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Veterans and Agent Orange: Update 2004 (2005)

Chapter: Appendix A: Epidemiologic Tables for Chapter 4

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Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

APPENDIX A
Epidemiologic Tables for Chapter 4

In Tables A-1, A-2, and A-3, respectively, studies are grouped according to whether their subjects had occupational exposures, had environmental exposures, or were specifically veterans. The tables provide an overview of design aspects of those epidemiologic studies reviewed in this and earlier reports that presented results on more than one health outcome or that investigated populations that have been repeatedly studied. The summaries include the study’s design type, the numbers of subjects in the study and comparison populations, and a synopsis of how subjects were selected, how data were collected, what inclusion criteria were used, and how exposure was determined. Results were discussed in the appropriate health outcome chapter of the Veterans and Agent Orange document in which the publication was reviewed. The references for this section are at the end of Chapter 4.

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

TABLE A-1 Epidemiologic Studies—Occupational Exposure

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

PRODUCTION WORKERS

NIOSH Studies Reviewed in Update 2002

Steenland et al., 2001

Cohort

A study to reexamine and compare diabetes data from the NIOSH cohort and the United States Air Force Ranch Hands in order to reconcile differences between the two study methods and protocols

267 NIOSH workers 990 Ranch Hand subjects

227 NIOSH comparisons 1,275 Ranch Hand comparisons

NIOSH Studies Reviewed in Update 2000

Calvert et al., 1999

Cohort

Continuing follow-up of workers employed more than 15 years ago at two plants that manufactured substances contaminated with TCDD to evaluate associations between serum TCDD and serum glucose (diabetes), TSH, total T4, and T3

281

260

Steenland et al., 1999

Cohort

Mortality study of workers at 12 industrial plants that produced chemicals contaminated with TCDD, using a job-exposure matrix to estimate TCDD exposure categories. Endpoints reported are all cancers, ischemic heart disease, and diabetes

5,132 (3,538 with exposure data divided into septiles of cumulative exposure; 608 with chloracne)

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Calvert et al., 1998

Cohort

Continuing follow-up of workers employed more than 15 years ago at two plants that manufactured substances contaminated with TCDD to evaluate the association between TCDD exposure and cardiovascular outcomes

281

260

Halperin et al., 1998

Cohort

Continuing study of a cohort of TCDD-exposed workers at two plants that manufactured substances contaminated with TCDD to assess the association between serum TCDD and immunological outcome variables for eligible workers and matched neighborhood controls

259

243

NIOSH Studies Reviewed in Update 1998

Sweeney et al., 1996, 1997/1998

Cross-sectional

Study of numerous noncancer end points for liver function, gastrointestinal disorders, chloracne, serum glucose, hormone and lipid levels, and diabetes in same group as Calvert et al. (1991)

281

260

Halperin et al., 1995

Cross-sectional

Study of surrogates for cytochrome P450 induction in same group as Calvert et al. (1991)

281

260

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

NIOSH Studies Reviewed in Update 1996

Calvert et al., 1994

Cross-sectional

Study of porphyria cutanea tarda in same group as Calvert et al. (1991)

281

260

Egeland et al., 1994

Cohort

Study of total serum testosterone and gondadotropin levels in chemical production workers exposed to dioxin, in same group as Calvert et al. (1991)

248

231

NIOSH Studies Reviewed in VAO

Sweeney et al., 1993

Cohort

Peripheral neuropathy in same group as Calvert et al. (1991)

281

260

Alderfer et al., 1992

Cohort

Assessment of psychological variables to determine depression in same group as Calvert et al. (1991)

281

260

Calvert et al., 1992

Cohort

Assessment of liver and gastrointestinal systems in same group as Calvert et al. (1991)

281

260

Calvert et al., 1991

Cohort

Study of workers employed at one of two plants manufacturing substances contaminated with TCDD at least 15 years prior to assessment of chronic bronchitis, COPD, ventilatory function, thorax, and lung abnormalities, compared to matched neighborhood controls

281

260

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Fingerhut et al., 1991

Cohort

Cancer mortality in male workers from 12 plants producing TCDD contaminated chemicals (1942–1984), compared to US population

5,172

Monsanto Studies Reviewed in VAO

Collins et al., 1993

Cohort

Mortality of workers (through 1987) exposed and not exposed to dioxin between March 8, 1949, and November 22, 1949, as indicated by presence of chloracne, compared to local population mortality rates

122 with chloracne; 632 without chloracne

Moses et al., 1984

Cohort

Study of health outcomes in Monsanto workers (1948–1969) with chloracne reported as a surrogate to 2,4,5-T exposure compared to health outcomes in workers without chloracne as surrogate for no exposure

117

109

Suskind and Hertzberg, 1984

Cohort

Evaluation of health outcomes (1979) at clinical examination among workers exposed to 2,4,5-T (1948–1969) compared to nonexposed workers at same Monsanto plant

204

163

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Zack and Gaffey, 1983

Cohort

Study of mortality experience of all white male workers (1955–1977) employed at a Monsanto plant through Dec. 31, 1977, compared to mortality rates of standardized US population

884

Zack and Suskind, 1980

Cohort

Evaluation of mortality experience among employees with chloracne exposed to TCP process accident in 1949 at Monsanto, compared to US male population standard

121

New Dow Studies

Bodner et al., 2003

Cohort

Additional 10-year follow-up of cohort studied by Cook et al. (1986), through 1995; Dow cohort findings compared with IARC International Study and NIOSH Dioxin Registry.

2,187

Dow Studies Reviewed in Update 2002

Burns et al., 2001

Cohort

Study comparing mortality in a cohort of chemical workers who manufactured or formulated 2,4-D between 1945 and 1994

1,567

40,600 non-exposed chemical workers; US population

Dow Studies Reviewed in Update 1998

Ramlow et al., 1996

Cohort

Study of mortality in a cohort of workers exposed to pentachlorophenol (PCP)

770

36,804 non-exposed

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Dow Studies Reviewed in Update 1996

Bloemen et al., 1993

Cohort

Additional years of follow-up of Bond et al. (1988) study cohort through 1986

878

36,804 non-exposed workers; US population

Dow Studies Reviewed in VAO

Bond et al., 1989a

Cohort

Study of incidence of chloracne among a cohort of workers potentially exposed to TCDD, and association with other risk factors

2,072

Internal comparison

Bond et al., 1989b

Cohort

Extension of Ott et al. (1987) study through 1984

2,187

Bond et al., 1988

Cohort

Study of mortality (through 1982) among workers potentially exposed to 2,4-D (1945–1983) compared to US white males and all other male employees not exposed

878

36,804 employees not exposed; US white male population

Bond et al., 1987

Cohort

Extension of Cook et al. (1980) study, mortality through 1982

322

2,026 employees without chloracne; US white male population

Cook et al., 1987; Ott et al., 1987

Cohort

Expanded Cook et al. (1986) study an additional three years, through 1982

2,187

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Sobel et al., 1987

Case-control

Study of STS among Dow chemical employees (1940–1979) compared to employees without STS for possible association with several chemical exposures

14

126

Cook et al., 1986

Cohort

Mortality experience (1940–1979) of men manufacturing chlorinated phenols compared to US white men

2,189

Bond et al., 1983

Cross-sectional

Study of differences in workers potentially exposed and not exposed to TCDD during chemical production for (1) morbidity and (2) medical examination frequency between 1976 and 1978

(1) 183

(2) 114

(1) 732

(2) 456

Townsend et al., 1982

Cohort

Study of adverse reproductive outcomes among wives of Dow chemical employees potentially exposed to TCDD (1939–1975) compared to reproductive outcomes among wives whose husbands were not exposed

370

345

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Cook et al., 1980

Cohort

Mortality experience (through 1978) of male workers involved in a chloracne incident (1964) from TCDD exposure, compared to mortality experience of US white men

61

Ott et al., 1980

Cohort

Mortality experience among workers exposed to 2,4,5-T in manufacturing (1950–1971) compared to mortality experience of US white men

204

BASF Studies Reviewed in Update 2000

Zober et al., 1997

Cohort (1953 accident)

Cross-sectional (1988 cohort)

Review and summary of previous BASF studies of morbidity and mortality in workers exposed to TCDD after BASF accidents in 1953 and 1988

154 surviving (as of 1989) members of 1953 accident cohort 42 exposed (1988) extruder personnel

No comparison group

BASF Studies Reviewed in Update 1998

Ott and Zober, 1996

Cohort

Cancer incidence and mortality experience (through 1992) of workers exposed to TCDD after the BASF accident, during reactor cleanup, maintenance, or demolition (based on the cohort of Zober et al., 1990)

243

BASF Studies Reviewed in Update 1996

Zober et al., 1994

Cohort

Morbidity experience in the same group as Zober et al. (1990)

158

161

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

BASF Studies Reviewed in VAO

Zober et al., 1990

Cohort

Mortality experience of workers exposed to TCDD (1954–1987) at BASF plant compared to population of Federal Republic of Germany (FRG)

247

Thiess et al., 1982

Cohort

Study of mortality experience among BASF employees potentially exposed to TCDD during Nov. 17, 1953, accident compared to population and other workers not exposed

74

180,000 (town); 1.8 million (district); 60.5 million (FRG); two groups of 74 each from other cohort studies

IARC Studies Reviewed in Update 2000

Neuberger et al., 1999

Austrian chloracne cohort

Morbidity up to 1993 of exposed chemical workers assessed by health insurance data and health examination, laboratory measures, and interviews with participating survivors and controls

159, including 50 who participated in examination

Two control groups comparable to the 50 participants—numbers not given

Hooiveld et al., 1998

Cohort

Mortality (through 1991), using SMRs, of workers at one Dutch factory assessed in relation to work and exposure history; SMR and relative risk analyses

562 (serum samples for 50); 140 males at accident

567

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Jäger et al., 1998

Cohort

Preliminary data from Neuberger et al. (1999; English abstract only)

159 in original cohort; 56 screened; 49 full data

Matched nonexposed controls

Neuberger et al., 1998

Cohort of exposed cases

Preliminary data from Neuberger et al. (1999)

50

Age- and sex-matched controls; number not given

Vena et al., 1998

Cohort

International study (36 cohorts from 12 countries) of workers producing or spraying phenoxy acid herbicides and chlorophenols, categorized into one of three TCDD or higher chlorinated dioxin categories. Noncancer mortality (1939–1992) was analyzed by standardized mortality rate comparisons and by Poisson multiple regression

