P1082 - Health Trends in Eighteen Year Old Military Dependents from 2008-2018

Background: Interest in and eligibility for military service are declining nationally, increasing dependence on recruiting from military connected families. One major impediment to joining the military, is medical ineligibility. Studies show national increases in adolescent obesity and mental health diagnoses, however there is little research on the comprehensive health of adolescents and trends in adolescent health over time. Limited research on military dependent children suggests similar trends, however comprehensive research documenting the health of military dependent adolescents specifically as it relates to their eligibility for military accession over time does not exist.

Purpose: To assess health trends of 18 year old military dependents by exploring trends in diagnosed medical conditions that would preclude adolescents from military service.

Methods: Military dependents aged 18 in 2008-2018 who received care at military treatment facilities and/or civilian facilities domestically and around the world were identified using the military data repository. Department of Defense Instruction disqualifying conditions were classified into 13 Agency for Healthcare Research and Quality Clinical Classification categories. International Classification of Diseases 9/10 codes in the outpatient record identified medically disqualifying conditions. Temporal diagnoses were not included. Annual prevalence of diagnoses was calculated for each category and overall. Negative binomial regression analysis determined trend by calculating incidence rate ratios by year. T-tests compared trends by sex in stratified analysis for disqualifying diagnoses.

Results: Between 83,480 and 124,049 18 year olds received MHS care annually. In 2008, 22.21% of the sample had one or more disqualifying conditions, which increased significantly to 39.39% in 2018 (PRR=1.04, 95% CI [1.03-1.06]). The prevalence of teens with disqualifying urogenital, musculoskeletal, obesity/endocrine, neurological, mental health, and allergy/infectious/rheumatology diagnoses increased significantly from 2008-2018 (Table 1). Blood, eyes and ears, and cardiac conditions were unchanged, and cancer prevalence decreased from 2008-18. Prevalence of obesity/endocrine disorders increased by 10%; mental health diagnoses increased 9% per year (Table 1). Prevalence of any disqualifying diagnosis and mental health diagnosis increased more rapidly for females as compared to males (Table 2).

Conclusion: The prevalence of diagnoses that would preclude adolescents aged 18 from joining the military increased from 2008 to 2018 in 9 of 13 included diagnostic categories. Obesity and mental health diagnoses impacted the largest percentage of adolescents and increased at the greatest rate. These two conditions are generally treatable, presenting opportunities for improvement with targeted prevention and intervention. The high percentages of included military dependents who would be medically disqualified from service suggests a considerable impact on current and future military recruitment and readiness. Pediatric and adolescent providers’ early identification and intervention can curb these trends in many of the identified categories which can positively impact the health of our dependent population and potentially our future fighting force.