Assessing Health Outcomes Among Veterans of Project SHAD (Shipboard Hazard and Defense) (2016) / Chapter Skim
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The IOM study found no difference in all-cause mortality between SHAD veterans and the comparison group, but there was an increased risk of death from heart disease among some SHAD veterans and responses to a 2004 health survey indicated poorer overall physical and mental health among the SHAD participants. The VA study found an increase in all-cause mortality among the SHAD veterans that was due primarily to heart disease.
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The intent of Project SHAD was to evaluate operational characteristics of ships and protective and dissemination equipment as well as the behavior of test agents in marine environments. Although exposure samples (e.g., gargle samples or chemical dosimeters on clothing)
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TABLE S-1 Hypotheses to Be Tested Concerning Certain Substances Used in SHAD Testing and Adverse Health Outcomes Substance Use in SHAD Test Health Outcome Hypothesized Coxiella burnetii Biological agent Chronic hepatitis Endocarditis Fatigue syndrome Osteomyelitis Vascular infection Escherichia coli Biological simulant Irritable bowel syndrome Staphylococcal Biological agent Asthma a enterotoxin type B Graves' disease Multiple sclerosis Rheumatoid arthritis Sarin Chemical agent Neurological effects (central nervous system) Neurological effects (peripheral nervous system)
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the crew of the USS George Eastman, a specially outfitted ship involved in multiple tests, including some with live agents; (2) members of the Project SHAD technical staff, including persons with service on the light tugs, who were identified in a roster from January 1965; and (3)
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In addition to the members of the study population known to be dead at the time of the first IOM study, additional deaths were determined through automated matching with records of the Veterans Benefits Administration and records available through Lexis/Nexis. Data on cause of death were obtained from the National Death Index or from death certificates obtained from state vital statistics offices for 91 percent of the members of the study population who were identified as deceased.
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Kaplan-Meier survival analysis showed no evidence of statistically significant difference between the participant and comparison groups in the overall number or timing of deaths. When cause of death, grouped by broad ICD categories, was examined using a Cox proportional hazards model that adjusted for age, Project SHAD veterans showed no statistically significant increases in hazard over the comparison population.
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An increase in use of VA health care among Project SHAD veterans relative to the comparison population was observed beginning in 2002, which is when VA began notifying SHAD veterans of their participation in the previously secret SHAD testing. By 2005, usage of VA health services among SHAD veterans remained higher than that of the comparison population, but the rate of increase in use from year to year became similar in the two groups.
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The study also benefited from the efforts during the previous IOM study to establish and validate the cohort of Project SHAD test participants from ship logs and diaries. The previous IOM study also provided the unique benefit of a comparison population of military personnel with service more comparable in time and character to that of the SHAD veterans than would typically be found.
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The committee invested considerable effort in learning about the SHAD tests and in formulating its approaches to data analysis. In the numerous analyses of both the full study population and of several subgroups, the only finding of a seemingly higher risk -- of heart disease mortality among the 356 men who served on the USS George Eastman -- did not attain statistical significance after adjustments for the multiple tests carried out on this group.
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