Nontraumatic deaths during U.S. Armed Forces basic training, 1977-2001

BACKGROUND

A Recruit Mortality Registry, linked to the Department of Defense Medical Mortality Registry, was created to provide comprehensive medical surveillance data for deaths occurring during enlisted basic military training.

METHODS

Recruit deaths from 1977 through 2001 were identified and confirmed through redundant sources. Complete demographic, circumstantial, and medical information was sought for each case and recorded on an abstraction form. Mortality rates per 100,000 recruit-years were calculated by using recruit accession data from the Defense Manpower Data Center.

RESULTS

There were 276 recruit deaths from 1977 through 2001 and age-specific recruit mortality rates were less than half of same-age U.S. civilian mortality rates. The majority (72%) of recruit deaths were classified as nontraumatic and 70% of these deaths (139 of 199) were related to exercise. Of the exercise-related deaths, 59 (42%) were cardiac deaths, and heat stress was a primary or contributory cause in at least 46 (33%). Infectious agents accounted for only 49 (25%) of the nontraumatic deaths. Nontraumatic death rates increased with age (rate ratio is 2.5 for 25+ v <25 years; p<0.001). The age- and gender-adjusted nontraumatic death rates were 2.6 times higher for African American than non-African American recruits (p<0.001).

CONCLUSIONS

Although recruit mortality rates are lower than the same-age U.S. civilian population, preventive measures focused on reducing heat stress during exercise might be effective in decreasing the high proportion of exercise-related death. The availability of 25 years of comprehensive recruit mortality data will permit the ongoing evaluation of cause-of-death trends, effectiveness of preventive measures, and identification of emerging threats during basic military training.

Traumatic deaths during U.S. Armed Forces basic training, 1977-2001

BACKGROUND

A Recruit Mortality Registry, linked to the Department of Defense Medical Mortality Registry, was created to provide comprehensive medical surveillance data for deaths occurring during enlisted basic military training.

METHODS

Recruit deaths from 1977 through 2001 were identified and confirmed through redundant sources. Complete demographic, circumstantial, and medical information was sought for each case and recorded on an abstraction form. Mortality rates per 100,000 recruit-years were calculated by using recruit accession data from the Defense Manpower Data Center.

RESULTS

There were 276 recruit deaths from 1977 through 2001 and age-specific recruit mortality rates were less than half of same-age U.S. civilian mortality rates. Only 28% (77 of 276) of recruit deaths were classified as traumatic (suicide, unintentional injury, and homicide), in comparison to three quarters in both the overall active duty military population and the U.S. civilian population (ages 15-34 years). The age-adjusted traumatic death rates were highest in the Army (four times higher than the Navy and Air Force, and 80% higher than the Marine Corps). The majority (60%) of traumatic deaths was due to suicide, followed by unintentional injuries (35%), and homicide (5%). The overall age-adjusted traumatic mortality rate was more than triple for men compared with women in all military services (rate ratio=3.9; p=0.01).

CONCLUSIONS

There was a lower proportion of traumatic deaths in recruits compared to the overall active duty military population and same-age U.S. civilian population. This finding could be attributed to close supervision, emphasis on safety, and lack of access to alcohol and motor vehicles during recruit training.

Causes of sudden death in young and middle-aged competitive athletes

The incidence of sudden death in athletes is low. Some pathologic conditions may predispose to sudden death during exercise in young athletes. In older individuals, exercise may trigger terminal arrhythmias in patients with severe coronary atherosclerosis. Screening programs with a history and a physical examination are recommended for high school and collegiate sports participants. For older individuals who are likely to have undetected or overt coronary heart disease and are exercising for physical fitness, caution regarding the level of activity and type of symptoms that are frequently associated with coronary disease may help prevent sudden death.