Sex Differences in Musculoskeletal Injuries Among Active Duty Service Members in the United States Military From 2017 to 2022, a Retrospective Cohort Study.

INTRODUCTION: United States (U.S.) military service members (SMs) are at unique risk for musculoskeletal injury (MSKI), which threatens health readiness and impedes SMs' ability to execute occupational duties. Female sex has been identified as a risk factor for specific types of MSKI. The primary aim was to investigate sex-based differences in MSKIs based on injury type, demographics, and occupational characteristics. MATERIALS AND METHODS: This study analyzed a retrospective cohort of American military service members who experienced MSKI between 2017 and 2022 using electronic health record data from the Military Health System Data Repository (MDR). Odds ratios (ORs) with 95% CIs compared associations by injury subtype (acute, non-acute, both) between sex and each demographic, occupational, and injury characteristic. RESULTS: Of the 624,842 injured SMs, 17% were female. Female SMs demonstrated 28% increased odds of experiencing non-acute MSKIs only (OR: 1.28; 95% CI, 1.26-1.31). Female SMs in the Navy (OR: 1.12; 95% CI, 1.10-1.14) and those employed in Health Care (OR: 1.22; 95% CI, 1.19-1.25) demonstrated greater odds of MSKI, compared to male counterparts. Female SMs demonstrated greater odds of overuse/non-specific injuries and stress fractures, but reduced odds of amputations, fractures and dislocations/subluxations, compared to male SMs. Compared to male SMs, females in junior officer ranks were 78% and 56% more likely to experience acute and non-acute MSKI. Among SMs with non-acute injuries, females were more likely to serve in Administration and Executives (OR: 2.11; 95% CI, 2.01-2.16), Health Care (OR: 2.99; 95% CI, 2.92-3.07), and Occupationally Unqualified/Trainee roles (OR: 1.21; 95% CI, 1.18-1.23). CONCLUSIONS: Significant sex-based differences elucidated high risk subpopulations to inform policy, with the goal of improving medical and operational readiness.