A comparative analysis of medically released men and women from the Canadian Armed Forces
Abstract: Introduction: Musculoskeletal (MSK) injuries and mental health (MH) disorders are the leading causes of medical attrition in the Canadian Armed Forces (CAF). Historically, medical attrition rates have been higher for women than men. In order to better understand the medical release trends of men and women, a descriptive analysis of the medical reasons for release was undertaken. Methods: Administrative data sources within the Department of National Defence were used to identify medically released personnel together with their primary medical diagnosis and demographic characteristics, including sex, age, and rank. The analysis included 5,180 Regular Force personnel medically released between April 1, 2014 and March 31, 2017. Results: While overall trends in the reasons for medical release were sometimes similar for men and women, statistically significant differences between the medical release reasons of men and women were found in several of the sub-groups considered. These sub-groups included non-commissioned members (NCMs), officers, Air personnel, and members who had not deployed in the 10 years prior to their release, as well as personnel in the earlier and later stages of their career. Discussion: An increased understanding of the differences between medically released men and women is important for the development of future injury and illness prevention strategies, which have the primary objective of improving the health and operational readiness of serving members, as well as a secondary objective of lowering medical attrition rates to improve overall retention in the CAF.
Abstract: Objectives: Increasing numbers of older adults are reentering community following incarceration (i.e., reentry), yet risk of incident neurodegenerative disorders associated with reentry is unknown. Our objective was to determine association between reentry status (reentry vs never-incarcerated) and mild cognitive impairment (MCI) and/or dementia. Methods: This nationwide, longitudinal cohort study used linked Centers for Medicare & Medicaid Services and Veterans Health Administration data. Participants were aged 65 years or older who experienced reentry between October 1, 2012, and December 31, 2018, with no preincarceration MCI/dementia, compared with age-matched/sex-matched never-incarcerated veterans. MCI/dementia was defined by diagnostic codes. Fine-Gray proportional hazards models were used to examine association. Results: This study included 35,520 veterans, mean age of 70 years, and approximately 1% women. The reentry group (N = 5,920) had higher incidence of MCI/dementia compared with the never-incarcerated group (N = 29,600; 10.2% vs 7.2%; fully adjusted hazard ratio [aHR] 1.12; 95% CI 1.00-1.25). On further investigation, reentry was associated with increased risk of dementia with or without prior MCI diagnosis (aHR 1.21; 95% CI 1.06-1.39) but not MCI only. Discussion: Transition from incarceration to community increased risk of neurocognitive diagnosis. Findings indicate health/social services to identify and address significant cognitive deficits on late-life reentry. Limitations include generalizability to nonveterans.