21,863

No comparison group

Flesch-Janys, 1997

Cohort

Mortality (1952–1984) study of German workers exposed to TCDD and other contaminants in the production of herbicides and insecticides. SMRs and Cox regression models were calculated

1,189

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

IARC Studies Reviewed in Update 1998

Kogevinas et al., 1997

Cohort

Mortality study (through 1992) of workers engaged in the production or application of phenoxy herbicides and composed of (1) the Saracci et al. (1991) cohorts, (2) the German cohorts of Becher et al. (1996), and (3) the NIOSH cohorts of Fingerhut et al. (1991)

26,615 total (21,863 exposed; 4,160 probably exposed; 592 unknown exposure)

Becher et al., 1996

Cohort

Cancer mortality (through 1989) among German workers in four chemical factories exposed to 2,4,5-T and/or trichlorophenol (subcohorts I and II) and phenoxy herbicides and chlorophenols (subcohorts III and IV)

2,479

Flesch-Janys et al., 1995

Cohort

Cancer and circulatory system mortality among workers in a chemical plant in Hamburg, Germany exposed in varying degrees to herbicides contaminated with PCDD/F

1,189

2,528 gas workers

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

IARC Studies Reviewed in Update 1996

Kogevinas et al., 1995

Case-control

Two nested case-control studies of the relationship between STS and NHL and occupational exposures in members of the IARC cohort

STS: 11 cases

NHL: 32 cases

5 controls per case

Kogevinas et al., 1993

Cohort

Cancer incidence and mortality experience of female workers in seven countries, potentially exposed to chlorophenoxy herbicides, chlorophenols, and dioxin compared to national death rates and cancer incidence rates

701

Lynge, 1993

Cohort

Cancer incidence in the same group as Lynge (1985), with follow-up extended through 1987

3,390 men

1,071 women

Kogevinas et al., 1992

Cohort

Study of mortality from STS and malignant lymphomas in an international cohort of production workers and herbicide sprayers (same group as Saracci et al., 1991)

14,439 (13,482 exposed; 416 probably exposed; 541 unknown exposure)

3,951 non-exposed employees

IARC Studies Reviewed in VAO

Bueno de Mesquita et al., 1993

Cohort

Mortality experience of production workers exposed to phenoxy herbicides and chlorophenols in the Netherlands compared to national rates

2,310

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Coggon et al., 1991

Cohort

Mortality experience among four cohorts of workers potentially exposed (1963–1985) to phenoxy herbicides and chlorophenols compared to national (England and Wales) expected numbers and to the local population where factory is located

1,104 Factory A

271 Factory B

345 Factory C

519 Factory D

Manz et al., 1991

Cohort

Mortality experience of workers (1952–1984) at Hamburg plant of Boehringer exposed to TCDD compared to national mortality and workers from another company

1,184 men

399 women

(a) population

(b) 3,120 gas workers

Saracci et al., 1991

Cohort

Study of mortality experience of 20 international cohorts of herbicide sprayers and production workers compared to mortality experience expected for the nation

16,863 men

1,527 women

Coggon et al., 1986

Cohort

Study of mortality experience (through 1983) among workers manufacturing and spraying MCPA (1947–1975) compared to expected numbers of deaths among men of England and Wales and for rural areas

5,754

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Lynge, 1985

Cohort

Study of cancer incidence among Danish workers exposed to phenoxyherbicides compared to expected results from the general population

3,390 men

1,069 women

Studies from Other Chemical Plants Reviewed in Update 2000

Hryhorczuk et al., 1998

Cohort

Morbidity study of workers involved in pentachlorophenol production at one factory between 1938 and 1978 and nonexposed workers at the same factory. Assesses chloracne, prophyria, and general health status

366

303

Jung et al., 1998

Cohort

Self-selected group of former workers at pesticide-producing factory participated in physical examination, laboratory measures, and questionnaires. Associations between serum PCDD/F, infectious disease, and immunologic measures were assessed

192

 

 

Lymphocyte proliferation and chromate resistance tests were compared between a subgroup of the mostly highly exposed workers at the study factory and an nonexposed group of workers in another industry

29 (highly exposed subgroup)

28 (external nonexposed group)

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Studies from Other Chemical Plants Reviewed in Update 1998

Tonn et al., 1996

Cohort

Study of the long-term immune system effects of TCDD in industrial workers involved in production and maintenance operations at a German chemical factory producing 2,4,5-T between 1966 and 1976

11

10

Studies from Other Chemical Plants Reviewed in VAO

Jennings et al., 1988

Cohort

Assessment of immunological abnormalities among workers exposed to TCDD during accident manufacturing 2,4,5-T compared to matched controls

18

15

Thomas, 1987

Cohort

Assessment of mortality experience as of Jan. 1, 1981, for white men employed in fragrance and flavors plant with possible exposure to TCDD, compared to US white men and for cancers compared to local men

1,412

May, 1982, 1983

Cohort

Health outcomes among workers exposed and probably exposed to TCDD following a 1968 accident, compared to non-exposed workers

41 exposed

54 possibly exposed

31

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Pazderova-Vejlupkova et al., 1981

Descriptive

Study of development of TCDD intoxication among men in Prague (1965–1968)

55

No comparison group

Poland et al., 1971

Cross-sectional

Assessment of porphyria cutanea tarda (PCT), chloracne, hepatotoxicity, and neuropsychiatric symptoms among 2,4-D and 2,4,5-T workers compared to other plant workers

73 total (20 administrators; 11 production supervisors; 28 production workers; 14 maintenance workers)

Internal comparison

Bashirov, 1969

Cross-sectional

Descriptive results of examination of workers involved in production of herbicides and study of workers at examination of cardiovascular and digestive systems compared to unexposed controls

292 (descriptive); 50 (examined)

20 (examined)

AGRICULTURAL AND FOREST PRODUCTS

Cohort Studies of Agricultural Workers Reviewed in Update 2002

Arbuckle et al., 2001

Cohort

Spontaneous abortions in couples living on full-time family-run farms in Ontario, Canada

2,110 women; 3,936 pregnancies

none

Masley et al., 2000

Cross-sectional survey

Targeted survey of households in an agricultural-based rural area of Saskatchewan, Canada

548 households; 1,407 individuals

none

Curtis et al., 1999

Cohort

Time to pregnancy in couples living on full-time family-run farms in Ontario, Canada

2,012 pregnancies

none continues

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Savitz et al., 1997

Cohort

Male pesticide exposure and pregnancy outcome among full-time family-run farms in Ontario, Canada

1,898 couples; 3,984 pregnancies

none

Cohort Studies of Agricultural Workers Reviewed in Update 2000

Arbuckle et al., 1999

Cohort

Spontaneous abortions in couples living on full-time family-run farms in Ontario, Canada

2,110 women (3,936 pregnancies)

none

Cohort Studies of Agricultural Workers Reviewed in Update 1998

Gambini et al., 1997

Cohort

Cancer mortality (1957–1992) among a cohort of rice growers in the Novara Province of northern Italy

958

Kristensen et al., 1997

Cohort

Birth defects among the offspring of Norwegian farmers born after 1924

192,417 births

61,351 births

Faustini et al., 1996

Cohort

Study of immune system components and function among farmers who mixed and applied commercial formulations containing the chlorophenoxy herbicides 2,4-D and MCPA

10

Internal comparison

Cohort Studies of Agricultural Workers Reviewed in Update 1996

Dean, 1994

Cohort

Study of mortality from brain and hematopoietic cancers of agricultural workers compared to nonagricultural workers in Ireland (1971–1987)

(population size unclear)

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Morrison et al., 1994

Cohort

Update of mortality experience in Wigle et al. (1990) cohort through 1987, with addition of farmers from Alberta and Manitoba

155,547

Semenciw et al., 1994

Cohort

Study of leukemia mortality in same group as Morrison et al. (1993)

155,547

Blair et al., 1993

Cohort

Study of causes of death, including cancer, among farmers in 23 states (1984–1988)

119,648 white men; 2,400 white women; 11,446 nonwhite men; 2,066 nonwhite women

Semenciw et al., 1993

Cohort

Study of multiple myeloma mortality of male farmers compared to male population of the three prairie provinces of Canada (1971–1987)

155,547

Senthilselvan et al., 1992

Cross-sectional

Study of the association between pesticide exposure and asthma in male farmers

1,939

No comparison group

Cohort Studies of Agricultural Workers Reviewed in VAO

Morrison et al., 1993

Cohort

Mortality experience of male Canadian farmers 45 years or older in Manitoba, Saskatchewan, and Alberta, Canada, (1971–1987) compared to Canadian prairie province mortality rates

145,383

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Eriksson et al., 1992

Cohort

Study of incidence of NHL, HD, and multiple myeloma (1971–1984) among selected occupational groups in Swedish men and women, compared to expected rates of disease in general population

Number in occupational group unknown

Hansen et al., 1992

Cohort

Study of cancer incidence among male and female Danish gardeners compared to incidence expected among the general population

4,015 (859 women; 3,156 men)

Morrison et al., 1992

Cohort

Mortality experience of male farmers 35 or older (1971–1987) compared to Canadian prairie province rates

155,547

Ronco et al., 1992

Cohort

Study of cancer incidence (1970–1980) among male and female Danish farm workers 15 to 74 years old, compared to expected numbers of cancers among persons economically active, and study of cancer mortality (November 1981–April 1982) among male and female Italian farmers 18 to 74 years old compared to persons in other occupational groups

No N given

No N given

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Lerda and Rizzi, 1991

Cohort

Study of farmers exposed to 2,4-D, as measured in urine, compared to unexposed men for differences in sperm volume, death count, motility, and abnormalities between March and June 1989

32

25

Wigle et al., 1990

Cohort

Mortality experience from NHL of male farmers 35 years or older (1971–1985) in Saskatchewan, Canada, compared to age- and period-specific mortality rates expected for Saskatchewan males

69,513

Corrao et al., 1989

Cohort

Study of cancer incidence among male farmers licensed (1970–1974) to use pesticides, compared to number of cancers expected among licensed nonusers

642

18,839

Wiklund et al., 1988a

Cohort

Malignant lymphoma incidence among agricultural and forestry workers in Sweden compared to the general population of men; 1960 census

