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Patient age, comorbidity burden, and disease severity at presentation are the major factors associated with surviving COVID-19. Hospital-level factors including ICU occupancy may confer additional risk to individual patients, particularly at times of maximal stress on healthcare systems. The interaction of patient- and hospital-level factors over time during pandemic disease remains an area of active exploration.To determine the impact of patient and hospital risk factors during episodic surges, characterize severity distribution between waves, and evaluate patient-level impact of ICU capacity on COVID-19 survivorship.Retrospective cohort study.Four acute care hospitals within an integrated healthcare network in San Diego, California.All patients (18+ y.o.) admitted with a positive PCR test for SARS-CoV-2 or ICD-10 code for COVID-19 from March 1, 2020 through June 30, 2021.Patient survivorship and length of stay.Six thousand eight hundred fifty-one patients were evaluated in this large cohort series. Patient level factors associated with mortality included: severity at admission (WHO Clinical Progression Score [WCPS]), age, gender, BMI, marital status, language preference, Elixhauser score, elevated laboratory (d-dimer, ferritin, LDH) or lower absolute lymphocyte count. When adjusting for patient age alone, survivorship during surges was also inversely associated with ICU occupancy, though this correlation was not present when adjusted for patient-level factors.Patient age, comorbidity burden, and severity at the time of presentation are the major factors associated with surviving COVID-19. Hospital-level factors including ICU occupancy may confer additional risk to individual patients, particularly at times of maximal stress on healthcare systems.

Purpose The characteristics of U.S. military personnel who use dietary supplements have not been well described. This study aimed to determine whether deployment experience and physical activity were associated with the use of bodybuilding, energy, or weight-loss supplement among U.S. military personnel. Methods Self-reported data from active-duty, Reserve, and National Guard participants of the Millennium Cohort Study collected from 2007–2008 (n = 106,698) on supplement use, physical activity, and other behavioral data were linked with deployment and demographic data. We used multivariable logistic regression sex-stratified models to compare the adjusted odds of each type of supplement use among those with deployment experience in support of operations in Iraq or Afghanistan and those engaged in aerobic or strength-training activities. Results Overall, 46.7% of participants reported using at least one type of supplement, and 22.0% reported using multiple supplements. Male deployers were more likely to use bodybuilding supplements, whereas female deployers were more likely to use weight-loss supplements. Physically active and younger subjects reported all types of supplement use. Men and women reporting 5 or less hours of sleep per night were more likely to use energy supplements. Conclusions The high prevalence of supplement use and important characteristics found to be associated with their use, including deployment, physical activity, and suboptimal sleep, suggest focus areas for future research and adverse event monitoring.

Purpose There is significant public and veteran concerns over the impact of military deployments to Iraq and Afghanistan on veterans' health. This study investigates morbidity among deployers by uniquely comparing after-deployment hospitalizations to before-deployment hospitalizations and hospitalizations among nondeployers. Methods To compare after-deployment with before-deployment rates of morbidity, we examined active-duty military personnel who deployed for the first time in support of the current conflicts in 2003 or 2004 and had at least 12 months of service before deployment. We also compared the after-deployment hospitalizations to hospitalizations of personnel serving on active duty from May 2002 through May 2004 without a deployment from September 2001 through August 2006. This historical prospective investigation utilized Cox's proportional hazards time-to-event modeling. Hospitalizations for any cause and hospitalizations based on 14 broad diagnostic categories were examined. Results After adjusting for demographic and occupational variables, the after-deployment risk for any-cause hospitalization was greater in comparison with before-deployment (hazard ratio, 1.57; 95% CI, 1.48–1.66) but lower in comparison with nondeployers (HR, 0.95, 95% CI, 0.92–0.98). Conclusions Active-duty service members have an increased risk of hospitalization after deployment compared with before deployment but a lower risk when compared with nondeployers.

PURPOSE: Studies researching service members’ health after deployment have relied on self-reported deployment history, although validity of these data remains unknown. This study compared self-reported and electronic deployment data and explored differences in functional health. METHODS: Self-reported and military deployment data were compared for more than 51,000 participants enrolled in the Millennium Cohort Study (2004–2006). Kappa statistics were used to measure agreement. Analysis of variance was used to assess functional health, as measured by the Medical Outcomes Study Short Form 36-Item Health Survey for Veterans (SF-36V). RESULTS: Of 51,741 participants who completed the initial deployment question, objective records and self-report agreed in 47,355 (92%). Agreement was substantial for deployment status, frequency, and number of deployments (kappa Z 0.81, 0.71, and 0.61, respectively). Deployment start dates agreed within 1 month for 82% of participants confirmed as deployed once. Participants’ Mental and Physical Component Summary scores from the SF-36V did not differ by agreement level. CONCLUSIONS: These findings indicate substantial agreement between self-reported and objective deployment information and no clinically meaningful differences in functional health for the small proportion with inconsistent deployment information. These findings should be reassuring to investigators who examine military deployment as a determinant of future health. Ann Epidemiol 2007;17:976–982. 2007 Elsevier Inc. All rights reserved.

Purpose The Millennium Cohort Study began in 2001 using mail and Internet questionnaires to gather occupational and environmental exposure, behavioral risk factor, and health outcome data from a large, population-based US military cohort. Standardized instruments, including the Patient Health Questionnaire, the Medical Outcomes Study Short Form-36 for Veterans, and the Posttraumatic Stress Disorder (PTSD) Checklist–Civilian Version, have been validated in various populations. The purpose of this study was to investigate internal consistency of standardized instruments and concordance of responses in a test-retest setting. Methods Cronbach alpha coefficients were used to investigate the internal consistency of standardized instruments among 76,742 participants. Kappa statistics were calculated to measure stability of aggregated responses in a subgroup of 470 participants who voluntarily submitted an additional survey within 6 months of their original submission. Results High internal consistency was found for 14 of 16 health components, with lower internal consistency found among two alcohol components. Substantial test-retest stability was observed for stationary variables, while moderate stability was found for more dynamic variables that measured conditions with low prevalence. Conclusions These results substantiate internal consistency and stability of several standard health instruments applied to this large cohort. Such reliability analyses are vital to the integrity of long-term outcome studies.

Purpose To describe medical symptom and condition reporting in relation to complementary and alternative medicine (CAM) use among members of the US military. Methods CAM was defined as health treatments not widely taught at US medical schools or typically available at US hospitals. By using data from the Millennium Cohort Study, we included participants who completed a survey from 2004 to 2006 (n = 86,131) as part of this cross-sectional analysis in which we sought to identify demographic characteristics and types of health-related symptoms and conditions associated with CAM use. Chi-square tests were used to compare health assessed by self-reported symptoms and conditions among those not reporting CAM use with those reporting practitioner-assisted or self-administered CAM. Results Of 86,131 participants, 30% reported using at least one practitioner-assisted CAM therapy, 27% reported using at least one self-administered CAM therapy, whereas 59% did not report using any CAM therapy. Both women and men who used CAM reported a greater proportion of specific health conditions and health-related symptoms compared with those not reporting CAM use (p Conclusions These findings illustrate that a relatively young adult occupational cohort of military personnel using CAM therapies also report multiple comorbidities which may indicate chronic illness management and poorer overall health.