Abstract
The study of effects associated with human exposure to repeated low-level blast during training or operations of select military occupational specialties (MOS) challenges medical science because acute negative effects that might follow such exposures cannot be expected to be clear or prevalent. Any gross effects from such occupational blast exposure on health or performance should be expected to have been already identified and addressed by affected military units through changes to their standard training protocols. Instead, effects, if any, should be expected to be incremental in nature and to vary among individuals of different susceptibilities and exposure histories. Despite the challenge, occupational blast-associated effects in humans are emerging in ongoing research. The purpose of the present study was to examine medical records for evidence of blast-associated effects that may have clinical significance in current standard of care. We hypothesized that populations exposed to blast by virtue of their military occupation would have poorer global medical outcomes than cohorts less likely to have been occupationally exposed. Records from a population of 50,254 service members in MOSs with a high likelihood of occupational blast exposure were compared to records from a matched cohort of 50,254 service members in MOSs with a lower likelihood of occupational blast exposure. These two groups were compared in hospitalizations, outpatient visits, pharmacy, and disability ratings. The clearest finding was higher risk among blast-exposed MOSs for ambulatory encounters for tinnitus, with adjusted risk ratios of 1.19 (CI 1.03–1.37), 1.21 (CI 1.16–1.26), and 1.31 (CI 1.18–1.45) across career time points. Other hypothesized effects (i.e., neurological outcomes) were smaller and were associated with acute exposure. This study documents that service members in occupations that likely include repeated exposure to blast are at some increased risk for neurosensory conditions that present in medical evaluations. Other hypothesized risks from occupational exposure may manifest as symptomology not visible in the medical system or current standard of care. Separate studies, observational and epidemiological, are underway to evaluate further the potential for occupational risk, but the evidence presented here may indicate near-term opportunities to guide efforts to reduce neurosensory risk among exposed service members.
Highlights
The term “occupational blast exposure” is intended to denote repeated exposures to low-level explosive blast events that occur as part of training and operational activities experienced by personnel in designated roles in the military and law enforcement
This matched cohort study compared healthcare utilization, prescription drug utilization, and disability discharge between Soldiers with specific combat arms occupations, with military occupational specialties (MOS) serving as a proxy for occupational exposure to explosive blast, vs. Soldiers with occupations that are likely to deploy to a combat zone but less likely to be occupationally exposed to blast
The group occupationally exposed to blast was slightly more likely to be white and have a higher education level at military entry than the Unexposed group. Of those who were deployed, both groups were deployed a similar number of times, yet the Exposed group was deployed, on average, slightly earlier (Exposed = 1.75 years of service; Unexposed = 1.90 years of service) and for a Exposed Unexposed Adjusted 95% CI (n = 50,254) (n = 50,254) relative risk (RR)*
Summary
The term “occupational blast exposure” is intended to denote repeated exposures to low-level explosive blast events that occur as part of training and operational activities experienced by personnel in designated roles in the military and law enforcement. Such roles include indirect fires (artillery, mortar), explosive breaching, and antiarmor weapon operation. These occupational roles will differ in blast exposure magnitude, frequency, periodicity, or concomitant factors such as acoustic insult, aerobic exertion, and psychological stress. The work presented here is an examination of medical records for clinical evidence for hypothesized occupational blast exposure effects
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