Identifying Seasonal Trends for Environmental Illness Incidence in the US Army

Research Paper Title

Seasonal Trends for Environmental Illness Incidence in the US Army.


The incidence of and risk factors for exertional heat illness (EHI) and cold weather injury (CWI) in the US Army have been well documented. The “heat season”, when the risk of EHI is highest and application of risk mitigation procedures is mandatory, has been arbitrarily defined as 01 May through 30 September, while the “cold season” is understood to occur from 01 October to 30 April each year. The proportions of EHI and CWI that occur outside of the traditional heat and cold seasons are unknown. Additionally, it is unknown if either of the seasonal definitions are appropriate. The primary purpose of this study was to determine the proportion of EHI and of CWI that occur within the commonly accepted seasonal definitions. The researchers also report the location-specific variability, seasonal definitions, and the demographic characteristics of the populations.


The US Army installations with the highest frequency of EHI and of CWI from 2008 to 2013 were identified and used for analysis. In total there were 15 installations included in the study, with five installations used for analysis in both the EHI and CWI projects. In- and out-patient EHI and CWI data (ICD-9-CM codes 992.0 to 992.9 and ICD codes 991.0 to 991.9, respectively) were obtained from the Defence Medical Surveillance System. Installation-specific denominator data were obtained from the Defence Manpower Data Centre, and incidence rates were calculated by week, for each installation. Segmental (piecewise) regression analysis was used to determine the start and end of the heat and cold seasons.


The analysis indicates that the heat season starts around 22 April and ends around 09 September. The cold season starts on 03 October and ends on 24 March. The majority (n = 6,445, 82.3%) of EHIs were diagnosed during the “heat season” of May 1 to September 30, while 10.3% occurred before the heat season started (01 January to 30 April) and 7.3% occurred after the heat season ended (01 October to 31 December). Similar to EHI, 90.5% of all CWIs occurred within the traditionally defined cold season, while 5.7% occurred before and 3.8% occurred after the cold season. The locations with the greatest EHI frequency were Ft Bragg (n = 2,129), Ft Benning (n = 1,560), and Ft Jackson (n = 1,538). The bases with the largest proportion of CWI in this sample were Ft Bragg (17.8%), Ft Wainwright (17.2%), and Ft Jackson (12.7%). There were considerable inter-installation differences for the start and end dates of the respective seasons.


The present study indicates that the traditional heat season definition should be revised to begin ∼3 weeks earlier than the current date of 01 May; the data indicate that the current cold season definition is appropriate. Inter-installation variability in the start of the cold season was much larger than that for the heat season. Exertional heat illnesses are a year-round problem, with ∼17% of all cases occurring during non-summer months, when environmental heat strain and vigilance are lower. This suggests that EHI mitigation policies and procedures require greater year-round emphasis, particularly at certain locations.


DeGroot, D.W., Rappole, C.A., McHenry, P. & Englert, R.M. (2021) Seasonal Trends for Environmental Illness Incidence in the U.S. Army. Military Medicine. doi: 10.1093/milmed/usab072. Online ahead of print.


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