Report: Females and younger service members have highest incidence rates of sunburn diagnoses

Females, white non-Hispanic, and younger service members had the highest incidence rates of sunburn diagnoses among active component service members, according to a new health surveillance report released today.

The incidence rate of sunburn diagnoses was higher among females at 168 per 100,000 person-years (p-yrs) compared to males (117 per 100,000 p-yrs). Among all racial/ethnic groups, white, non-Hispanic service members had the highest incidence rate at 173.8 per 100,000 p-yrs. Sunburn incidence rates were highest among the younger age groups, peaking among service members 19 years of age and younger (320 per 100,000 p-yrs), said the report published in the July issue of the Medical Surveillance Monthly Report (MSMR) from the Armed Forces Health Surveillance Center (AFHSC).

Individuals in the Marine Corps and Army, enlisted service members, and recruits also demonstrated higher incidence rates of sunburn compared to their respective counterparts. The other/unknown and armor/motor transport occupational categories were associated with the highest incidence rates of sunburn and the pilot/air crew category had the lowest incidence rate (Table 1). Further analysis by three-digit occupational categories showed that 10 specific occupations accounted for 50 percent of all cases (Table 2). Ten percent of sunburn cases were characterized as "not occupationally qualified," a category that includes recruits, students, and trainees.

The report describes the counts, rates, and trends of clinically significant sunburns (i.e., those associated with documented medical encounters for diagnoses of sunburn) among active component service members. During the 12-year surveillance period, a total of 19,172 incident cases of clinically significant sunburn were diagnosed among active component service members (Table 1). The overall crude incidence rate was 124.8 per 100,000 p-yrs. Most of the cases were first degree sunburn (n=15,375; 80.2%); 19.6% (n=3,757) were second degree sunburn; and 0.2% (n=40) were third degree sunburn. Only a small percentage of sunburn cases were hospitalized (n=23; 0.1%) (data not shown).

The surveillance period was 2002-2013. The surveillance population included all active component service members of the Army, Navy, Air Force, Marine Corps, and Coast Guard. The data used in this analysis were derived from the Defense Medical Surveillance System (DMSS), which maintains electronic records of all actively serving U.S. military members' hospitalizations and ambulatory healthcare visits in U.S. military and civilian (contracted/purchased care through the Military Health
System) and medical facilities worldwide.

"The cases of sunburn identified in this study were service members who actually sought medical care for their sunburns," said Navy Captain Kevin L. Russell, Director of the AFHSC. "Although it is likely that most service members who get sunburned do not seek health care, it remains a concern that the rates of first and second degree sunburns did not come down during the study period."

The finding that rates of sunburn diagnoses were highest among the youngest age group is similar to observations in other studies reporting the prevalence of sunburn and sun exposure among teenagers and young adults in large populations.13,14

The incidence rate among recruits was more than 3.5 times that of non-recruits. Higher rates may be due to a greater proportion of younger service members in recruit status, the nature of recruit training (e.g., intense outdoor physical training), the location of recruit training centers (many in sunny Southern climates), and lack of knowledge or preparation for sun exposure. Higher rates of sunburn diagnosis among recruits may also reflect easier access and increased incentive to report to sick call.

"We know how to prevent sunburn," Russell said. "But the challenges are to get all service members to understand the importance of using protective measures to avoid incidences of sunburn. There may also be opportunities for improved institutional policies and procedures."

In a separate article about sunburn diagnoses among those deployed in Southwest/Central Asia, a total of 427 service members were diagnosed with sunburn while deployed in that region during a six-year surveillance period. The incidence rate among deployed service members was 51.4 per 100,000 p-yrs.

Incidence rates increased 140% from 2008 to 2011, and then decreased in 2012. The incidence rate in 2013 (63.7 per 100,000 p-yrs) was higher than in 2012 and was the second highest annual rate during the period. Of all documented cases, most (n=368; 86.1%) were diagnosed as first degree sunburn. No third degree sunburns were diagnosed during the period.

The surveillance period was January 1, 2008 through December 31, 2013. The surveillance population included all active component service members of the Army, Navy, Air Force, Marine Corps, and Coast Guard who served at least 1 day in a theater of operations in the U.S. Central Command area or responsibility during the surveillance period.

Incidence rates of sunburn were higher among females than males (female-to-male rate ratio [RR]=2.2) and among white, non-Hispanics (67.6 per 100,000 p-yrs) than any other racial/ethnic subgroup of service members (Table 1). Service members who were enlisted, in the Air Force or Army, and aged 20-24 years had higher incidence rates of sunburn than their respective counterparts.

The overall crude rate of sunburn diagnoses while serving in Southwest/ Central Asia was approximately one-third of the rate among non-deployed service members. The risks of prolonged and intensive sun exposures during combat assignments in Asia are likely similar to or higher than those during most peace time assignments; however, service members in war zones may be more likely to follow sun safety measures (e.g., wearing sunscreen, utilizing shaded areas) and less likely to receive care for sunburns (particularly first-degree sunburns) in medical treatment facilities.

Also, in general, military members serving in war zones have less time for recreational activities, wear military uniforms more often (which cover the arms and legs and include donning head gear and protective sunglasses while outdoors), and are prohibited from drinking alcohol. Alcohol intake has been associated with increased risk of sunburn.1,2