Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan (2011) / Chapter Skim
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8 Feasibility and Design Issues for an Epidemiologic Study of Veterans Exposed to Burn Pit Emissions
8 Feasibility and Design Issues for an Epidemiologic Study of Veterans Exposed to Burn Pit Emissions
Pages 117-128
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From page 117... ...
Although the chapter focuses on an epidemiologic study of persistent health outcomes in military personnel and veterans associated with exposure to JBB burn pit emissions, the closure of the burn pit in 2009 precludes the collection of further data on concentrations of air pollutants at the time of the operation of the burn pit. Therefore, the committee also considers the possibility of an epidemiologic study of military personnel and veterans exposed to burn pit emissions at any U.S.
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From page 118... ...
For the study of long-term health outcomes associated with exposure to burn pit emissions, the most appropri ate comparison population would be deployed military personnel or veterans who have not been exposed to burn pit emissions either because they were stationed at military bases without burn pits or they were stationed at JBB before or after the burn pits were in operation. Recruiting a control group from this population would reduce the potential for a healthy-warrior effect, as both the exposed and comparison groups of deployed personnel would be similar in terms of their baseline health status.
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From page 119... ...
Other outcomes of interest, such as various cancers or neurological diseases, may be too uncommon for there to be adequate power to assess whether they are associated with burn pit exposures. The committee recommends that a pilot feasibility study be conducted to assess whether there will be suf ficient power to study specific health outcomes given the currently unknown number of military personnel who might have been exposed to burn pit emissions.
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From page 120... ...
However, burn pits are still in operation at other military bases and personal monitoring at those bases, particularly for potentially highly exposed populations such as the pit operators, could be conducted. Environmental monitoring is an indirect method of exposure assessment.
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From page 121... ...
Furthermore, controlling for confounding factors is of greater importance in situations where the magnitude of the association, in this case burn pit emissions and health outcomes, is modest relative to the relationship between the confounder and either burn pit exposure or the health outcome. For example, smoking is strongly associated with respiratory disease so it may be more difficult to attribute an increase in respiratory disease among exposed military personnel who smoke to burn pit emissions compared with nonsmokers.
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From page 122... ...
AVAILABLE DATASETS AND RESOURCES Available datasets that may provide relevant information on either exposures to burn pit emissions or long-term health outcomes associated with such exposures are discussed below. Ongoing and planned studies of active-duty military personnel or veterans that can be used to assess long-term health outcomes associated with burn pit emis sions are also described.
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From page 123... ...
Thus, military personnel would be exposed during off-duty time spent in their quarters as well as during duty hours. Further information on housing available on bases and indoor air monitoring would also help characterize potential expo sures to burn pit emissions.
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From page 124... ...
from retrospective estimates of exposure to burn pit emissions in military personnel deployed at the JBB. To determine the incidence of chronic diseases or cancers with long latency, individuals must be followed for many years.
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From page 125... ...
The recommendation for a nondeployed comparison group is based on the committee's judgment that pollution in the region from sources other than burn pits may pose greater health risks than burn pit emissions. Elements of a three-tiered prospective cohort study of active-duty military personnel and veterans designed to assess potential chronic health effects related to burn pit emissions are presented in Table 8-1.
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From page 126... ...
CONCLUSIONS AND RECOMMENDATIONS As outlined by the committee's statement of task, several important aspects of epidemiologic study design and their feasibility have been discussed. Considering the feasibility issues, the committee has developed the fol lowing recommendations for a potential study of long-term health effects associated with exposure to burn pits: • cohort study of veterans and active duty military should be considered to assess potential long-term A health effects related to burn pit emissions in the context of the other ambient exposures at the JBB.
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From page 127... ...
The committee's analysis of available data from the environmental monitoring conducted at JBB suggests that exposure to PM emitted from sources such as diesel and jet engines, upwind Iraqi urban areas, and soil, may be of greater concern than exposure to burn pit emissions. • E xposure assessment should include detailed deployment information including distance and direction indi viduals lived and worked from the JBB burn pit, duration of deployment, and job duties.
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From page 128... ...
2008. Screening health risk assessment burn pit exposures Balad Air Base, Iraq and addendum report.
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