involving emotional state (n=542), and post-traumatic stress disorder (PTSD) (n=523) were the next 6 most frequent diagnoses in males (Table 2).

In 2020, the most frequent discharge diagnosis among females was adjustment disorder (n=1,352). Pregnancy- and delivery-related conditions represented the next 5 leading causes of hospitalizations among females, and this category alone accounted for 59.7% of all hospitalizations of females (Table 3). The top 5 discharge diagnoses in this condition category included post-term (late) pregnancy (n=1,332), abnormality in fetal heart rate and rhythm (n=922), maternal care due to uterine scar from previous surgery (n=856), premature rupture of membranes [onset of labor within 24 hours of rupture] (n=847), and first degree perineal laceration during delivery (n=793). After the top 6 discharge diagnoses described above for females, the other leading causes of hospitalizations among females were recurrent major depressive disorder without psychotic features (n=454), PTSD (n=448), major depressive disorder [single episode, unspecified] (n=380), and alcohol dependence (n=304). Combined, mental health disorder diagnoses accounted for one-sixth (17.1%) of all hospitalizations of females.

Injury/poisoning

As in the past, in 2020, 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=3,326), more than half (63.4%) had a missing or invalid NATO Standardization Agreement (STANAG) code (Table 4). More than one-third (35.6%) of all “unintentional” injury/poisoning-related hospitalizations in U.S. military facilities (n=1,068) were considered caused by falls and miscellaneous (n=380), while land transport (n=236) accounted for 22.1% 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 acetaminophen derivatives, unspecified injury, infection following a procedure, concussion, or poisoning by/adverse effect of/under dosing of other and unspecified antidepressants (Table 3).

Durations of hospitalizations 

During 2011–2020, 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 7 categories, 5% of hospitalizations had longer durations: circulatory system disorders (13 days), nervous system/sense organ disorders (14 days), infectious/parasitic diseases (15 days), injury/poisoning (21 days), neoplasms (26 days), other non-pregnancy-related factors influencing health status and contact with health services (primarily orthopedic aftercare and rehabilitation following a previous illness or injury) (30 days), and mental health disorders (30 days) (Figure 4). It is noteworthy that, for one specific infectious disease, COVID-19, although the median length of hospital stay was 5 days, 5% of patients had hospital stays of 18 days or longer. 

Hospitalizations, by service 

Among active component members of the 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, Navy, and Marine Corps, mental health disorders were the leading cause of hospitalizations (Table 5). For the Navy, this was a change from the results for 2019, when pregnancy and delivery-related conditions were most numerous. The crude hospitalization rate for mental health disorders among active component Army members (15.2 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, and fourth in the Navy and Air Force (Table 5). The hospitalization rate for injury/poisoning was highest among Army (5.6 per 1,000 p-yrs) and Marines Corps members (4.8 per 1,000 p-yrs) and lowest among Air Force members (2.6 per 1,000 p-yrs).

EDITORIAL COMMENT

The hospitalization rate for all causes among active component members in 2020 was the lowest rate of the past 10 years. As in past years, in 2020, 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 crude rates of hospitalizations for mental health disorders increased between 2015 and 2017 and have remained relatively stable between 2017 and 2020. The annual number of mental health disorder-related hospitalizations has been approximately 18,000 since 2017. 

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. The decrease in hospitalizations in 2020 may also have been a consequence of the COVID-19 pandemic, during which elective admissions to hospitals were discouraged and the public health measures of social distancing and use of personal protective equipment may have reduced the incidence of not only infectious diseases but also of injuries. Continued monitoring of hospitalizations and all other health care 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 2020; however, these hospitalizations are not accounted for in this report. Please refer to the snapshot pertaining to the reserve component elsewhere in this issue of the MSMR. In addition, many injury/poisoning-related hospitalizations occur in non-military 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, it should be noted that medical data from sites that were using the new electronic health record for the Military Health System, MHS GENESIS, between July 2017 and October 2019 are not available in the DMSS. These sites include Naval Hospital Oak Harbor, Naval Hospital Bremerton, Air Force Medical Services Fairchild, and Madigan Army Medical Center. Therefore, medical encounter data for individuals seeking care at any of these facilities from July 2017 through October 2019 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, 2011–2020

FIGURE 2. Ratesa of hospitalization, by ICD-10 major diagnostic category, age group, and sex, active component, U.S. Armed Forces, 2020

FIGURE 3. Length of hospital stay, active component, U.S. Armed Forces, 2011–2020

FIGURE 4. Length of hospital stay, by ICD-10 major diagnostic category, active component, U.S. Armed Forces, 2011–2020

Table 1
TABLE 2. Numbers and percentages of the most frequent diagnoses during hospitalization, by ICD-10 major diagnostic category, males, active component, U.S. Armed Forces, 2020

TABLE 3. Numbers and percentages of the most frequent diagnoses during hospitalization, by ICD-10 major diagnostic category, females, active component, U.S. Armed Forces, 2020

TABLE 4. Numbers and percentages of injury-related hospitalizations,a by causal agent,b active component, U.S. Armed Forces, 2020

TABLE 5. Numbers and rates of hospitalizations, by service and ICD-10 diagnostic category, active component, U.S. Armed Forces, 2020

You also may be interested in...

