The use of existing military administrative and health databases for injury surveillance and research.

This issue of the American Journal of Preventive Medicine presents a comprehensive look at the major health problem of the nation’s military population—injuries. Injuries are an important health concern both in the United States and globally.1,2 The 1.5 million members of the services, predominantly young adults, are subject to many of the same hazards that cause injuries to the civilian population in the course of work, travel, and recreation, and are of special pertinence to the study of occupational injuries. The military comprises many occupational specialties that are similar to civilian workforce specialties such as maintenance, transportation, clerical, medical, and others. This issue is particularly timely as the nation seeks to implement the recently developed National Occupational Research Agenda (NORA).3 The NORA Trauma Injury Team Report sought to identify priority areas for investigation, recognize deficiencies in data quality and the methodologies that enable injuries to be prevented, implement efforts and models to permit researchers to address problems, and increase the utility of occupational injury research.4 As the mechanism to identify worker groups with high frequency and risk of injury, surveillance is considered to be the driving force of research and prevention efforts. Without proper attention to surveillance, priority areas based on the magnitude of the problem, risk of injury, and amenability to prevention will go unserved; limited research resources will be directed according to political considerations rather than informed strategy; and the ability to evaluate these efforts will be lost. Population-based administrative databases useful for epidemiologic and outcome studies have typically included national surveys, federal health care programs, large insurance programs or health care delivery systems, statewide hospital discharge databases, and workers’ compensation databases.4,5 However, some of the richest sources of data, those of the Armed Services, have until recently been left untouched. The publication of the Atlas of Injuries in the U.S. Armed Forces by the Department of Defense (DoD) Injury Surveillance and Prevention Work Group6 is an important first step in recognizing the importance of injuries to the Armed Forces. This report and an earlier report to the Armed Forces Epidemiological Board (AFEB)7 clearly identify the value of medical surveillance databases in the military. The creation of a relational database with the ability to link personnel records of the total active duty Army population with various outcome measures (e.g., hospitalization, losttime injury, physical disability, fatality)8 is an example of how more effective use can be made of available data for injury prevention. The number of articles in this supplement that use this database demonstrates the utility of these efforts. The more recent availability of online DoD-wide medical surveillance data for both inpatients and outpatients9 represents another major step forward in the maturation of the field of occupational injury epidemiology and coincides with the presentation of needs for effective research. This commentary describes how many of the research needs pertaining to surveillance systems have already been addressed by existing military administrative databases and suggests that these sources be better used to systematically investigate and devise prevention strategies for important occupational hazards.