Disability After Deployment Injury: Are Women and Men Service Members Different?

Abstract

Background Civilian trauma literature suggests sexual dimorphism in outcomes after trauma. Because women represent an increasing demographic among veterans, the question remains if war trauma outcomes, like civilian trauma outcomes, differ between genders. Questions/purposes (1) Do women service members develop different conditions resulting in long-term disability compared with men service members after injuries sustained during deployment? (2) Do women service members have more or less severe disability after deployment injury compared with men service members? (3) Are men or women more likely to return to duty after combat injury?Methods The Department of Defense Trauma Registry was queried for women injured during deployment from 2001 to 2011. The subjects were then queried in the Physical Evaluation Board database to determine each subject's return-to-duty status and what disabling conditions and disability percentages were assigned to those who did not return to duty. Frequency of disabling conditions, disability percentages, and return-to-duty rates for 368 women were compared with a previously published cohort of 450 men service members, 378 of whom had orthopaedic injuries.Results Women who were unable to return to duty had a higher frequency of arthritic conditions (58% 378] of men, p = 0.0410; RR, 0.169; 95% CI, 0.023-1.224). Women had more severely rated posttraumatic stress disorder (PTSD) compared with men (38% ± 23% versus 19% ± 17%). Forty-eight percent (64 of 133) of battle-injured women were unable to return to active duty, resulting in a lower return-to-duty rate compared with men (34% [450 of 1333]; p = 0.003). Conclusions After deployment-related injury, women have higher rates of arthritis, lower rates of pain disorders, and more severely rated PTSD compared with men. Women are unable to return to duty more often than men injured in combat. These results suggest some difference between men's and women's outcomes after deployment injury, important information for military and Veterans Administration providers seeking to minimize postdeployment disability.

Editorial Comment: 2017 SOMOS Proceedings

“…Despite 17 years of continued progress, the long-term effects of these severe battlefield injuries remain apparent [6]. Regardless of the injury, the recovery process can be a challenge and partnering with our colleagues in physical The authors certify that neither they, nor any members of their immediate families, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.)…”

Gendered Innovations in Orthopaedic Science: Equal But Different

“…Further, being female has been identified as an independent risk factor for injury, notably stress fractures [4,6]. Deploymentrelated injuries are more severe with lower return to duty for women [8]. Such disparate rates raise concerns that valuable members of the military risk eliminating themselves through injury as they push towards more elite physical standards established on the male physiology.…”

Military Mothers

“…In a recent review of the Department of Defense Trauma Registry statistics, US Servicewomen casualties were younger (26.1 years of age, compared to 27.8 years of age for males); had more severely rated injuries and overall higher injury severity scores compared to their male counterparts, despite the most common mechanism of battle-injury being IEDs for both genders (Hylden, Johnson & Rivera, 2014). Further reviews have analysed US databases to assess whether there is a difference in long-term disability and subsequent return to duty rates between Servicemen and Servicewomen (Rivera, Hylden & Johnson, 2015). Though US Servicewomen deployed between 2001 and 2011 had lower rates of pain disorders, they had a higher prevalence of arthritic conditions (58%) compared to their male counterparts (35%).…”