354,620

1,725,845

Wiklund and Holm, 1986

Cohort

STS incidence among agricultural and forestry workers in Sweden compared to the general population of men; 1960 census

354,620

1,725,845

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Wiklund, 1983

Cohort

Study of cancer incidence (diagnosed 1961–1973) among agricultural workers in Sweden compared to rates expected from the 1960 population census

19,490

Burmeister, 1981

Cohort

Study of mortality of farmers compared to nonfarmers in Iowa (1971–1978)

6,402

13,809

Cohort Studies of Forestry Workers Reviewed in Update 2002

Thörn et al., 2000

Cohort

Study of mortality and cancer incidence in a cohort of Swedish lumberjacks exposed to phenoxy herbicides

261

243

Cohort Studies of Forestry Workers Reviewed in VAO

Green, 1991

Cohort

Mortality experience of male forestry workers (1950–1982) in Ontario, compared to expected mortality of the male Ontario population

1,222

Green, 1987

Cohort

Suicide experience in a cohort of Canadian forestry workers by number of years in forestry trade as a surrogate for exposure to phenoxy herbicides compared to population

1,222

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Van Houdt et al., 1983

Cross-sectional

Study of acne and liver dysfunction in a select group of Dutch forestry workers exposed to 2,4,5-T, compared to non-exposed workers

54

54

New Cohort Studies of Herbicide and Pesticide Appliers

Flower et al., 2004

Prospective cohort

Parental pesticide application and cancer risk in offspring of pesticide appliers in AHS cohort

20,625 appliers and spouses; 21,375 children born during or after 1975

Swaen et al., 2004

Cohort

Mortality follow-up in Dutch male herbicide appliers

1,341

Alavanja et al., 2003

Prospective cohort

Correlation between pesticide exposure (including 2,4-D and 2,4,5-T) and prostate cancer in pesticide appliers

55,332

Cohort Studies of Herbicide and Pesticide Appliers Reviewed in Update 2002

Hoppin et al., 2002

Cohort

Study predicting wheeze among farmers who applied pesticide in the Agricultural Health Study

3,838 appliers with wheeze

16,630 appliers without wheeze

Cohort Studies of Herbicide and Pesticide Appliers Reviewed in Update 2000

Alavanja et al., 1998

Cohort

Analysis of self-reported health care visits having resulted from pesticide use by Iowa and North Carolina pesticide appliers

35,879

None

Dich and Wilkund 1998

Cohort

Study of men licensed for pesticide application in Sweden. Cancer cases ascertained from cancer registry and standardized incidence ratio reported for prostate cancer

20,025

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Cohort Studies of Herbicide and Pesticide Appliers Reviewed in Update 1998

Heacock et al., 1998

Cohort

Fertility study among British Columbia workers potentially exposed to chlorophenate wood preservatives in 14 sawmills between 1955 and 1988; includes the cohort of Hertzman et al. (1997)

18,016 births

1,668 births

Hertzman et al., 1997

Cohort

Mortality study among British Columbia workers potentially exposed to chlorophenate wood preservatives in 11 sawmills between 1950 and 1985

23,829

2,658

Dimich-Ward et al., 1996

Cohort; Nested case-control

Analysis of birth defects among offspring born between 1952 and 1988 of the Hertzman et al. (1997) cohort

19,675 births among 9,512 fathers

5 nondefect births as controls per case

Garry et al., 1996a

Cohort

Study of chromosome abnormalities based on the cohort of Garry et al. (1994)

23 fumigant appliers; 18 insecticide appliers; 20 herbicide appliers

33

Garry et al., 1996b

Cohort

Birth defects among the offspring of male pesticide appliers in Minnesota born between 1989 and 1992

4,935 births among 34,772 pesticide appliers (125 with birth anomalies)

3,666 births with anomalies in the general population

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Zhong and Rafnsson, 1996

Cohort

Cancer mortality among various subgroups of pesticide users in Iceland

2,449 (1,860 males and 589 females)

Cohort Studies of Herbicide and Pesticide Appliers Reviewed in Update 1996

Asp et al., 1994

Cohort

Mortality and cancer morbidity experience of male chlorophenoxy herbicide appliers (same cohort as Riihimaki et al., 1982, 1983) in Finland (1955–1971), through 1989, compared to general population rates for morbidity and mortality

1,909

Garry et al., 1994

Cross-sectional

Evaluation of health outcomes resulting from exposure to pesticides by male pesticide appliers in Minnesota

719

No comparison group

Cohort Studies of Herbicide and Pesticide Appliers Reviewed in VAO

Swaen et al., 1992

Cohort

Cancer mortality experience (through 1987) among Dutch male herbicide appliers licensed before 1980, compared to total male Dutch population

1,341

Bender et al., 1989

Cohort

Cancer mortality of Minnesota highway maintenance workers compared to expected numbers based on white Minnesota men

4,849

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Wiklund et al., 1989a

Cohort

Risk of cancer in Wiklund et al. (1987) cohort through 1982

20,245

Wiklund et al., 1989b

Cohort

Risk of STS, HD, and NHL in Wiklund et al. (1987) cohort through 1984

20,245

Wiklund et al., 1988b

Cohort

Risk of STS in Wiklund et al. (1987) cohort through 1984

20,245

Wiklund et al., 1987

Cohort

Risk of HD and NHL among Swedish pesticide appliers from date of license through 1982, compared to expected number of cases in the total population

20,245

Blair et al., 1983

Cohort

Mortality experience of white male Florida pesticide appliers compared to US and Florida men

3,827

Riihimaki et al., 1983

Cohort

Cancer morbidity and mortality in cohort of Riihimaki et al. (1982), through 1980

1,926

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Riihimaki et al., 1982

Cohort

Study of mortality among herbicide appliers exposed to 2,4-D and 2,4,5-T in Finland compared to mortality expected in the population

1,926

Smith et al., 1982

Cohort

Study of adverse reproductive outcomes among chemical appliers and agricultural contractors by category of exposure: none; chemicals not 2,4,5-T; 2,4,5-T

113 pregnancies (chemicals not 2,4,5-T); 486 pregnancies (2,4,5-T)

401 pregnancies (not exposed)

Barthel, 1981

Cohort

Study of male agricultural production workers (1948–1972) for incidence of cancer, compared to incidence rates expected in the population

1,658

Smith et al., 1981

Cohort

Study of chemical appliers (1973–1979) in New Zealand compared to agricultural contractors for differences in adverse reproductive outcomes

459

422

Axelson et al., 1980

Cohort

Additional years of follow-up to cohort established in Axelson and Sundell (1974)

348

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Axelson and Sundell, 1974

Cohort

Study of mortality and cancer incidence among cohorts of Swedish railroad workers spraying herbicides (>45 days) compared to the expected number of deaths (1957–1972) from Swedish age- and sex-specific rates

348 total herbicide exposure; 207 phenoxy acids and combinations; 152 amitrole and combinations; 28 other herbicides and combinations

CASE-CONTROL STUDIES

Case-Control Studies Reviewed in Update 2000

Ekström et al., 1999

Case-control

All new cases of histologically confirmed gastric adenocarcinoma in two geographic areas in Sweden; age-and gender-matched control group randomly selected using computerized population register

565

1,164

Hardell and Eriksson, 1999

Case-control

Male cases 25 or older with histopathologically confirmed NHL during 1987–1990 in northern and mid-Sweden; age matched controls from National Population Registry

404

741

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

García et al., 1998

Case-control

Matched-paired study of congenital malformations or defects in an agricultural region of Spain

261

261

Case-Control Studies Reviewed in Update 1998

Blatter et al., 1997

Case-control

Multicenter Dutch study of paternal occupation and risk of spina bifida in offspring (1980–1992)

222

764

Liou et al., 1997

Case-control

Study of occupational and environmental risk factors and Parkinson’s disease (PD) in Taiwan (1993–1995)

120

240

Tatham et al., 1997

Nested case-control

Population-based study of occupational risk factors for subgroups of NHL patients based on the CDC’s Selected Cancers Study (CDC, 1990a,b,c,d)

1,048

1,659

Nanni et al., 1996

Case-control

Population-based study in northeastern Italy of occupational and chemical risk factors for chronic lymphocytic leukemia (CLL) and NHL (1987–1990)

187

977

Schulte et al., 1996

PMR analysis with nested case-control

Study of neurodegenerative diseases and occupational risk factors from 27 states

130,420 death certificates

 

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Seidler et al., 1996

Case-control

Study of PD and various rural factors, including exposure to herbicides and wood preservatives in Germany

380

379 neighborhood controls; 376 regional controls

Case-Control Studies Reviewed in Update 1996

Hardell et al., 1994

Case-control

Study of the association between occupational exposures and parameters related to NHL in white males in Sweden

105

335

Mellemgaard et al., 1994

Case-control

Study of cases of renal cell carcinoma (20–79 years) in Denmark, compared to population-based sample without cancer for identification of occupational risk factors

365

396

Nurminen et al., 1994

Case-control

Study of structural defects in infants born to mothers engaged in agricultural work during the first trimester of pregnancy, compared to infants with structural defects born to mothers who did not engage in agricultural work during the first trimester

1,306

1,306

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Brown et al., 1993

Case-control

Population-based case-control study of multiple myeloma in Iowa men for association with pesticide exposures

173

650

Persson et al., 1993

Case-control

Study of risk factors potentially associated with HD and NHL in males identified from the Regional Cancer Registry in Sweden

NHL: 93

HD: 31

204

Semchuk et al., 1993

Case-control

Study of cases of PD (36–90 years) in Canada, compared to population-based sample for association with occupational exposure to herbicides and other exposures

75 men

150 men

55 women

110 women

Zahm et al., 1993

Case-control

Study of NHL and exposure to pesticides in white women diagnosed with NHL between July 1, 1983, and June 30, 1986

206

824

McDuffie et al., 1990

Case-control

Study of pesticide exposure in male cases of primary lung cancer in Saskatchewan, compared to control subjects matched by age, sex, and location of residence

273

187

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Case-Control Studies Reviewed in VAO

Cantor et al., 1992

Case-control

Population-based case-control study of NHL in Iowa and Minnesota men for association with farming exposures

