Exertional rhabdomyolysis among active component members of the U.S. Armed Forces, 2020-2024

Abstract: Exertional rhabdomyolysis is a pathologic muscle breakdown associated with strenuous physical activity. A largely preventable condition, it persists as an occupational hazard of military training and operations, especially in high heat environments among individuals pushing their endurance limits. A total of 464 cases of exertional rhabdomyolysis were identified in 2024, corresponding to a crude incidence rate of 35.9 cases per 100,000 person-years, and is the lowest case count recorded during the 2020-2024 period of surveillance. The 2024 case numbers demonstrated a 9.6% reduction from the peak rate in 2023, and the proportion of 39.7% hospitalized in 2024 represented a 4.0% decrease from 2023. In 2024, all services, excepting the Navy, showed declines in incidence rates, ranging from 2.0% in the Coast Guard to 29.1% in the Air Force, compared to 2023. Consistent with prior reports, subgroup-specific crude rates in 2024 were highest among men, those less than 20 years old, non-Hispanic Black service members, Marine Corps or Army members, and those in combat-specific or 'other' military occupations. Recruit trainees continued to experience the highest rates of exertional rhabdomyolysis in 2024, with a rate more than 13 times greater than officers and enlisted members. During the 2020-2024 surveillance period, 2024 evinced the lowest incidence rate of exertional rhabdomyolysis, nearly 10% lower than the peak observed in 2023. The Air Force showed the largest reduction, with incidence rates decreasing approximately 30% from the previous year.

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