Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan (2011) / Chapter Skim
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6 Health Effects Associated with Combustion Products
6 Health Effects Associated with Combustion Products
Pages 63-108
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From page 63... ...
Thus, the committee decided to approach its review of the health effects stemming from exposure to burn pits by identifying populations that were considered to be the most similar to military personnel with regard to exposures to burn pits or other sources of combustion products. The committee then conducted an extensive literature search for epidemiologic studies on long-term health outcomes seen in those populations.
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From page 64... ...
Since the composition of combustion products varies greatly depending on burn characteristics and fuel, and little is known about specific exposures to the burn pits at JBB and elsewhere, the committee was unable to directly compare constituents and concentrations of the pollutants that military personnel at JBB and the surrogate populations were exposed to, nor was it able to compare the duration and frequency of these exposures. Furthermore, all the groups considered in this chapter experience a variety of additional exposures independent of their exposure to combustion products from burn pits, fires, or municipal incinerator emissions.
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From page 65... ...
The committee adopted a policy of using only published papers that had undergone peer review as the basis of its conclusions. An exception was made for the epidemiologic studies conducted by the DoD to assess health effects in military personnel exposed to burn pits; theses studies are summarized below and discussed after the peer reviewed epidemiologic studies for each health outcome.
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From page 66... ...
• imited/Suggestive Evidence of No Association: There are several adequate studies, covering the full range L of levels of exposure that humans are known to encounter, that are mutually consistent in not showing a positive association between exposure to combustion products and a health outcome. A conclusion of no association is inevitably limited to the conditions, levels of exposure, and length of observation covered by the available studies.
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From page 67... ...
In addi tion, the committee examined the literature on other outcomes such as the autoimmune disorders systemic lupus erythematosus and rheumatoid arthritis, and on chronic multisymptom illness because these health outcomes were evaluated in the DoD epidemiologic studies of OEF/OIF military personnel deployed to sites with burn pits (AFHSC et al.
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From page 68... ...
The second study looked at respiratory health of military personnel who had been exposed to burn pits and were participants in the Millennium Cohort Study; this study is discussed in the section of this chapter on respiratory outcomes. The third and fourth studies, also of participants of the Millennium Cohort Study, focused on service members who had been exposed to burn pits and their risk of having chronic multisymptom illness (CMI)
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From page 69... ...
. Personnel exposed to combustion products from burn pits might be at increased risk of respiratory diseases as some chemicals released by the burning of waste (as described in Chapters 4 and 5)
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From page 70... ...
Respiratory Disease in Firefighters The committee recognizes that firefighter exposures may be very different depending on the type of fire. Structural firefighters primarily work to extinguish fires on anthropogenic objects -- for example, buildings, furniture, manufactured items -- whereas wildland firefighters are exposed to combustion products from the burning of the natural environment, that is, forests and grasslands.
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From page 71... ...
The authors found no increased respi ratory problems attributable to fire exposure and concluded that "the major combustion products responsible for respiratory damage were self-administered, arising from burning tobacco rather than from burning buildings." Miedinger et al.
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From page 72... ...
Respiratory Disease in Incinerator Workers No studies of occupational respiratory disease among incinerator workers were identified by the committee. Pulmonary Function in Incinerator Workers Key Studies No key studies of pulmonary function in incinerator workers were identified.
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From page 73... ...
Respiratory Disease in Communities Near Incinerators No studies assessing respiratory disease incidence or mortality in populations exposed to incinerator emissins were identified by the committee. Pulmonary Function in Communities Near Incinerators Key Studies No key studies of pulmonary function in populations exposed to incinerator emissions were identified by the committee.
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From page 74... ...
The inves tigators compared incidence rates of diseases and disorders at two military bases in Iraq with burn pits (JBB and Camp Taji) and with four comparison groups (nondeployed personnel in the United States, those deployed to two sites without burn pits in Kuwait [Camps Arifjan and Buehring]
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From page 75... ...
However, personnel without exposure to burn pits at Camps Arifjan and Buehring in Kuwait, and at the Korean base had similarly reduced or nonsignificant IRRs, indicating a healthy warrior effect but no disease potentially associated with being deployed to sites with burn pits. The DoD report also included details of a Millennium Cohort Study analysis that found no significant differences in newly diagnosed asthma, bronchitis, emphysema, or self-reported respiratory symptoms between those deployed to areas within 5 miles of burn pits and those not exposed.
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From page 76... ...
In conclusion, the committee finds that there is inadequate/insufficient evidence to determine whether an association exists between respiratory disease and combustion products in the populations discussed here. However, several studies that found reductions in pulmonary function among firefighters and incinerator workers provide limited/suggestive evidence for an association between exposure to combustion products and decreased pulmonary function in these populations.
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From page 77... ...
Neurologic Disease in OEF/OIF Veterans Exposed to Burn Pits No studies of neurologic disease among OEF/OIF veterans were identified by the committee. Conclusions Occupational studies of firefighters and incinerator workers do not show increased rates of mortality or elevated prevalence of neurologic disease.
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From page 78... ...
2002 Gulf War RR Myocardial Infarction Aronson et al. 1994 K Firefighters SMR 1.07 (0.93–1.23)
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From page 79... ...
. Studies on circulatory outcomes in firefighters, incinerator workers, communities near incinerators, and Gulf War veterans are discussed below.
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From page 80... ...
. The risk of ischemic heart disease, other circulatory diseases, and cerebrovascular disease was decreased for firefighters, but not significantly.
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From page 81... ...