622

1,245

Smith and Christophers, 1992

Case-control

Study of STS and malignant lymphomas in men diagnosed 1982–1988 in Australia, compared to other cancers for association with exposure to phenoxy herbicides and chlorophenols

82

82 other cancers; 82 population controls

Brown et al., 1990

Case-control

Population-based case-control study of leukemia in Iowa and Minnesota men for association with farming exposures

578

1,245

Eriksson et al., 1990

Case-control

Study of male cases of STS (25–80 years) diagnosed 1978–1986 in central Sweden compared to population-based sample without cancer for association with occupational exposure to phenoxyacetic acids and chlorophenols

218

212

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Wingren et al., 1990

Case-control

Study of male cases of STS (25–80 years) diagnosed 1975–1982 in southeast Sweden, compared to two referent groups: (1) population-based sample, (2) with other cancers, for association with phenoxyacetic acids and chlorophenols

71

315 population based; 164 other cancers

Zahm et al., 1990

Case-control

Study of white men 21 years or older diagnosed with NHL (1983–1986) in Nebraska, compared to residents of the same area without NHL, HD, multiple myeloma (MM), chronic lymphocytic leukemia for association with herbicides (2,4-D) on farms

201

725

Alavanja et al., 1989

PMR analysis with nested case-control

Mortality experience of United States Department of Agriculture (USDA) forest or soil conservationists (1970–1979) evaluated for specific cancer excess; case-control study of specific cancers identified from PMR analysis

1,411

Boffetta et al., 1989

Nested case-control

National study of MM compared to other cancer controls for association with exposures including pesticides and herbicides

282

1,128

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

LaVecchia et al., 1989

Case-control

Study of Italian men and women with HD, NHL, and MM (1983–1988), compared to population of Italy for association with occupations and herbicide use

69 HD

153 NHL

110 MM

396

Persson et al., 1989

Case-control

Study of HD and NHL among living men and women in Sweden, compared to those without these cancers for association with occupational exposures, including phenoxy herbicides

54 HD

106 NHL

275

Woods and Polissar, 1989

Case-control

Study of NHL from the Woods et al. (1987) cohort for association with phenoxy herbicides in farm workers

576

694

Alavanja et al., 1988

PMR analysis with nested case-control

Mortality experience of USDA extension agents (1970–1979) evaluated for specific cancer excess; case-control study of specific cancers identified from PMR analysis

1,495

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Dubrow et al., 1988

Case-control

Death certificate study (1958–1983) of NHL and HD among white male residents of Hancock County, Ohio, compared to a random sample of those dying from other causes for association with farming

61 NHL

15 HD

304

Hardell and Eriksson, 1988

Case-control

Study of male cases of STS (25–80 years) diagnosed between 1978 and 1983 in northern Sweden compared to two referent groups: (1) population based, (2) with other cancers, for association with occupational exposure to phenoxyacetic acids and chlorophenols

55

(1) 330

(2) 190

Musicco et al., 1988

Case-control

Study of brain gliomas diagnosed 1983–1984 in men and women in Italy, compared to (1) patients with nonglioma nervous system tumors and (2) patients with other neurologic diseases, for association with chemical exposures in farming

240

(1) 465

(2) 277

Olsson and Brandt, 1988

Case-control

Study of NHL (1978–1981) in Swedish men, compared to two groups of men without NHL for association with occupational exposures including phenoxy acids

167

50 same area; 80 other parts of Sweden

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Hardell et al., 1987

Case-control

Study of Kaposi’s sarcoma in AIDS patients (23–53 years old) compared to controls for association with TCDD and pesticide exposure in Sweden

50

50

Pearce et al., 1987

Case-control

Expanded study (Pearce et al., 1986b) of NHL to include ICD-9 200-diagnosed cases and additional controls for association with farming exposures

183

338

Woods et al., 1987

Case-control

Study of STS or NHL in men 20–79 years old (1983–1985) in western Washington State compared to a population sample without these cancers for association with occupational exposure to phenoxy herbicides and chlorinated phenols

128 STS

576 NHL

694

Hoar et al., 1986

Case-control

Study of STS, NHL, and HD in Kansas (1976–1982), compared to controls without cancer for association with 2,4-D, 2,4,5-T, and other herbicides in white men 21 years or older

133 STS

121 HD

170 NHL

948

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Morris et al., 1986

Case-control

Study of multiple myeloma (1977–1981) in four SEER areas compared to population controls for risk factors associated with MM, including farm use of herbicides

698

1,683

Pearce et al., 1986a

Case-control

Study of male MM cases diagnosed 1971–1981 in New Zealand, compared to controls for other cancers for potential association with phenoxy herbicides and chlorophenols

76

315

Pearce et al., 1986b

Case-control

Study of NHL cases (ICD-9 202) in men diagnosed between 1977 and 1981 in New Zealand, compared to sample with other cancers and population sample, for association with occupational exposure to phenoxy herbicides and chlorophenols

83

168 other cancers; 228 general population

Smith and Pearce, 1986

Case-control

Update of Smith et al. (1983) with diagnoses through 1982

51 in update (133 when combined with Smith et al., 1983)

315 (407)

Vineis et al., 1986

Case-control

Study of cases of STS in men and women diagnosed 1981–1983 in northern Italy, compared to population sample of controls for association with phenoxy herbicide exposure

37 men

31 women

85 men

73 women

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Blair and White, 1985

Case-control

Study of leukemia cases by cell type in Nebraska (1957–1974) compared to nonleukemia deaths for association with agricultural practices

1,084

2,168

Pearce et al., 1985

Case-control

Study of malignant lymphoma and multiple myeloma in men diagnosed 1977–1981 in New Zealand, compared to men with other cancers for association with agricultural occupations

734

2,936

Balarajan and Acheson, 1984

Case-control

Study of STS (1968–1976) diagnosed in men in England and Wales compared to men with other cancers for association with farming, agriculture, and forestry occupations

1,961

1,961

Donna et al., 1984

Case-control

Study of ovarian cancer in women (1974–1980) for association with herbicide use, compared to women without ovarian cancer

60

127

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Hardell et al., 1984

Case-control

Study of primary liver cancer diagnosed 1974–1981 in men 25–80 years old residing in northern Sweden compared to population based controls for association with occupational exposure to phenoxyacetic acids and chlorophenols

98

200

Smith et al., 1984

Case-control

Study of STS among New Zealand residents (1976–1980) compared to those without these cancers for association with occupational exposures, including phenoxy herbicides

82

92

Burmeister et al., 1983

Case-control

Study of multiple myeloma, NHL, prostate, and stomach cancer mortality (1964–1978) in white men 30 years or older compared to mortality from other causes for association with farming practices including herbicide use in Iowa

550 MM

1,101 NHL

4,827 prostate

1,812 stomach

1,100

2,202

9,654

3,624

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Hardell and Bengtsson, 1983

Case-control

Study of HD diagnosed in men 25–85 years old, between 1974 and 1978 in northern Sweden, compared to population-based sample without cancer for association with occupational exposure to phenoxyacetic acid and chlorophenols

60

335

Smith et al., 1983

Case-control

Preliminary report of men with STS reported 1976–1980 in New Zealand, compared to controls with other cancers for association with phenoxyacetic acid exposure

80

92

Burmeister et al., 1982

Case-control

Study of leukemia deaths (1964–1978) in white men ≥ 30 years old in Iowa, compared to nonleukemia deaths for association with farming

1,675

3,350

Cantor, 1982

Case-control

Study of NHL in Wisconsin among males (1968–1976) compared to men dying from other causes for association with farming exposures

774

1,651

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Hardell et al., 1982

Case-control

Study of nasal and nasopharyngeal cancers diagnosed 1970–1979 in men 25–85 years old residing in northern Sweden, compared to controls selected from previous studies (Hardell and Sandstrom, 1979; Hardell et al., 1981) for association with occupational exposure to phenoxyacetic acids and chlorophenols

44 nasal; 27 nasopharyngeal

541

Carmelli et al., 1981

Case-control

Cases of spontaneous abortions occurring to women (1978–1980) compared to live births for association with paternal exposure to 2,4-D

134

311

Eriksson et al., 1979, 1981

Case-control

Cases of STS diagnosed between 1974 and 1978 in southern Sweden compared to population based sample without cancer for association with occupational exposure to phenoxyacetic acids and chlorophenols

110

219

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Hardell, 1981

Case-control

(1) Cases of STS (Hardell and Sandstrom, 1979) and malignant lymphomas (Hardell et al., 1981) compared to colon cancer cases

(2) Colon-cancer cases compared to population-based controls for association with occupational exposure to phenoxyacetic acids and chlorophenols

(1) 221

(2) 154

154

541

Hardell et al., 1980; Hardell et al., 1981

Case-control

Cases of malignant lymphomas (HD, NHL, unknown) diagnosed in men 25–85 years old, between 1974 and 1978 in northern Sweden, compared to population-based controls for association with occupational exposure to phenoxyacetic acids and chlorophenols

60 HD

109 NHL

338

Blair and Thomas, 1979

Case-control

Cases in Nebraska (1957–1974) compared to deaths from other causes for association with agricultural practices

1,084

2,168

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Hardell and Sandstrom, 1979

Case-control

Cases of STS (26–80 years old) diagnosed between 1970 and 1977 in northern Sweden, compared to population-based controls for association with occupational exposure to phenoxyacetic acids and chlorophenols

52

206

PAPER AND PULP WORKERS

Paper and Pulp Worker Studies Reviewed in Update 2000

Schildt et al., 1999

Case-control

Matched study of histopathologically verified oral cancer cases. Mailed exposure questionnaire on lifetime occupational history, oral cancer risk factors, pesticide use, smoking, SES, and place of residence

410

410

Rix et al., 1998

Cohort

Cancer incidence rates of blue-collar workers at three Danish paper mills were compared to population rates from national population and mortality registers

14,788 (14,362 were identified for follow-up)

Paper and Pulp Worker Studies Reviewed in VAO

Jappinen and Pukkala, 1991

Cohort

Cancer incidence (through 1987) among male Finnish pulp and paper workers (1945–1961), compared to rates in the local central hospital district

152

Approximately 135,000

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Henneberger et al., 1989

Cohort

Mortality experience through August 1985 of white men employed in Berlin, New Hampshire, paper and pulp industry, compared to expected mortality in US white men

883

Solet et al., 1989

Cohort

Mortality (1970–1984) among white male United Paperworkers International union members, compared to expected number of deaths in US men

201

Robinson et al., 1986

Cohort

Mortality experience through March 1977 of white male workers employed in five paper or pulp mills compared to expected number of deaths among US population

3,572

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

aThe dash (—) indicates the comparison group is based on a population (e.g., US white males, country rates), and details are giv en in the text for specifics of the actual population.