MSMR Vol. 29 No. 07 - July 2022

Report
7/1/2022

A monthly publication of the Armed Forces Health Surveillance Division. This issue of the peer-reviewed journal contains the following articles: Surveillance trends for SARS-CoV-2 and other respiratory pathogens among U.S. Military Health System Beneficiaries, Sept. 27, 2020 – Oct. 2,2021; Establishment of SARS-CoV-2 genomic surveillance within the MHS during March 1 – Dec. 31 2020; Suicide behavior among heterosexual, lesbian/gay, and bisexual active component service members in the U.S. Armed Forces; Brief report: Phase I results using the Virtual Pooled Registry Cancer Linkage system (VPR-CLS) for military cancer surveillance.

Recommended Content:

Health Readiness & Combat Support | Public Health | Medical Surveillance Monthly Report

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Non-service Member Beneficiaries of the Military Health System, 2021

Article
6/1/2022

In 2021, mental health disorders accounted for the largest proportions of the morbidity and health care burdens that affected the pediatric and younger adult beneficiary age groups. Among adults aged 45–64 and those aged 65 or older, musculoskeletal diseases accounted for the most morbidity and health care burdens. As in previous years, this report documents a substantial majority of non-service member beneficiaries received care for current illness and injury from the Military Health System as outsourced services at non-military medical facilities.

Recommended Content:

Medical Surveillance Monthly Report

Surveillance snapshot: Illness and injury burdens, reserve component, U.S. Armed Forces, 2021

Article
6/1/2022
Surveillance snapshot: Illness and injury burdens, reserve component, U.S. Armed Forces, 2021

Recommended Content:

Medical Surveillance Monthly Report

Morbidity Burdens Attributable to Various Illnesses and Injuries, Deployed Active and Reserve Component Service Members, U.S. Armed Forces, 2021

Article
6/1/2022

As in previous years, among service members deployed during 2021, injury/poisoning, musculoskeletal diseases and signs/symptoms accounted for more than half of the total health care burden during deployment. Compared to garrison disease burden, deployed service members had relatively higher proportions of encounters for respiratory infections, skin diseases, and infectious and parasitic diseases. The recent marked increase in the percentage of total medical encounters attributable to the ICD diagnostic category "other" (23.0% in 2017 to 44.4% in 2021) is likely due to increases in diagnostic testing and immunization associated with the response to the COVID-19 pandemic.

Recommended Content:

Medical Surveillance Monthly Report

Medical Evacuations out of the U.S. Central and U.S. Africa Commands, Active and Reserve Components, U.S. Armed Forces, 2021

Article
6/1/2022
Medical Evacuations out of the U.S. Central and U.S. Africa Commands, Active and Reserve Components, U.S. Armed Forces, 2021

The proportions of evacuations out of USCENTCOM that were due to battle injuries declined substantially in 2021. For USCENTCOM, evacuations for mental health disorders were the most common, followed by non-battle injury and poisoning, and signs, symptoms, and ill-defined conditions. For USAFRICOM, evacuations for non-battle injury and poisoning were most common, followed by disorders of the digestive system and mental health disorders.

Recommended Content:

Medical Surveillance Monthly Report

Ambulatory Visits, Active Component, U.S. Armed Forces, 2021

Article
6/1/2022

In 2021, the overall numbers and rates of active component service member ambulatory care visits were the highest of any of the last 10 years. Most categories of illness and injury showed modest increases in numbers and rates. The proportions of ambulatory care visits that were accomplished via telehealth encounters fell to under 15% in 2021, compared to 19% in 2020.

Recommended Content:

Medical Surveillance Monthly Report

Hospitalizations, Active Component, U.S. Armed Forces, 2021

Article
6/1/2022

The hospitalization rate in 2021 was 48.0 per 1,000 person-years (p-yrs), the second lowest rate of the most recent 10 years. For hospitalizations limited to military facilities, the rate in 2021 was the lowest for the entire period. As in prior years, the majority (71.2%) of hospitalizations were associated with diagnoses in the categories of mental health disorders, pregnancy-related conditions, injury/poisoning, and digestive system disorders.

Recommended Content:

Medical Surveillance Monthly Report

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2021

Article
6/1/2022

In 2021, as in prior years, the medical conditions associated with the most medical encounters, the largest number of affected service members, and the greatest number of hospital days were in the major categories of injuries, musculoskeletal disorders, and mental health disorders. Despite the pandemic, COVID-19 accounted for less than 2% of total medical encounters and bed days in active component service members.

