Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan (2011) / Chapter Skim
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Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes
Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes
Pages 139-180
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From page 139... ...
Appendix C Epidemiologic Studies Cited in Chapter 6: Health Outcomes Table C-1 includes descriptions of epidemiologic studies cited in Chapter 6. Key and supporting studies are presented alphabetically with studies of Gulf War veterans listed in a separate section at the end of the table.
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; years since Total Cohort: censored at age 85 significant by chance Retrospective 1950 and 1989 at first exposure (first Brain cancer and other NS tumors (ICD9 191- years; cata stratified alone; healthy worker cohort study. six fire departments employment)
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10-19 Years Employment: Circulatory diseases: SMR 1.20, 95% CI 1.10 1.31; Ischemic heart disease: SMR 1.35, 95% CI 1.21-1.49; Respiratory diseases: SMR 0.68, 95%CI 0.49-0.96; Suicide: SMR 0.37, 95% CI 0.18-0.78; All other causes NS. 141 continued
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2001 4,305 firefighters Ever employed as a Cancer incidence and mortality, calculated as Age, sex and calendar This study follows up employed in New firefighter; duration SIR and SMR relative to New Zealand male period standardized. on a testicular cancer Retrospective Zealand between of employment as a population, follow-up 1977 through 1995 for cluster described by cohort study 1977-1995.
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3,066 white male Firefighter Cause of death. Compared with the general US Rate ratios standardized Reliability of death 1991 firefighters from San employment (yes/ male population.
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Full-time and Shift or season of Spirometric measurements of lung function 1997 seasonal wildland firefighting. and self administered questionnaire data were fire management collected before and after the 1992 firefighting Cohort study workers in Region season.
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Deaths among Employment as a Ischemic heart disease deaths in males 16-60 Age standardized. Differential reporting of 1999 488,539 white firefighter.
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, sex. diagnosed 1989- waste incinerator.
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or outer elevated pre- or post-1988, but when stratified within 7 km of a (3-7 km radius) by year, the risk was significantly elevated in waste incinerator, areas and pre- vs.
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830 male firefighters Time spent working Cause of death (1977-1991) ; compared with Age and calendar Healthy worker effect; 1995 having served at on assignments the general French male population.
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an exposure. lung function or respiratory symptoms with smoke exposure or duration of service was found.
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of all, stomach, lung, Retrospective a municipal waste sites in the United Stage 1 (22-sites randomly sampled) at 0-3 km and liver cancers near cohort study incinerator in Kingdom.
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Firth et al. 1996 Cases of cancer Occupation listed as SIR Cancer incidence.
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cohort study to the general 4.97; Brain and CNS cancer: RR 3.78, 95% CI The ethnic composition male population of 1.22-11.71; Circulatory system diseases: RR of the firefighters differs Hawaii. 1.16, 95% CI 1.10-1.32; Cirrhosis of the liver: greatly from that of the
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adjusted; data index not validated employed between weighted by an stratified by exposure empirically or by Retrospective 1927 and 1987 exposure opportunity All malignant neoplasms: SMR 127, 95% CI opportunity, duration exposure monitoring; cohort study by the Edmonton index (relative time 102-155; Kidney and ureter cancer: SMR 414, of employment, and insufficient statistical or Calgary fire exposed to fire by 95% CI 166-853; Mental disorders: SMR 455, cohort of entry (before power to detect lower [Respiratory-s; department. 370 job classification)
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<30 Years of Employment: All causes, All cancers, Lung cancer, Ischemic heart disease NS. ≥30 Years of Employment: Ischemic heart disease: SMR 167 (p<0.05)
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calendar year; stratified categories; included a Retrospective Seattle, WA, active assignments Full cohort by duration of exposure sub-analysis of those cohort study employed for at (having the All causes: SMR 76, 95% CI 69-85; and time since first surviving 30 years since least 1 year between possibility of fire Circulatory system disease: SMR 78, 95% exposure; no adjustment first exposure. [Respiratory-s; 1945 and 1980.
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Hours et al. 2003 102 male workers Exposure was Self-reported symptoms; physical exam; red Regression analyses 100% participation of from 3 urban categorized by and white blood cell counts, blood lead, liver were adjusted for workers; Case-control incinerators in job type: crane or enzymes; and pulmonary function; smoking, age, and work exposed workers smoked study France compared equipment operators incinerator workers reported more symptoms of location.
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Kang et al. 2008 2,125 white, Primary occupation Cancer incidence Age and smoking.
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TABLE C-1 Continued 158 Study and Design Population Exposure Outcomes Adjustments Limitations and Comments Kilburn et al. 14 Firefighters PCBs and Neurophysical and neuropsychological test None 1989 exposed to burning byproducts at a fire results.
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events in some strata; Retrospective (1,883 from death certificate. occupational mortality database; among white exposure and disease cohort study cancer)
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gender adjusted. Disease misclassification Retrospective professional Males dependant on validity cohort study.