ABBREVIATIONS:2,4-D, 2,4-dichlorophenoxyacetic acid; 2,4,5-T, 2,4,5-trichlorophenoxyacetic; AHS, Agricultural Health Study; CDC, Centers for Disease Control and Prevention; CLL, Chronic lymphocytic leukemia; COPD, chronic obstructive pulmonary disease; FRG, Federal Republic of Germany; HD, Hodgkin’s disease; IARC, International Agency for Research on Cancer; ICD, International Classification of Diseases; MCPA, methyl-4 chlorophenoxyacetic acid; MM, multiple myeloma; NIOSH, National Institute for Occupational Safety and Health; NHL, non-Hodgkin’s lymphoma; PCDD, polychlorinated dibenzodioxin; PCDF, polychlorinated dibenzofurons; PD, Parkinson’s disease; PCP, pentachlorophenol; PCT, porphyria cutanea tarda; PMR, proportionate mortality ratio; SEER, surveillance, epidemiology, and end results; SES, socioeconomic status; SIR, standardized incidence ratio; SMR, standardized mortality ratio; STS, soft-tissue sarcoma; TCDD, 2,3,7,8-tetrachlorodibenzo-p-dioxin; TCP, 2,4,5-trichlorophenol; TSH, thyroid-stimulating hormone; T3, triiodothryonine; T4, thyroxine; USDA, US Department of Agriculture; Update 2000, Veterans and Agent Orange: Update 2000 (IOM, 2001); Update 1998, Veterans and Agent Orange: Update 1998 (IOM, 1998); Update 1996, Veterans and Agent Orange: Update 1996 (IOM, 1996); and VAO, Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam (IOM, 1994).

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

TABLE A-2 Epidemiologic Studies—Environmental Exposure

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

New Studies from Seveso

Baccarelli et al., 2004

Population based

mRNA concentrations, AhR, ARNT, CYP1A1, CYP1B1 genes, and EROD activity in peripheral blood lymphocytes in a Seveso, Italy cohort

62

59

Eskenazi et al., 2004

Cohort

Relationship between serum TCDD concentration and age at exposure in SWHS participatants

899

None

Eskenazi et al., 2003a

Cohort

Association between maternal serum TCDD and birth outcome SWHS participants

888

None

Landi et al., 2003

Population based

Effect of TCDD-mediated alterations in AhR-dependent pathway in Seveso zone A and B residents

62

59

Baccarelli et al., 2002

Population based

Immunologic effects in Seveso residents, compared with previous published results

62

59

Eskenazi et al., 2002a

Cohort

Association between menstrual cycle characteristics and serum TCDD in SWHS participatants

381

None

Eskenazi et al., 2002b

Cohort

Association between endometriosis and serum TCDD concentration in SWHS participants

601

None

Studies from Seveso Reviewed in Update 2002

Warner et al., 2002

Cohort

Study to evaluate the association between individual serum TCDD levels and breast cancer risk in women who participated in the SWHS

15

981

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Studies from Seveso Reviewed in Update 2000

Bertazzi et al., 2001

Cohort

Mortality (through 1996) study of residents in industrial accident exposure-related geographic regions

804 zone A

5,941 zone B

38,624 zone R

232,745

Pesatori et al., 1998

Cohort

Mortality (through 1991) study of residents in industrial accident exposure-related geographic regions

805 zone A

5,943 zone B

38,625 zone R

232,747

Studies from Seveso Reviewed in Update 1998

Bertazzi et al., 1997, 1998

Cohort

Study of cancer incidence among Seveso residents in contaminated zones (A, B, R) after 15 years of follow-up through 1991

45,373 total

805 zone A

5,943 zone B

38,625 zone R

232,747

Mocarelli et al., 1996

Cohort

Study of sex ratio among the offspring of Seveso residents born in zone A from (1) 1977 to 1984 and (2) 1985 to 1994

(1) 74 births (28 male, 48 female)

(2) 124 births (60 male, 48 female)

 

Studies from Seveso Reviewed in Update 1996

Bertazzi et al., 1993

Cohort

Study of cancer incidence in Seveso residents (aged 20 to 74 years) in contaminated zones (A, B, R) exposed to TCDD on July 10, 1976, compared to neighboring residents in nonexposed areas

724 zone A

4,824 zone B

31,647 zone R

181,579

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Pesatori et al., 1993

Cohort

Evaluation of cancer incidence in Seveso residents aged 1–19 years in the first postaccident decade compared to age-matched residents of neighboring non-exposed areas

Approximately 20,000

167,391

Studies from Seveso Reviewed in VAO

Bertazzi et al., 1992

Cohort

Comparison of mortality of children (1976–1986) exposed during Seveso accident compared to children in uncontaminated areas

306 zone A

2,727 zone B

16,604 zone R

95,339

Pesatori et al., 1992

Cohort

Cancer incidence (1976–1986) among those in zones A, B, R around Seveso compared to residents of uncontaminated surrounding areas

Data given in person-years

Data given in person-years

Assennato et al., 1989a

Cohort

Comparison of dermatologic and laboratory findings in children during periodic exams following accident in Seveso

193 with chloracne

123

Assennato et al., 1989b

Cohort

Study of health outcomes in workers assigned to cleanup or referent group following Seveso accident

36

36

Bertazzi et al., 1989a,b

Cohort

Comparison of mortality experience (1976–1986) of residents of contaminated zones (A, B, R) around Seveso to mortality experience of non-exposed residents in neighboring towns

556 zone A

3,920 zone B

26,227 zone R

167,391

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Barbieri et al., 1988

Cohort

Comparison of prevalence of peripheral nervous system involvement among Seveso residents with chloracne, compared to residents of unexposed areas

152

123

Mastroiacovo et al., 1988

Cohort

Comparison of birth defects occurring among zone A, B, and R mothers with live and stillbirths to birth mothers who were non-A, B, or R residents

26 zone A

435 zone B

2,439 zone R

12,391 (non-A, B, or R)

Mocarelli et al., 1986

Cross-sectional

Study of laboratory measures of serum and urine in Seveso zone A and B children measured over 6 years (1977–1982), compared to zone R children

69 zone A

528 zone B

874 zone R

241, subset of zone R

Ideo et al., 1985

Cross-sectional

Evaluation of levels of enzyme activity among residents of Seveso zone B and an noncontaminated community

117 adults

127 adults

Tenchini et al., 1983

Cross-sectional

Cytogenetic analysis of maternal and fetal tissue among Seveso exposed, compared to control sample

19

16

Ideo et al., 1982

Cross-sectional

Evaluation of hepatic enzymes in children exposed in Seveso compared to normal values

16 zone A

51 zone B

60 Bristo Assizio

26 Cannero

Caramaschi et al., 1981

Cohort

Evaluation of chloracne among children in Seveso, compared to children with no chloracne, and association with other health outcomes between chloracne and no-chloracne groups

146

182

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Filippini et al., 1981

Cohort

Comparison of prevalence of peripheral neuropathy on two screening examinations among Seveso residents, compared to residents in non-exposed areas

308

305

Bisanti et al., 1980

Descriptive

Descriptive report of selected health outcomes among residents of Seveso located in zones A, B, R

730 zone A

4,737 zone B

31,800 zone R

No comparison group

Boeri et al., 1978

Cohort

Evaluation of neurological disorders among Seveso residents exposed to TCDD on July 10, 1976, compared to residents in nonexposed areas

470 zone A

152 zone R

Times Beach/Quail Run Studies Reviewed in VAO

Evans et al., 1988

Cross-sectional

Comparison of retesting for skin delayed-type hypersensitivity among nonresponders in earlier test (Stehr et al., 1986)

28

15

Stockbauer et al., 1988

Cohort

Study of adverse reproductive outcomes (1972–1982) among mothers potentially exposed to TCDD-contaminated areas of Missouri (1971) compared to births among nonexposed mothers

402 births

804 births

Stehr-Green et al., 1986; Hoffman et al., 1987

Cohort

Health effects (1971–1984) in Quail Run Mobile Home Park residents compared with residents of noncontaminated mobile home parks

154

155

Webb et al., 1987

Cross-sectional

Pilot study of Missouri residents exposed to TCDD in the environment (1971) for health effects, comparing potentially high-exposed to low-exposed residents

68 (high exposure)

36 (low exposure)

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Stehr et al., 1986

Cross-sectional

Pilot study of Missouri residents exposed to TCDD in the environment (1971) for health effects, comparing potentially high-exposed to low-exposed residents

68 (high exposure)

36 (low exposure)

Studies of Vietnamese Reviewed in Update 1996

Cordier et al., 1993

Case-control

Study of cases of hepatocellular carcinoma (1989–1992) in males living in Vietnam, compared to other hospitalized patients for association with a range of exposures including herbicides

152

241

Studies of Vietnamese Reviewed in VAO

Dai et al., 1990

Cohort

Study of infant mortality (1966–1986) in two South Vietnam villages exposed to Agent Orange spraying compared to infant mortality in unsprayed area

5,609

3,306

Phuong et al., 1989a

Case-control

Study of deformed babies and hydatidiform mole compared to normal births (1982) in Ho Chi Minh City for association with mother’s exposure to Agent Orange and TCDD in Vietnam conflict

15 birth defects

50 hydatidiform moles

104

134

Phuong et al., 1989b

Cohort

Comparison of reproductive anomalies among births to women (May 1982–June 1982) living in areas heavily sprayed with herbicides in southern Vietnam, to women from Ho Chi Minh City

7,327 births

6,690 births

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Constable and Hatch, 1985

Review

Summaries of reproductive outcomes among Vietnamese populations, includes nine unpublished studies

 

 

Other New Environmental Studies

Fierens et al., 2003

Population-based, cross-sectional

Association between serum dioxin, prevalence of diabetes, endometriosis in several Belgian towns

194

63

Fukuda et al., 2003

Ecologic cohort

Correlation between incinerator dioxin emissions and mortality in 803 Japanese municipalities

