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From page 88... ...
1,367,827 ILER records lacked a matching VA record. After excluding those without a valid diagnosis of any health outcome during an outpatient or inpatient visit between 2017 and 2023 in the VHA data, 1,145,301 veterans comprised the final VHA-linked ILER dataset, which served as the pool for potential case and control sampling.
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n=1,145,301 NOTES: Cell sizes of 10 or less are noted as <10; analyses conducted in VINCI on April 8, 2025. Initial encounter age calculated using valid birth dates between 1900 and 2005.
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had an average of 2–9 health annual outpatient encounters, while one-fifth (20.0%) had 10 or more encounters; 89.4% were assigned a primary care provider.
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Missing 81,487 (7.1%) VA and Insurance-Related Characteristics Military Sexual Yes, screened reports MST 69,643 (6.1%)
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Race, ethnicity, urbanicity, VA region (VISN) , VA enrollment priority group, and VA disability rating were determined as the value closest to the first health encounter from 2017 to 2023 that was not unknown, declined, or missing.
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ILER = Individual Longitudinal Exposure Record; MST = military sexual trauma; VA = Department of Veterans Affairs. EXPOSURES Table 5-3 summarizes the number of veterans in the sample with at least one of the committee's exposures of interest: burn pits, dust and PM, exhaust, fuels, incinerator emissions, metals, mold, radiation, and solvents.
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DESCRIPTION OF THE STUDY SAMPLE 5-7 FIGURE 5-2 Combination heatmap displaying percentage of the population with two overlapping exposures within the sample with each exposure.
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5-8 POST-9/11 VETERAN EXPOSURES & HEALTH FIGURE 5-3 Combination heatmap displaying number of the population with two overlapping exposures.
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DESCRIPTION OF THE STUDY SAMPLE 5-9 FIGURE 5-4 Distribution of distinct exposures among veterans with ILER data. NOTE: ILER = Individual Longitudinal Exposure Record.
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ALS = amyotrophic lateral sclerosis; CMI = chronic multisymptom illness; ILER = Individual Longitudinal Exposure Record; PTSD = posttraumatic stress disorder; TBI = traumatic brain injury.
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From page 98... ...
In addition, rates of mental health diagnoses are appreciably higher in the study sample and the post-9/11 combat service cohort than in the broader VHA cohort. By contrast, rates of neurologic health outcomes are lower, as expected, since the broader population of VHA users includes many older veterans with service before 9/11.
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From page 99... ...
5-12 POST-9/11 VETERAN EXPOSURES & HEALTH depression were the most common individual outcomes and most frequently co-occurring outcomes in the sample population. Chapters 6, 7, and 8 present the committee's results on possible relationships between the exposures and mental and behavioral health outcomes, neurologic outcomes, and CMI, respectively.
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