Disposition of the Air Force Health Study (2006) / Chapter Skim
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3 The Air Force Health Study Database
3 The Air Force Health Study Database
Pages 68-89
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From page 68... ...
The information in that chapter related to medical records and other study data is summarized here, and some additional details on changes in the study population over time are presented. The original cohort of Ranch Hand personnel totaled 1,2421 subjects who had served in the C-123 crews in Operation Ranch Hand herbicide spray missions and included pilots, copilots, navigators, spray operators, and ground support crews.
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Comparison subjects were matched to Ranch Hand subjects by age, race, and military occupation. Most of the AFHS research is focused on the morbidity component of the study, where exceptionally detailed data gathering took place.
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5A subject would be classified as new to the cohort if his status as a Ranch Hand or comparison subject was being corrected from the initial classification, or if he was moved from the pool of potential comparison subjects to the status of an active study participant.
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Participants Ranch Hand Subjects Comparison Subjects Number of subjects 777 1,174 Mean age 63.1 63.0 Race (%) Black 6.3 6.5 Nonblack 93.7 93.5 Military occupation (%)
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remained unmatched to a compariso n. ‡ Numbers of eligible and participating Ranch Hands reflect AFHS reports (AFHS, 2000 & 2005b)
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n = 777 ‡ Analyses n = 1,174 FIGURE 3-2 AFHS-Morbidity Study Population.
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. Because the investigators expected greater non-compliance from comparison subjects than from Ranch Hand subjects, 431 subjects were added as replacements before Cycle 1.
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The entire comparison pool population was used for additional analyses in the 1989 mortality follow-up. These numbered 20,340 veterans at the 20-year follow-up: 1,262 Ranch Hand subjects and 19,078 comparison subjects (Ketchum and Michalek, 2005)
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The data10 take up ~525 GB of space on the machines, including operating system and backup files (J. Robinson, Air Force Health Study, personal communication, September 21, 2005)
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The committee's interim letter report (IOM, 2005) offered recommendations for several database documentation activities that will -- if carried out -- produce authoritative lists of what variables were collected and when.
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These include paper originals of cycle physical exam reports and completed questionnaires; medical records from the subjects' physicians, dentists, and other health providers; X rays and other diagnostic imagery; lists of medications taken; military administrative records such as duty station orders, flight records, performance reports, awards and decorations, and discharge documents; vital status records such as birth and death certificates; limited information on the subjects' spouse(s) and children; research reference materials; and the study's reports and papers.
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From page 79... ...
The tapes take up ~160 linear feet of storage space.16 Table 3-5 shows the quantities of these materials. OBSTACLES AND LIMITATIONS TO FURTHER USE OF AFHS DATA The committee considered three primary categories of obstacles and limitations to further use of the AFHS medical records and other study data: those related to the design and execution of the study; logistical -- that is, those relating to the management and analysis of the data; and procedural -- those addressing how personal information on study subjects is handled.
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17At the time of the Cycle 1 exam,185 Ranch Hands and 184 comparison subjects were on active duty; in addition, 210 Ranch Hand subjects and 234 comparison subjects held current military or civilian flying certificates, which have rigorous physical and mental fitness requirements (AFHS, 1984a)
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ecause all of our study subjects served in Vietnam or Southeast Asia, contrasting Ranch Hands with comparisons may not fully reveal health differences associated with service in Vietnam" (AFHS, 2005a)
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The interim letter report offered several specific recommendations intended to create a more complete and uniform accounting of the AFHS medical records and other study data. The final section of this chapter recapitulates these recommendations.
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The medical records and other AFHS study data have features that present challenges to the preservation of the privacy of the study subjects and the confidentiality of their personal information. Two prominent features related to the electronic records files and materials originally collected in hard copy but not digitized are discussed below.
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FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS On the basis of its review of AFHS reports, its site visit to the study facility, the scientific literature, and other information presented in this chapter, the committee has reached the following findings regarding the medical records and other study data collected in the course of the Air Force Health Study. As noted in the interim letter report, the committee finds that: The medical records and other study data collected in the course of the AFHS have been properly maintained.
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describes the committee's conclusion that the present state of the documentation and organization of AFHS medical records and other study data was an obstacle to retaining and maintaining these materials after the currently scheduled termination date of the study. The committee therefore recommended that: Action should be taken prior to the currently scheduled termination date of the AFHS to reorganize and document the study's medical records and other study data in a form and format that allows them to be easily understood, evaluated, managed, or analyzed by persons outside of the AFHS.
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From page 86... ...
A master identification table with rows containing variable descriptions, columns representing each of the six exam cycles, and the intersections listing the variable name used in that cycle, would be a useful adjunct to this effort. • Create a document/database describing the contents, format, and location of the AFHS collection of materials that have been scanned into PDF image files -- subjects' medical records, diagnostic imagery, military and vital status records, and the like -- and explaining the collection's organizational structure.
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1984a. Air Force Health Study (Project Ranch Hand II)
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Agent Orange -- Actions Needed to Improve Communications of Air Force Ranch Hand Study Data and Results.
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2000. Agent Orange -- Actions Needed to Improve Communications of Air Force Ranch Hand Study Data and Results (GAO/NSIAD-00-31)
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