426 Municipalities with plants

164 Municipalities without plants

Other Environmental Studies Reviewed in Update 2002

Revazova et al., 2001

Cohort

Cytogenetic effects in women exposed to different levels of dioxin while living in Chapaevsk, Russia

15 possibly exposed workers

30 nonexposed but living close to plant

Revich et al., 2001

Cohort

Study of dioxin exposures in Chapaevsk, Russia which looked at various health outcomes in children and adults

Children and adults in Chapaevsk, Russia

Samara region and all of Russia

Other Environmental Studies Reviewed in Update 2000

Schreinemachers, 2000

Cross-sectional

Study of cancer mortality rates in four northern wheat-producing states using wheat acreage per county as surrogate for exposure

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Other Environmental Studies Reviewed in Update 1998

Gallagher et al., 1996

Case-control

Community-based study of primary basal cell carcinoma (BCC) and patients with primary squamous-cell carcinoma (SCC) in Alberta, Canada

BCC: 226

SCC: 180

406

Lovik et al., 1996

Cohort

Study of immune system parameters in hobby fishermen in the Frierfjord in southeastern Norway

24

10

Masala et al., 1996

Case-control

Multicenter study of NHL, HD, MM, and AML in Italy by region

HD: 421

NHL: 1,822

MM: 325

AML: 263

Internal comparison by region

Svensson et al., 1995

Cohort

Mortality and cancer incidence experience in two cohorts of Swedish fishermen

East coast: 2,896

West coast: 8,477

Weisglas-Kuperus et al., 1995

Cohort

Study of the immunological effects of prenatal andpostnatal PCB or TCDD exposure in 207 Dutch infants from birth to 18 months

105 breast-fed

102 bottle-fed

Wolf and Karmaus, 1995

Cross-sectional

Study of the effects of inhalation exposure to TCDD and related compounds in wood preservatives on cell-mediated immunity in German day care center employees

221

189

Other Environmental Studies Reviewed in Update 1996

Butterfield et al., 1993

Case-control

Study of possible environmental risk factors associated with young-onset Parkinson’s disease

63

68

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Peper et al., 1993

Descriptive

Study of environmental exposure to dioxins and furans and potential association with adverse neuropsychological effects in Germany

19

None

Other Environmental Studies Reviewed in VAO

Lampi et al., 1992

Nested case-control/cohort

Study of cancer incidence among a community in Finland exposed to water and food contaminated with chlorophenols (1987), compared to other communities; study of several cancers compared to population controls for association with potential risk factors including food and water consumption

56 colon cancer; 40 bladder cancer; 8 STS; 7 HD; 23 NHL; 43 leukemia

688

Vineis et al., 1991

Ecological design

Presentation of rates (1985–1988) of NHL, HD, and STS in men and women 15–74 years old living in provinces in Italy where phenoxy herbicides are used in rice weeding and defined in two categories

63 HD

253 NHL

49 STS

No non-exposed controls

Fitzgerald et al., 1989

Cohort

Health outcomes in group exposed to electrical transformer fire in 1981 compared to standardized rates among upstate New York residents

377

Jansson and Voog, 1989

Cohort/case study

Case study of facial cleft (April–August 1987) and study of facial clefts (1975–1987) compared to the rates expected in Swedish county with incinerators

20,595 births after incineration 6 case studies

71,665 births before incineration

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Cartwright et al., 1988

Case-control

Study of living cases of NHL (1979–1984) in Yorkshire, England, compared to other hospitalized patients for association with a range of exposures including fertilizers or herbicides

437

724

Michigan Department of Public Health, 1983

Descriptive

Comparison of Michigan county rates of mortality for STS and connective tissue cancer (1960–1981), compared to state and national rates for potential excess in areas where dioxin may be in the environment

County rates

State and national rates

Gordon and Shy, 1981

Case-control

Study of agricultural chemical exposures and potential association with cleft palate or lip in Iowa and Michigan, compared to other live births

187

985

Hanify et al., 1981

Ecological design

Study of adverse birth outcomes occurring 1960–1966, compared to 1972–1977 for association with 2,4,5-T spraying in the later period

9,614 births

15,000 births

Nelson et al., 1979

Ecological design

Study of prevalence of oral cleft palates in high, medium, and low 2,4,5-T sprayed areas in Arkansas (1948–1974)

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

US EPA, 1979

Ecological design

Study of spontaneous abortions occurring during 1972–1977 in herbicide-sprayed areas around Alsea, Oregon, compared to spontaneous abortions occurring in unsprayed areas

2,344 births

1,666 births—unsprayed area; 4,120 births—urban area

aThe dash (—) indicates the comparison group is based on a population (e.g., US white males, country rates), with details given in the text for specifics of the actual population.

ABBREVIATIONS: 2,4,5-T, 2,4,5-trichlorophenoxyacetic; AhR, arylhydrocarbon receptor; AML, acute myelogenous leukemia; ARNT, arylhydrocarbon receptor nuclear transporter; BCC, basal cell carcinoma; CYP1A1, cytochrome p450 1A1; CYP1B1, cytochrome p450 1B1; EROD, 7-ethoxyresorufun-O-deethylase; HD, Hodgkin’s disease; MM, multiple myeloma; NHL, non-Hodgkin’s lymphoma; PCB, polychlorinated biphenyls; PD, Parkinson’s disease; SCC, squamous cell carcinoma; SWHS, Seveso Women’s Health Study; STS, soft-tissue sarcoma; TCDD, 2,3,7,8-tetrachlorodibenzo-p-dioxin; Update 2000, Veterans and Agent Orange: Update 2000 (IOM, 2001); Update 1998, Veterans and Agent Orange: Update 1998 (IOM, 1998); Update 1996, Veterans and Agent Orange: Update 1996 (IOM, 1996); US EPA, United States Environmental Protection Agency; and VAO, Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam (IOM, 1994).

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

TABLE A-3 Epidemiologic Studies—Veterans’ Exposure

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

UNITED STATES STUDIES

New Ranch Hand Studies

Akhtar et al., 2004

Cohort

Follow-up to Ketchum et al. (1999), comparing cancer incidence among Ranch Hands with Vietnam veterans who served in Southeast Asia but did not spray herbicides and with US national cancer rates

1,189 Ranch Hands for external analysis; 1,009 Ranch Hands for internal analysis

1,776 Comparison subjects for external analysis; 1,429 comparison subjects for internal analysis

Barrett et al., 2003

Cohort

Serum TCDD measurement and psychological functioning among Ranch Hand veterans

1,109

1,493

Michalek et al., 2003

Cohort

Correlation for TCDD elimination and Ranch Hands with diabetes

343

No comparison group

Pavuk et al., 2003

Cohort

Study to examine the relationship between serum TCDD and thyroid function in Ranch Hand veterans

1,009

1,429

Ranch Hand Studies Reviewed in Update 2002

Barrett et al., 2001

Cohort

Based on tests of cognitive function in 1982, and dioxin levels measured in 1987 and 1992; analyzed association between serum dioxin levels and cognitive function among Ranch Hand veterans

937

1,052

Michalek et al., 2001a

Cohort

Based on physical examination through 1992 and medical records reviewed through March of 1993; analyzed association between serum dioxin levels and hepatic abnormalities among Ranch Hand veterans

1,109

1,493

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Michalek et al., 2001b

Cohort

Based on physical examination in 1982, 1985, 1987, 1992, and 1997 and medical records through 1997; analyzed association between serum dioxin levels and peripheral neuropathy among Ranch Hand veterans

761

1,086

Michalek et al., 2001c

Cohort

Based on physical examination in 1982, 1985, 1987, and 1992 and medical record through 1997; analyzed association between serum dioxin levels and hematologic function among Ranch Hand veterans

953

1,280

Steenland et al., 2001

Cohort

A study to reexamine and compare diabetes data from the NIOSH cohort and the US Air Force Ranchs Hands in order to reconcile differences between the two study methods and protocols

267 NIOSH workers

227 NIOSH comparisons

990 Ranch Hands

1,275 Ranch Hand comparisons

Ranch Hand Studies Reviewed in Update 2000

AFHS, 2000

Cohort

Evaluation of 266 health-related end points, including assessments of 10 clinical areas: general health, neoplasia, neurological, psychological, gastrointestinal, cardiovascular, hematologic, endocrine, immunologic, and pulmonary

995

1,299

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Longnecker and Michalek, 2000

Cohort

Based on physical examination and medical record review through 1992, analyzed association between serum dioxin concentrations and diabetes mellitus among the comparison group (no Ranch Hands)

1,281

1,197

Ketchum et al., 1999

Cohort

Based on physical examination and medical record review through 1992, analyzed association between serum dioxin levels and cancer, skin cancer, and other than skin cancer among Ranch Hand veterans

980

1,275

Michalek et al., 1999a

Cohort

To further elucidate the relationship between dioxin and diabetes mellitus, this analysis studies the effect of dioxin body burden on the relationship between sex hormone-binding globulin and insulin and fasting glucose among Ranch Hand veterans

871

1,121

Michalek et al., 1999b

Cohort

Based on physical examinations in 1982, 1985, 1987, and 1992, examination of immunologic response and exposure to dioxin among Ranch Hand and comparison cohorts

914

1,186

372 (lymphocyte counts conducted)

491 (lymphocyte counts conducted)

Burton et al., 1998

Cohort

Based on physical examination and medical record review through 1992, analyzed association between serum dioxin levels and occurrence and timing (relative to Southeast Asia service) of chloracne and acne among Ranch Hand veterans

930

1,200

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Michalek et al., 1998b

Cohort

Updates all-cause and cause-specific postservice mortality (through 1993) among veterans of Operation Ranch Hand, using standardized mortality ratios

1,261

19,080

Michalek et al., 1998c

Cohort

Prospective study of exposure and long-term health, survival, or reproductive outcome

1,208 veterans

903 offspring

1,549 veterans

1,254 offspring

Michalek et al., 1998d

Cohort

Third report in a series investigating dioxin body burden and preterm birth, intrauterine growth retardation, and infant death among offspring of Ranch Hand veterans

859

1,223

Ranch Hand Studies Reviewed in Update 1998

Michalek et al., 1998a

Cohort

Paternal serum dioxin concentrations and infant death among offspring of Ranch Hands

