Student Research: James Terrio

MPH, , 2003
Faculty Advisor:

The Effectiveness of the Preplacement Examination in Identifying Army Officers at Risk for Disability


Abstract

The U.S. Army performed more than 1,575,000 examinations for medical fitness between 1995 and 2000 on individuals applying for enlisted active duty status and performed over 15,000 exams between 1999-2000 for individuals applying for active duty status as a commissioned officer. The medical fitness evaluations are used to screen out candidates unsuitable for military service, and to establish a medical baseline documenting pre-existing conditions. This study compares longevity of employment in cadets commissioned with a medical waiver to those found fully medically qualified. It also examines disability rates in cadets receiving waivers and cadets found fully medically qualified.

We conducted a retrospective cohort study of Reserve Officer Training Corps (ROTC) cadets attending ROTC Advance Camp at Ft Lewis, Washington. The medical waiver status of the cadets at the time of their physical examination at ROTC Advanced Camp was used to identify the two sub-cohorts of interest. Compensated disability was the outcome of interest. The primary analysis used Cox proportional survival analysis. There was no significant effect of waiver status on subsequent disability (hazard ratio, HR, 1.02; 95% confidence interval, CI, 0.49, 2.13), adjusted for the other covariates on disability as defined in this study (including age, marital status, and work restriction at time of commissioning).

The risk of disability was found to be significantly greater for female gender (HR 1.64; 95% CI 1.02, 2.63) and marginally greater for other race/ethnicity (HR 1.88; 95% CI 0.98, 3.59); however, there was a significant interaction between these variables. A post hoc analysis revealed that Caucasian females had a significantly greater risk (relative risk, RR 2.5; 95% CI 1.49,4.17) of disability than Caucasian males. Conversely, males in the African American and other (non-Hispanic) race/ethnicity groups had greater risk for disability than females (RR 1.85, 95% CI 0.69,4.94). These findings were not anticipated, and it is not possible to conclude whether they are meaningful or artifactual.