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. for socioeconomic sources and risks could Ecologic study waste incinerator, No significant increased cancer mortality status.
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decreased PMRs fortress.wa.gov/doh/ Cohort study from 1950-1999. for: Disorders of Character, Behavior occmort/OMQuery.aspx.
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al. 2001 firefighters and 88 firefighter, duration chronic respiratory symptoms.
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22,192 live births Paternal occupation OR Birth defects in 20 categories. Matched on date No consideration of 1990 with birth defects in as a firefighter All births and hospital of maternal exposures.
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deaths) and 2,074 All cause mortality: SMR 82, 95% CI 11-87; Cohort study police officers in Non-malignant respiratory disease: SMR 81 Seattle, Tacoma, (95% CI 73-89)
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Sardinas et al. 306 Firefighter Firefighter or 115 Ischemic heart disease deaths among Analysis used weighted Only premature deaths 1986 and 401 policemen policeman listed as firefighters.
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Residents PEFR results; among sensitive individuals, (subjectively determined were members those exposed to a biomedical waste by neighborhood of exposed incinerator had significantly lower mean PEFR appearance) and were or unexposed results compared to the control community and no closer than 5 km communities; those exposed to a municipal waste incinerator from the incinerator; assigned average adjusted for age, sex, had significantly higher mean FEV1 and PEFR community exposure results than the control community (both height, and race.
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adjusted; stratified disease misclassification Stockholm, Sweden, of fires fought by All causes: SMR 82, 95% CI 73-91; by age, employment dependant on reliability Retrospective employed for at each individual. Circulatory diseases: SMR 84, 95% CI 71-98; time, latency period, of death certificate cohort study least 1 year between Asthma, bronchitis, and emphysema: SMR 0, fire exposure index, information.
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1980 30 Texan firefighters Severe smoke Spirometry immediately after exposure, after 6 Healthy controls No consideration of exposed to severe exposure at weeks, and 18 months later. matched for age, height, disease or exposure prior Cohort study smoke in a chemical particular fire.
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Retrospective waste incinerator. Spatial clusters of increased risk were observed cohort study for soft-tissue sarcoma (SIR 1.44, p=0.12)
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Smoking identified as 1980 Wales firefighters. (minus time in non- chronic respiratory symptoms and disease, and more significant health active fire duty)
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. Iowa Persian 3,695 GW veterans Oil-well fire smoke Prevalence of self-reported symptoms and Stratified for age, sex, Study not designed to Gulf Study and non-GW exposure collected illnesses.
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2002 405,142 active-duty Modeled PM DoD hospitalizations 1991-1999. Adjusted for "influential Objective measure of GW veterans who exposure to Hospitalization rates among those in exposure covariates," defined disease not subject to Cohort study were in theater represent oil-well groups 1-6 were compared to personnel as demographic or recall bias; no issues during the time of fire smoke exposure determined to be unexposed.
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assessed by survey and simultaneous exposures. criteria for exposures, oil-well clinical study; Case-control unexplained illness fire smoke)
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were male veterans who Case-control study comparing exposures never had a child with experienced by fathers with and without a birth defect but had at children having birth defects- No exposure least one healthy child (time of mission, location of mission, oil- matched with veterans well fire smoke, sandstorm, chemical arms, who fathered a child and pesticides) was related to birth defects.
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TABLE C-1 Continued 176 NOTE: AIDS = acquired immune deficiency syndrome; CDC = Centers for Disease Control and Prevention; CHD = coronary heart disease; CI = confidence interval; CNS = central nervous system; DoD = Department of Defense; EMS = emergency medical services; FEF25-–75 = forced expiratory flow between 25% and 75%; FEF50 = forced expiratory flow at 50%; FEV1 = forced expiratory volume in one second; FVC = forced vital capacity; GW = Gulf War; IDR = incidence density ratio; IRR = incidence rate ratio; km = kilometers; L/sec = liters per second; MN = malignant; MOR = mortality odds ratio; NS = not significant; OR = odds ratio; PEFR = peak expiratory flow rate; PM = particulate matter; PMR = proportional mortality ratio; PVC = polyvinyl chloride; RR = relative risk; RV = residual volume; SIR = standardized incidence ratio; SMR = standardized mortality ratio; SMOR = standardized mortality odds ratio; SPMR = standardized proportional mortality ratio; TEQ = toxicity equivalent; TLC = total lung capacity; V25 = maximum expiratory flow rates at 25% of FVC; V50 = maximum expiratory flow rates at 50% of FVC; VA = Department of Veterans Affairs; VC = vital capacity.
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Army Gulf War veterans and modeled exposure to oil well fire smoke. Military Medicine 167(9)
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1996. Cancer incidence near municipal solid waste incinerators in Great Britain.
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1998. Health status of Persian Gulf War veterans: Self-reported symptoms, environmental exposures and the effect of stress.
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2004. Risk of adverse reproductive outcomes associated with proximity to municipal solid waste incinerators with high dioxin emission levels in Japan.
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