Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Disability After Deployment Injury: Are Women and Men Service Members Different?

Jessica C. Rivera MD, Christina M. Hylden MD, Anthony E. Johnson MD

Abstract

Background

Civilian trauma literature suggests sexual dimorphism in outcomes after trauma. Because women represent an increasing demographic among veterans, the question remains if war trauma outcomes, like civilian trauma outcomes, differ between genders.

Questions/purposes

(1) Do women service members develop different conditions resulting in long-term disability compared with men service members after injuries sustained during deployment? (2) Do women service members have more or less severe disability after deployment injury compared with men service members? (3) Are men or women more likely to return to duty after combat injury?

Methods

The Department of Defense Trauma Registry was queried for women injured during deployment from 2001 to 2011. The subjects were then queried in the Physical Evaluation Board database to determine each subject’s return-to-duty status and what disabling conditions and disability percentages were assigned to those who did not return to duty. Frequency of disabling conditions, disability percentages, and return-to-duty rates for 368 women were compared with a previously published cohort of 450 men service members, 378 of whom had orthopaedic injuries.

Results

Women who were unable to return to duty had a higher frequency of arthritic conditions (58% [48 of 83] of women versus 35% [133 of 378] of men, p = 0.002; relative risk [RR], 1.64; 95% confidence interval [CI], 1.307–2.067) and lower frequencies of general chronic pain (1% [one of 83] of women versus 19% [59 of 378] of men, p < 0.001; RR, 0.08; 95% CI, 0.011–0.549) and neurogenic pain disorders (1% [one of 83] of women versus 7% [27 of 378] of men, p = 0.0410; RR, 0.169; 95% CI, 0.023–1.224). Women had more severely rated posttraumatic stress disorder (PTSD) compared with men (38% ± 23% versus 19% ± 17%). Forty-eight percent (64 of 133) of battle-injured women were unable to return to active duty, resulting in a lower return-to-duty rate compared with men (34% [450 of 1333]; p = 0.003).

Conclusions

After deployment-related injury, women have higher rates of arthritis, lower rates of pain disorders, and more severely rated PTSD compared with men. Women are unable to return to duty more often than men injured in combat. These results suggest some difference between men’s and women’s outcomes after deployment injury, important information for military and Veterans Administration providers seeking to minimize postdeployment disability.

Level of Evidence

Level III, prognostic study.

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