Exposome Signatures of Lower Back Pain Among Active Duty U.S. Army and Marine Corps Rotary Wing Pilots and Maintenance Crews

Lumbosacral pain (LBP) is common among active-duty military service members (ADSM). According to the 2019 Health of the Force report, "from 2016 through 2018, low back pain had the highest number of associated encounters and costs of all diagnoses for Active Component Soldiers." A 2019 Department of Defense report to Congress included medical record data (2005-2015) showing that spinal disorder accounted for 15.2% of all Army aircrew diagnoses, with lumbago accounting for almost 5% of all diagnoses. Our goal was to characterize reliable predictors of LBP, extracted from the exposome signatures of ADSM. This retrospective, observational cohort study used the Medical Assessment and Readiness System (MARS) to evaluate longitudinal data sourced from various medical and manpower resources. This study included 54,601 ADSM in the Army and Marine Corps rotary wing Aviation Community (AMAC) from 2016 to 2020. Multinomial mixed-effects logistic regression was used to assess the relationship the relationship between demographic, medical, and operational variables against the occurrence of LBP (e.g., ICD10: M54.5). Descriptive analyses were performed to contrast the attributes of ADSM in the rotary wing/aircrew maintenance community with and without LBP. Nearly half of rotary wing pilots (43.1%) are diagnosed with LBP. Although time in service was similar between rotary wing pilots with LBP (14 ± 6 years) and without LBP (13 ± 6 years), the data show that only 83.2% of individuals without LBP had been deployed compared with 90.1% of those with LBP. Active-duty military service members with LBP had a slightly higher mean age compared with ADSMs without LBP as observed in both pilot components (35 ± 7 years; 32 ± 7 years) and maintenance crews (28 ± 8 years; 24 ± 6 years). Among rotary wing pilots with LBP, 12.1% used tobacco compared with only 9.7% among pilots without LBP. Similarly, 23.9% of maintenance crews with LBP used tobacco compared with only 21.0% among maintenance crew without LBP. Independent of age, married individuals were 1.43 × more likely to have an LBP diagnosis, P < .001. Our longitudinal approach aims to incorporate big data science analytics from MARS with that of objective biochemical indicator species validations observed in active duty service members suffering from back pain. We have developed a parallel complementarity template with the potential of substantiating foundational mechanisms underlying disease processes to design prospective personalized algorithms, which could also be used as predictive models.