859 children: 323 background exposure, 267 low exposure, 269 high exposure

1,223 children

Henriksen et al., 1997

Cohort

Study of the relationship between serum dioxin and glucose levels, insulin levels, and diabetes mellitus in Ranch Hands through 1992

989

1,276

AFHS, 1996; Michalek et al., 1998b

Cohort

Mortality update of Ranch Hands through the end of 1993 in the same cohort as AFHS (1983, 1984b, 1985, 1986, 1989, 1991a, 1995)

1,261

19,080

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Henriksen et al., 1996

Cohort

Study of serum dioxin and reproductive hormones in Ranch Hands in 1982, 1985, 1987, and 1992

1,045 (participants, 1982)

474 (provided semen)

1,224 (participants, 1982)

532 (provided semen)

Ranch Hand Studies Reviewed in Update 1996

AFHS, 1995

Cohort

Mortality updates of Ranch Hands compared with Air Force C-130 air and ground crew veterans in Southeast Asia who did not participate in herbicide spraying missions

1,261 (original cohort)

19,101 (original cohort)

Wolfe et al., 1995

Cohort

Paternal serum dioxin levels and reproductive outcomes of Ranch Hand veterans compared with Air Force veterans from Southeast Asia who did not participate in herbicide spraying missions

932

1,202

Ranch Hand Studies Reviewed in VAO

AFHS, 1992

Cohort

Reproductive outcomes of participants in the Air Force Health Study (AFHS)

791

942

AFHS, 1984a, 1987, 1990, 1991b, 1995

Cohort

Baseline morbidity and follow-up exam results of the AFHS

1,208 (baseline)

1,668 (baseline)

AFHS, 1983, 1984b, 1985, 1986, 1989, 1991a

Cohort

Mortality updates of Ranch Hands compared with Air Force C-130 air and ground crew veterans in Southeast Asia who did not participate in herbicide spraying missions

1,261 (original cohort)

19,101 (original cohort)

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Michalek et al., 1990

Cohort

Mortality of Ranch Hands compared with Air Force C-130 air and ground crew veterans in Southeast Asia

1,261

19,101

Wolfe et al., 1990

Cohort

Health status of Ranch Hands at second follow-up, compared with Air Force C-130 air and ground crew veterans in Southeast Asia

995

1,299

Centers for Disease Control (CDC) Studies Reviewed in VAO

Decoufle et al., 1992

Cohort

Association between self-reported health outcom es and perception of exposure to herbicides based on Vietnam Experience Study (VES)

7,924

7,364

O’Brien et al., 1991

Cohort

Interview report and mortality for NHL based on VES

8,170

7,564

CDC, 1990a

Case-control

Selected Cancers Study—population-based case-control study of all men born between 1921 and cancer registries and controls selected by 1953; cases diagnosed area covered by eight random-digit dialing

1,157 NHL; 342 STS; 310 HD; 48 nasal carcinoma; 80 nasopharyngeal carcinoma; 130 primary liver cancer

1,776

CDC, 1990b

Case-control

Selected Cancers Study—population-based case-control study of all men born between 1921 and 1953; cases diagnosed area covered by eight cancer registries and controls selected by random-digit dialing: NHL

1,157

1,776

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

CDC, 1990c

Case-control

Selected Cancers Study: soft-tissue sarcoma

342

1,776

CDC, 1990d

Case-control

Selected Cancers Study: HD, nasal cancer, nasopharyngeal cancer, and primary liver cancer

310 HD; 48 nasal carcinoma; 80 nasopharyngeal carcinoma; 130 primary liver cancer

1,776

CDC, 1989b

Cohort

Vietnam Experience Study—random sample of US Army enlisted men 1965–1971

2,490

1,972

CDC, 1988a

Cohort

VES—random sample of US Army enlisted men 1965–1971: psychosocial outcomes

2,490

1,972

CDC, 1988b

Cohort

VES: physical health outcomes

2,490

1,972

CDC, 1988c

Cohort

VES: reproductive outcomes

12,788 children

11,910 children

CDC, 1987; Boyle et al., 1987

Cohort

VES: mortality

9,324

8,989

Erickson et al., 1984 a,b

Case-control

CDC birth defects study of children born in the Atlanta area between 1968 and 1980, comparing fathers’ Vietnam experience and potential Agent Orange exposure between birth defects cases and normal controls

7,133

4,246

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Department of Veterans Affairs (VA) Studies Reviewed in Update 2002

Kang et al., 2001

Cohort

Study evaluating the health of Army Chemical Corps Vietnam veterans compared to Army Chemical Corps veterans who did not serve in Vietnam

2,872

2,737

Kang et al., 2000a

Cohort

Self-report pregnancy outcomes for female Vietnam veterans compared to contemporary female veterans not deployed to Vietnam. Odds ratios were calculated for reproductive history and various birth defects

3,392 women; 1,665 women with an indexed pregnancy

3,038 women; 1,912 women with an indexed pregnancy

Kang et al., 2000b

Cohort

Study of gynecologic cancers among female Vietnam veterans compared to femae veteran controls

484

5,946

Department of Veterans Affairs (VA) Studies Reviewed in Update 1998

Dalager and Kang, 1997

Cohort

Morbidity and mortality experience (1968–1987) of Army Chemical Corps Vietnam veterans compared to US men; extension of Thomas and Kang (1990)

2,872

2,737

Mahan et al., 1997

Case-control

Study of lung cancer among Vietnam veterans (1983–1990)

329

269 men hospitalized without cancer; 111 patients with colon cancer

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

McKinney et al., 1997

Cross-sectional

Study of the smoking behavior of veterans and nonveterans using the 1987 National Medical Expenditure Survey (NMES)

15,000

Bullman and Kang, 1996

Cohort

Mortality study of veterans with nonlethal (combat and noncombat) wounds sustained during the Vietnam war

34,534

Watanabe and Kang, 1996

Cohort

Mortality experience (1965–1988) of Army and Marine Corps Vietnam veterans; extension of Breslin et al. (1988) and Watanabe et al. (1991)

33,833

36,797

Dalager et al., 1995b

Case-control

Cases of HD-diagnosed 1969–1985 among Vietnam era veterans

283

404

Watanabe and Kang, 1995

Cohort

Postservice mortality among Marine Vietnam veterans

10,716

9,346

VA Studies Reviewed in Update 1996

Dalager et al., 1995a

Cohort

Update of Thomas et al. (1991) through December 31, 1995

4,586

5,325

Bullman et al., 1994

Case-control

Study of the association between testicular cancer and surrogate measures of exposure to Agent Orange in male Vietnam veterans

97

311

VA Studies Reviewed in VAO

Bullman et al., 1991

Case-control

PTSD cases in Vietnam veterans compared to Vietnam veterans without PTSD for association with traumatic combat experience

374

373

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Dalager et al., 1991

Case-control

Cases of NHL diagnosed 1969–1985 among Vietnam-era veterans compared to cases of other malignancies among Vietnam-era veterans for association with Vietnam service

201

358

Eisen et al., 1991

Cohort

Health effects of male monozygotic twins serving in the armed forces during Vietnam era (1965–1975)

2,260

2,260

Thomas et al., 1991

Cohort

Mortality experience (1973–1987) among women Vietnam veterans compared to women non-Vietnam veterans and for each cohort compared to US women

4,582

5,324

Watanabe et al., 1991

Cohort

Mortality experience (1965–1984) of Army and Marine Corps Vietnam veterans compared to: (1) branch-specific (Army and Marine) Vietnam-era veterans; (2) all Vietnam-era veterans combined; (3) the US male population

24,145 Army, 5,501 Marines

(1) 27,145 Army, 4,505 Marines

(2) 32,422 STET/OIC

(3) US male population

Bullman et al., 1990

Cohort

Mortality experience of Army I Corps Vietnam veterans compared to Army Vietnam-era veterans

6,668 deaths

27,917 deaths

Farberow et al., 1990

Case-control

Psychological profiles and military factors associated with suicide and motor vehicle accident (MVA) fatalities in Los Angeles County Vietnam-era veterans (1977–1982)

22 Vietnam suicides; 19 Vietnam-era suicides

21 Vietnam MVA; 20 Vietnam-era MVA

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Thomas and Kang, 1990

Cohort

Morbidity and mortality experience (1968–1987) of Army Chemical Corps Vietnam veterans compared to US men

894

True et al., 1988

Cross-sectional

PTSD and Vietnam combat experience evaluated among Vietnam-era veterans

775

1,012

Breslin et al., 1988

Burt et al., 1987

Cohort

Mortality experience (1965–1982) of Army and Marine Corps Vietnam veterans, compared to Vietnam-era veterans who did not serve in Southeast Asia standardized by age and race; nested case-control study of NHL

24,235

26,685

Kang et al., 1987

Case-control

STS cases (1975–1980) diagnosed at the Armed Forces Institute of Pathology, compared to controls identified from patient logs of referring pathologists or their departments for association with Vietnam service and likelihood of Agent Orange exposure

217

599

Kang et al., 1986

Case-control

STS cases (1969–1983) in Vietnam-era veterans for association with branch of Vietnam service as a surrogate for Agent Orange exposure

234

13,496

American Legion Studies Reviewed in VAO

Snow et al., 1988

Cohort

Assessment of PTSD in association with traumatic combat experience among American Legionnaires serving in Southeast Asia (1961–1975)

2,858

Study group subdivided for internal comparison

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Stellman SD et al., 1988

Cohort

Assessment of physical health and reproductive outcomes among American Legionnaires who served in Southeast Asia (1961–1975) for association with combat and herbicide exposure

2,858

3,933

Stellman JM et al., 1988

Cohort

Assessment of social and behavioral outcomes among American Legionnaires who served in Southeast Asia (1961–1975) for association with combat and herbicide exposure

2,858

3,933

State Studies Reviewed in Update 1998

Clapp, 1997

Case-control

Selected cancers identified (1988–1993) among Massachusetts Vietnam veterans, compared to Massachusetts Vietnam-era veterans with cancers of other sites; update of Clapp et al. (1991)

245

999

State Studies Reviewed in Update 1996

Visintainer et al., 1995

Cohort

Mortality experience (1965–1971) among male Michigan Vietnam veterans, compared to non-Vietnam veterans from Michigan

