Health outcomes of U.S. active component service members working in high risk occupations for blast overpressure exposure: a retrospective cohort study.

Abstract

Active component military service members are exposed to increased risk of occupational blast overpressure (BOP) exposure during deployment as well as training. This retrospective cohort study examined the incidence of first-time diagnoses of traumatic brain injury (TBI), insomnia, migraine headache, depressive or anxiety disorders, noise-induced hearing injury (NIHI), and essential hypertension among active component service members (ACSMs) in the U.S. Army, Air Force, and Marine Corps. Incidence rates (IRs) were compared between ACSMs who served in occupations at high risk for BOP exposure (n=831,050) and those who never served in such occupations (n=2,229,594). Overall incidence of TBI was 243.8 per 10,000 person-years in the high-risk occupational cohort and 140.9 per 10,000 person-years in the low-risk occupational cohort. Incidence of NIHI was 342.7 and 218.1 per 10,000 person-years in the high- and low-risk cohorts, respectively. After adjusting for demographic and military characteristics, ACSMs in occupations with high risk of BOP experienced higher IRs of TBI (adjusted IR ratio [aIRR] 1.43; 95% CI 1.42, 1.44) and NIHI (aIRR 1.39; 95% CI 1.38, 1.40). Increasing time since entering the cohort was associated with a greater increase in migraine headache incidence among ACSMs in high-risk BOP occupations compared with those in low-risk occupations. Despite these differences, the distribution of disease burden categories from 2024 health care encounters was similar among cohorts. These findings emphasize the importance of mitigating occupational blast hazards and strengthening surveillance efforts to protect the long-term health of ACSMs. Adjusted IRs of TBI and NIHI were higher among service members in occupations at high risk for BOP exposure than among those who had never worked in such occupations. Increasing time in the cohort was associated with a greater increase in migraine headache incidence among service members in high-risk BOP occupations than among those in low-risk occupations.