@article{ref1,
title="Risk of stress fracture varies by race/ethnic origin in a cohort study of 1.3 million U.S. Army soldiers",
journal="Journal of bone and mineral research",
year="2017",
author="Bulathsinhala, Lakmini and Hughes, Julie M. and McKinnon, Craig J. and Kardouni, Joseph R. and Guerriere, Katelyn I. and Popp, Kristin L. and Matheny, Ronald W. and Bouxsein, Mary L.",
volume="32",
number="7",
pages="1546-1553",
abstract="Stress fractures (SF) are common and costly injuries in military personnel. Risk for SF has been shown to vary with race/ethnicity. Previous studies report increased SF risk in White and Hispanic Soldiers compared to Black soldiers. However, these studies did not account for the large ethnic diversity in the U.S. Military. <br><br>PURPOSE: We aimed to identify differences in SF risk among racial/ethnic groups within the U.S. Army. <br><br>METHODS: A retrospective cohort study was conducted using data from the Total Army Injury and Health Outcomes Database from 2001 until 2011. SF diagnoses were identified from ICD-9 codes. We used Cox-proportional hazard models to calculate time to SF by racial/ethnic group after adjusting for age, education, and body mass index. We performed a sex-stratified analysis to determine whether the ethnic variation in SF risk depends on sex. <br><br>RESULTS: We identified 21,549 SF cases in 1,299,332 Soldiers (over 5,228,525 person-years of risk), revealing an overall incidence rate of 4.12 per 1,000 person-years (7.47 and 2.05 per 1,000 person years in women and men, respectively). Using Non-Hispanic Blacks as the referent group, Non-Hispanic White women had the highest risk of SF, with a 92% higher risk of SF than Non-Hispanic Black women [1.92 (1.81-2.03)], followed by American Indian/Native Alaskan women [1.72 (1.44-1.79)], Hispanic women [1.65 (1.53-1.79)] and Asian women [1.32 (1.16-1.49)]. Similarly, Non-Hispanic White men had the highest risk of SF, with a 59% higher risk of SF than Non-Hispanic Black men [1.59 (1.50-1.68))], followed by Hispanic men [1.19 (1.10-1.29)]. <br><br>CONCLUSION: When examining the total U.S. Army population, we found substantial differences in the risk of stress fracture among racial/ethnic groups, with Non-Hispanic White Soldiers at greatest risk and Hispanic, American Indian/Native Alaskan, and Asian Soldiers at an intermediate risk. Additional studies are needed to determine the factors underlying these race- and ethnic-related differences in stress fracture risk. This article is protected by copyright. All rights reserved.<br><br>This article is protected by copyright. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0884-0431",
doi="10.1002/jbmr.3131",
url="http://dx.doi.org/10.1002/jbmr.3131"
}