Traumatic brain injury (TBI) has been called the “signature injury” of recent conflicts in Iraq and Afghanistan.
TBIs are concerning because they can cause long-term issues like headaches, memory problems, and trouble thinking clearly.
A new study looked at which military jobs put service members most at risk for TBIs.
It found that certain combat-related jobs had much higher rates of TBIs.
Enlisted personnel were also more likely to experience TBIs than officers.
This highlights the need for better TBI prevention among high-risk military occupations.
Key Facts:
- About 27% of active service members in the study reported at least one TBI while serving.
- Combat roles like infantry had a 45% higher risk of TBI than non-combat roles like administration.
- Enlisted personnel had a 72% higher risk of TBI than officers.
- Those with a TBI history before enlisting were over 5 times more likely to experience another TBI while serving.
Source: Military Medicine (Vol. 188; Issue 9-10)
Examining TBI Risk by Military Occupation
Researchers analyzed data from over 40,000 active service members to compare TBI rates between different military jobs, known as Military Occupational Specialties (MOS).
This is the first study to separately examine TBI risk for enlisted personnel versus officers in each MOS.
Looking at these groups separately gives a clearer picture of who is most at risk.
Higher TBI Rates Seen in Combat Roles
The study found that service members in combat-focused roles like infantry and tactical operations had the highest rate of TBIs while serving.
For example, about 32% of those in tactical operations roles reported experiencing at least one TBI.
This was 45% higher compared to around 24% of those in non-combat roles like administration.
Other jobs involving frequent combat exposure also had elevated TBI rates:
- Communications/intelligence: 28% reported TBI
- Combat engineering: 26% reported TBI
- Artillery/gunnery: 27% reported TBI
The heightened risk seems directly tied to combat-related blast exposures and injuries.
As expected, service members in health care roles did not show increased TBI risk.
Higher TBI Rates Among Enlisted Personnel
When looking at enlisted personnel and officers separately, a striking pattern emerged.
Around 28% of enlisted personnel across all MOSs experienced a TBI.
Among officers, only 24% reported TBIs.
After accounting for factors like sex, military branch, and prior TBIs, enlisted personnel had a 72% higher odds of TBI compared to officers.
This held true even when comparing enlisted personnel and officers within the same types of units, like infantry.
The researchers suggest several potential reasons for this discrepancy:
- Enlisted personnel take on higher-risk tasks earlier in their careers. Officers generally serve in supervisory roles.
- Officers may have less blast exposure in combat since they are further from the front lines.
- Combining data for enlisted personnel and officers may have obscured higher risks in enlisted ranks.
Among enlisted personnel, those in front-line combat roles faced the highest risk:
- Infantry/gun crews/seamanship: 79% higher odds of TBI
- Combat engineering: 23% higher odds
But those in technical support roles also faced increased risks:
- Equipment repair: 23% higher odds
- Healthcare: 19% higher odds
- Communications/intelligence: 16% higher odds
For officers, intelligence roles carried the highest TBI risk at 27% higher odds.
This differs from past research likely due to combining officer and enlisted data.
The Impact of Previous Head Injuries
A major risk factor for TBI was a prior history of head injuries before enlisting.
Those with 2 or more past TBIs had over 10 times the risk compared to those with none.
This aligns with sports research showing prior concussions raise the chances of future concussions.
Why we need to understand TBI patterns
These findings reveal how TBI risks vary substantially between military occupations.
Some key implications:
- Targeted TBI prevention is needed for high-risk enlisted combat roles. This could include better helmets, rest periods between blasts, and removing personnel immediately after head injuries.
- All service members should be screened for prior TBIs before enlisting and monitored closely if reporting multiple past TBIs.
- More research is needed on the settings and causes of TBIs in technical roles. Were these combat-related or from training and equipment accidents? This distinction can further focus prevention efforts.
- Data for officers and enlisted personnel should be analyzed separately rather than grouped together, which can mask higher risks in enlisted ranks.
Limiting TBIs in the military is crucial given their short and long-term impacts on health and disability.
Identifying and protecting those most at risk is an essential first step.
References
- Study: Occupation and risk of traumatic brain injury in the millennium cohort study
- Authors: Kalyn C. Jannace et al. (2023)