3,364 deaths

5,229 deaths

State Studies Reviewed in VAO

Fiedler and Gochfeld, 1992; Kahn et al., 1992a,b,c

Cohort

New Jersey study of outcomes in select group of herbicide-exposed Army, Marine, and Navy Vietnam veterans, compared to veterans self-reported as unexposed

10 Pointman I

55 Pointman II

17 Pointman I

15 Pointman II

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Clapp et al., 1991

Case-control

Selected cancers identified (1982–1988) among Massachusetts Vietnam veterans, compared to Massachusetts Vietnam-era veterans with cancers of other sites

214

727

Deprez et al., 1991

Descriptive

Study of Maine Vietnam veterans compared to atomic test veterans and general population for health status and reproductive outcomes

249

113 atomic test veterans

Levy, 1988

Cross-sectional

Study of PTSD in chloracne as indicator of TCDD-exposed and control Vietnam veterans in Massachusetts

6

25

Anderson et al., 1986a

Cohort

Mortality experience of Wisconsin veterans compared to nonveterans (Phase 1); mortality experience of Wisconsin Vietnam veterans and Vietnam-era veterans compared to nonveterans and other veterans (Phase 2)

110,815 white male veteran deaths; 2,494 white male Vietnam-era veteran deaths; 923 white male Vietnam veteran deaths

342,654 white male non-veteran deaths 109,225 white male other veteran deaths

Anderson et al., 1986b

Cohort

Mortality experience of Wisconsin Vietnam-era veterans and Vietnam veterans compared to US men, Wisconsin men, Wisconsin nonveterans, and Wisconsin other veterans

122,238 Vietnam-era veterans 43,398 Vietnam veterans

Goun and Kuller, 1986

Case-control

Cases of STS, NHL, and selected rare cancers compared to controls without cancer for Vietnam experience in Pennsylvania men (1968–1983)

349

349 deceased

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Holmes et al., 1986

Cohort

Mortality experience (1968–1983) of West Virginia veterans, Vietnam veterans, and Vietnam-era veterans compared to nonveterans; Vietnam veterans compared to Vietnam-era veterans

615 Vietnam veterans

610 Vietnam-era veterans

Pollei et al., 1986

Cohort

Study of chest radiographs of New Mexico Agent Orange Registry Vietnam veterans compared to radiographs of control Air Force servicemen for pulmonary and cardiovascular pathology

422

105

Kogan and Clapp, 1985, 1988

Cohort

Mortality experience (1972–1983) among white male Massachusetts Vietnam veterans, compared to non-Vietnam veterans and to all other nonveteran white males in Massachusetts

840 deaths

2,515 deaths of Vietnam-era veterans

Lawrence et al., 1985

Cohort

Mortality experience of New York State (1) Vietnam-era veterans compared to nonveterans and (2) Vietnam veterans compared to Vietnam-era veterans

(1) 4,558

(2) 555

17,936

941

Rellahan, 1985

Cohort

Study of health outcomes in Vietnam-era (1962–1972) veterans residing in Hawaii associated with Vietnam experience

232

186

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Wendt, 1985

Descriptive

Descriptive findings of health effects and potential exposure to Agent Orange among Iowa veterans who served in Southeast Asia

10,846

None

Greenwald et al., 1984

Case-control

Cases of STS in New York State compared to controls without cancer for Vietnam service and herbicide exposure including Agent Orange, dioxin, or 2,4,5-T

281

281 live controls

130 deceased controls

Newell, 1984

Cross-sectional

Preliminary (1) cytogenetic, (2) sperm, and (3) immune response tests in Texas Vietnam veterans compared to controls

(1) 30

(2) 32

(3) 66

30

32

66

Other US Veteran Studies Reviewed in VAO

Tarone et al., 1991

Case-control

Study of cases between January 1976 and June 1981 with testicular cancer (18–42 years old) compared to hospital controls for association with Vietnam service

137

130

Aschengrau and Monson, 1990

Case-control

Study of cases with late adverse pregnancy outcomes compared to normal control births for association with paternal Vietnam service (1977–1980)

857 congenital anomalies

61 stillbirths

48 neonatal deaths

998

Goldberg et al., 1990

Cohort

Study of male twin pairs who served in Vietnam era (1965–1975) for association between Vietnam service and PTSD

2,092

2,092

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Aschengrau and Monson, 1989

Case-control

Association between husband’s military service and women having spontaneous abortion at or by 27 weeks compared to women delivering at 37 weeks

201

1,119

AUSTRALIAN STUDIES

Australian Studies Reviewed in Update 2000

AIHW, 1999

Cohort

Validation of the male veterans study (CDVA, 1998a) using medical documents, doctors’ certification and records on a disease or death registry

6,842

CDVA, 1998a

Cohort

Self-reported data on male members of the Australian Defence Force and the Citizen Military Force who landed in Vietnam or entered Vietnamese water. Questions on physical (including reproductive history) and mental health, and that of their partner(s) and children

49,944 mailed; 39,955 responded

CDVA, 1998b

Cohort

Self-reported data on female members of the Australian Defence Force and the Citizen Military Force who landed in Vietnam or entered Vietnamese water. Questions on physical (including reproductive history) and mental health, and that of their partner(s) and children

278 mailed

225 responded

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Australian Studies Reviewed in Update 1998

Crane et al., 1997a

Cohort

Mortality experience (through 1994) of Australian veterans who served in Vietnam

59,036 males

484 females

Crane et al., 1997b

Cohort

Mortality experience (through 1994) of Australian national servicemen who served in Vietnam

18,949

24,646

O’Toole et al., 1996a,b,c

Cross-sectional

Survey of self-reported health status (1989–1990) of Australian Army Vietnam veterans

641

Australian Studies Reviewed in VAO

Field and Kerr, 1988

Cohort

Study of Tasmanian Vietnam veterans compared to neighborhood controls for adverse reproductive and childhood health outcomes

357

281

Fett et al., 1987a

Cohort

Australian study of mortality experience of Vietnam veterans compared to Vietnam-era veterans through 1981

19,205

25,677

Fett et al., 1987b

Cohort

Australian study of cause-specific mortality experience of Vietnam veterans compared to Vietnam-era veterans through 1981

19,205

25,677

Forcier et al., 1987

Cohort

Australian study of mortality in Vietnam veterans by job classification, location, and time of service

19,205

Internal comparison

Suggested Citation:"Appendix A: Epidemiologic Tables for Chapter 4." Institute of Medicine. 2005. Veterans and Agent Orange: Update 2004. Washington, DC: The National Academies Press. doi: 10.17226/11242.
×

Reference

Study Design

Description

Study Group (N)

Comparison Group (N)a

Donovan et al., 1983, 1984

Case-control

Australian study of cases of congenital anomalies in children born (1969–1979), compared to infants born without anomalies for association with paternal Vietnam service

8,517

8,517

OTHER VIETNAM-VETERANS’ STUDIES

Other New Vietnam-Veterans’ Studies

Kim H-A et al., 2003

Cohort

Immunotoxicologic effects of Agent Orange exposure on Korean Vietnam veterans

51 (24 Veterans–patient; 27 veterans–normal)

36

Kim J-S et al., 2003

Cross–sectional

Agent Orange exposure and Korean Vietnam veterans

1,224

154

Mo et al., 2002

Cohort

Skin and general disease patterns among Korean Vietnam veterans

332

None

Other Vietnam Veterans Studies Reviewed in Update 1998

Chinh et al., 1996

Cohort

Study of antinuclear antibodies and sperm autoantibodies among Vietnamese veterans who served 5–10 years in a “dioxin-sprayed zone”

25

63 age-matched controls; 36 additional male controls

a The dash (—) indicates the comparison group is based on a population (e.g., US white males, country rates), with details given in the text for specifics of the actual population.

ABBREVIATIONS: 2,4,5-T, 2,4,5-trichlorophenoxyacetic; AFHS, Air Force Health Study; CDC, Centers for Disease Control and Prevention; CDVA, Commonwealth Department of Veterans’ Affairs; HD, Hodgkin’s disease; MVA, mother vehicle accidents; NIOSH, National Institute for Occupational Safety and Health; NHL, non-Hodgkin’s lymphoma; NMES; National Medical Expenditure Survey; PTSD, posttraumatic stress disorder; SMR, standardized mortality ratio; STS, soft-tissue sarcoma; TCDD, 2,3,7,8-tetrachlorodibenzo-p-dioxin; Update 2000, Veterans and Agent Orange: Update 2000 (IOM, 2001); Update 1998, Veterans and Agent Orange: Update 1998 (IOM, 1998); Update 1996, Veterans and Agent Orange: Update 1996 (IOM, 1996); and VAO, Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam (IOM, 1994).

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Next: Appendix B: Agendas of Public Meetings »
Veterans and Agent Orange: Update 2004 Get This Book
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 Veterans and Agent Orange: Update 2004
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Sixth in a series of congressionally mandated studies, this book is an updated review and evaluation of the available evidence regarding the statistical assoication between exposure to herbicides used in Vietnam and various adverse health outcomes suspected to be linked with such exposure.

This book builds upon the information contained in the earlier books in the series:

  • Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam (1994)
    • Veterans and Agent Orange: Update 1996
    • Veterans and Agent Orange: Update 1998
    • Veterans and Agent Orange: Update 2000
    • Veterans and Agent Orange: Update 2002
    • Veterans and Agent Orange: Herbicides and Dioxin Exposure and Type 2 Diabetes (2000)
    • Veterans and Agent Orange: Herbicide/Dioxin Exposure and Acute Myelogenous Leukemia in the Children of Vietnam Veterans (2002)

      Veterans and Agent Orange: Update 2004 focuses primarily on scientific studies and other information developed since the release of these earlier books. The previous volumes have noted that sufficient evidence exists to link chronic lymphocytic leukemia, soft-tissue sarcoma, non-Hodgkin's lymphoma, Hodgkin's disease, and chloracne with exposure. The books also noted that there is "limited or suggestive" evidence of an association between exposure and respiratory cancers, prostate cancer, multiple myeloma, the metabolic disorder porphyria cutanea tarda, early-onset transient peripheral neuropathies, Type 2 diabetes, and the congenital birth defect spinal bifida in veterans' children. This volume will be critically important to both policymakers and physicians in the federal government, Vietnam veterans and their families, veterans' organizations, researchers, and health professionals.

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