, ischemic heart disease (39 deaths) , and other circulatory diseases (16 deaths)
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From page 82... ...
studied police and firefighters employed for at least 10 years in New Jersey and found increased risks of arteriosclerotic heart disease (PMR 1.22) compared to U.S.
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From page 83... ...
assessed mortality among 176 municipal waste incinerator workers near Stockholm, Sweden. Using national and local mortality rates to calculate SMRs, the risks for circulatory diseases, ischemic heart disease, or cerebrovascular diseases was not increased among incinerator workers.
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From page 84... ...
A limitation of this study is that health effects needed to be severe enough for hospital admission and, thus, less severe outcomes might be missed. Circulatory Disease in OEF/OIF Veterans Exposed to Burn Pits The DoD determined incidence relative risks for health outcomes in military personnel deployed to sites with burn pits (JBB and Taji in Iraq)
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From page 85... ...
Key Studies No key studies of birth defects in children of male firefighters were identified by the committee. Supporting Studies Olshan et al.
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From page 86... ...
Reproductive Outcomes for Parents Living Near Incinerators Key Studies No key studies pertaining to reproductive effects among people living near incinerators were reviewed by the committee. Supporting Studies The committee reviewed eight community-based incinerator studies in two general outcome categories: the first five studies (Jansson and Voog 1989; Cresswell et al.
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From page 87... ...
However, the inclusion criterion was not applied equally to the cases; thus, control selection was plausibly related to exposure, and the results of the case-control analyses were subject to selection bias. Reproductive Outcomes in OEF/OIF Veterans Exposed to Burn Pits One preliminary epidemiologic investigation is described in a DoD report on a wide range of health outcomes among troops deployed to burn pit sites in Iraq and Afghanistan.
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From page 88... ...
For most of the studies, maternal residence was determined at the time of birth, without data on the duration of residence in the study area relative to the pregnancy, introducing doubt about antenatal exposure in relation to windows of susceptibility for different fetal organ systems. For children born to male and female personnel deployed in the Gulf and Iraq Wars, the committee found some evidence suggesting an association between adverse outcomes for preterm births and low birth-weight and parental exposure to combustion products, but not for birth defects or other outcomes, as detailed in the IOM reports (2005, 2010)
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From page 89... ...
Stratification showed significantly increased risks of certain cancers for those employed 9 years or less (all cancers, colon, pancreas, lung, prostate) , or more than 20 years (colon, kidney, multiple myeloma)
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From page 90... ...
Supporting Studies Several other cohort studies on cancer incidence and mortality found no increased risk of cancer among firefighters. Bates et al.
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From page 91... ...
A meta-analysis conducted by Howe and Burch (1990) concluded there was no increased risk of overall cancer, lung cancer, or colon cancer, but the pooled risk estimates were significantly elevated for brain cancer and multiple myeloma, indicating the possibility of an association.
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From page 92... ...
(1996) conducted a retrospective study of cancer incidence in a population of over 14 million people living near 72 solid waste incinerators in Great Britain to investigate whether cancer incidence was associated with expo sure to combustion products from the incinerators.
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From page 93... ...
. The Gulf War and Health report on combustion products (IOM 2005)
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From page 94... ...
Brain, colon, and testicular cancer were reported at increased risks in some studies. The committee carefully considered the evidence for an association between combustion products and those cancers in firefighters, incinerator workers, and Gulf War soldiers.
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From page 95... ...
2005 Gulf War RR 0.97 (0.82–1.16)
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From page 96... ...
2005 Gulf War RR 1.17 (0.61–2.25) Cecum Bates et al.
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From page 97... ...
2005 Gulf War RR 0.82 (0.39–1.73) Respiratory Beaumont et al.
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From page 98... ...
2005 Gulf War RR 0.72 (0.47–1.10)
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From page 99... ...
Michelozzi et al. 1998 S Incinerator communities SMR 2.76 (0.31–9.34)
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From page 100... ...
2009 Gulf War RR 0.90 (0.73–1.11)
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From page 101... ...
Studies of Gulf War veterans exposed to oil-well–fire smoke also showed no cancer sites of concern, including brain cancer. Based on a review of the epidemiologic literature, the committee concludes that there is inadequate/ insufficient evidence of an association between long-term exposure to combustion products and cancer in the populations studied.
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From page 102... ...
SUMMARY The committee studied the epidemiologic literature on exposure to combustion products from sources believed to be relevant to the burn pit exposures at JBB and other bases with burn pits in Iraq and Afghanistan. From that epidemiologic literature, the committee concludes that further study of health effects specifically among OEF/ OIF veterans is necessary.
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From page 103... ...
The committee recognizes that the risks associated with being a fire fighter, incinerator worker, or living near and incinerator might not provide a comprehensive picture of the risks posed to military personnel from burn pit emissions. Nevertheless, given the lack of information on the health effects associated with such exposures, the committee believes that studies of these surrogate populations provide a reasonable approach for evaluating the long-term consequences of exposure to combustion products similar to burn pit emissions.
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From page 104... ...
1996. Cancer incidence near municipal solid waste incinerators in Great Britain.
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From page 105... ...
1993. Increased risk of esophageal cancer among workers exposed to combustion products.
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From page 106... ...
2002. Exposures to the Kuwait oil fires and their association with asthma and bronchitis among Gulf War veterans.
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From page 107... ...
1998. Health status of Persian Gulf War veterans: Self-reported symptoms, environmental exposures and the effect of stress.
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From page 108... ...
2008. Reproductive health and pregnancy outcomes among French Gulf War veterans.
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