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Tick-borne Encephalitis in Military Health System Beneficiaries, 2012–2021

Article
5/1/2022
iStock—The castor bean tick (Ixoedes ricinus). Credit: Erik Karits

Tick-borne Encephalitis in Military Health System Beneficiaries, 2012–2021. Tick-borne encephalitis (TBE) is a viral infection of the central nervous system that is transmitted by the bite of infected ticks, mostly found in wooded habitats in parts of Europe and Asia

Recommended Content:

Medical Surveillance Monthly Report

Evaluation of ICD-10-CM-based Case Definitions of Ambulatory Encounters for COVID-19 Among Department of Defense Health Care Beneficiaries

Article
5/1/2022
SEATTLE, WA, UNITED STATES 04.05.2020 U.S. Army Maj. Neil Alcaria is screened at the Seattle Event Center in Wash., April 5. Soldiers from Fort Carson, Colo., and Joint Base Lewis-McChord, Wash. have established an Army field hospital center at the center in support of the Department of Defense COVID-19 response. U.S. Northern Command, through U.S. Army North, is providing military support to the Federal Emergency Management Agency to help communities in need. (U.S. Army photo by Cpl. Rachel Thicklin)

This is the first evaluation of ICD-10-CM-based cased definitions for COVID-19 surveillance among DOD health care beneficiaries. The 3 case definitions ranged from highly specific to a lower specificity, but improved balance between sensitivity and specificity.

Recommended Content:

Medical Surveillance Monthly Report

Update: Sexually Transmitted Infections, Active Component, U.S. Armed Forces, 2013–2021

Article
5/1/2022
This illustration depicts a 3D computer-generated image of a number of drug-resistant Neisseria gonorrhoeae bacteria. CDC/James Archer

This report summarizes incidence rates of the 5 most common sexually transmitted infections (STIs) among active component service members of the U.S. Armed Forces during 2013–2021. In general, compared to their respective counterparts, younger service members, non-Hispanic Black service members, those who were single and other/unknown marital status, and enlisted service members had higher incidence rates of STIs.

Recommended Content:

Medical Surveillance Monthly Report

The Association Between Two Bogus Items, Demographics, and Military Characteristics in a 2019 Cross-sectional Survey of U.S. Army Soldiers

Article
5/1/2022
NIANTIC, CT, UNITED STATES 06.16.2022 U.S. Army Staff Sgt. John Young, an information technology specialist assigned to Joint Forces Headquarters, Connecticut Army National Guard, works on a computer at Camp Nett, Niantic, Connecticut, June 16, 2022. Young provided threat intelligence to cyber analysts that were part of his "Blue Team" during Cyber Yankee, a cyber training exercise meant to simulate a real world environment to train mission essential tasks for cyber professionals. (U.S. Army photo by Sgt. Matthew Lucibello)

Data from surveys may be used to make public health decisions at both the installation and the Department of the Army level. This study demonstrates that a vast majority of soldiers were likely sufficiently engaged and answered both bogus items correctly. Future surveys should continue to investigate careless responding to ensure data quality in military populations.

Recommended Content:

Medical Surveillance Monthly Report

Exertional Heat Illness at Fort Benning, GA: Unique Insights from the Army Heat Center

Article
4/1/2022
Navy Petty Officer 3rd Class Ryan Adams is being used as an example victim for cooling a heat casualty at the bi-annual hot weather standard operating procedure training aboard Marine Corps Base Camp Lejeune, N.C., Aug. 24. Adams is demonstrating the "burrito" method used to cool a heat related injury victim. Photo by Pfc. Joshua Grant.

Exertional heat illness (hereafter referred to as heat illness) spans a spectrum from relatively mild conditions such as heat cramps and heat exhaustion, to more serious and potentially life-threatening conditions such as heat injury and exertional heat stroke (hereafter heat stroke).

Recommended Content:

Medical Surveillance Monthly Report

Exertional Rhabdomyolysis, Active Component, U.S. Armed Forces, 2017–2021

Article
4/1/2022
The Embry-Riddle Army ROTC Ranger Challenge team heads out on the 12-mile road march after completing the timed obstacle course event of the 6th Brigade Army ROTC Ranger Challenge January 14, 2022 at Fort Benning, Ga. The Titan Brigade’s Ranger Challenge took place at Fort Benning, Ga. January 13-15, 2022. Photo by Capt. Stephanie Snyder

Exertional rhabdomyolysis is a potentially serious condition that requires a vigilant and aggressive approach. Some service members who experience exertional rhabdomyolysis may be at risk for recurrences, which may limit their military effectiveness and potentially predispose them to serious injury.

Recommended Content:

Medical Surveillance Monthly Report

Heat Illness, Active Component, U.S. Armed Forces, 2021

Article
4/1/2022
Airmen participate in the 13th Annual Fallen Defender Ruck March at Joint Base San Antonio, Nov. 6, 2020. The event honors 186 fallen security forces, security police and air police members who have made the ultimate sacrifice. Photo By: Sarayuth Pinthong, Air Force.

From 2020 to 2021, the rate of incident heat stroke was relatively stable while the rate of heat exhaustion increased slightly

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 13
Refine your search
Last Updated: August 02, 2021

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.