Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry (2017) / Chapter Skim
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4 Analysis Methods and Descriptive Statistics
4 Analysis Methods and Descriptive Statistics
Pages 73-104
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From page 73... ...
, support any conclusions about health conditions caused by exposure to burn pits. Given the inherent limitations of registries in providing representative and reliable data, the committee took a cautious approach to its analysis of registry data.
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From page 74... ...
A key advantage of the AH&OBP Registry is that eligibility is well-defined by period of deployment and deployment locations and documented by DMDC, which also maintains a broad array of demographic and military characteristics information for all service members. To examine how well the experience of the registry respondents reflects the experience of the larger eligible deployed population, the committee used the data from the CTS and Gulf War Oil Well Fire Smoke Registry to define and characterize the eligible population.
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From page 75... ...
; ulf War Oil Well Fire Smoke Registry file provides demographic information on all persons deployed • G in support of the Gulf War (from 1990 to 1991)
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From page 76... ...
Sub-analyses could be conducted to compare respondents to eligible persons known to have documented burn pit exposure -- a more appropriate comparison group than potential exposure based on country and year of deployment. Such an exercise would provide additional insight into how characteristics may differ between registry respondents and the eligible population.
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From page 77... ...
The committee sought that data to help answer VA's request for recommendations regarding the means of addressing the medical needs of veterans with health conditions related to burn pit exposure and "associations of self-reported exposures with Veterans Health Administration (VHA) health care experience." Specifically, the VHA Assistant Deputy Under Secretary for Health Enrollment Files contain enrollment, eligibility, demographic, cost, and location information for VHA enrollees and non-enrollees who have received VA care.
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From page 78... ...
DoD deployment information (both the CTS and Gulf War Oil Well Fire Smoke Registry files) was used as the gold standard for determining deployment dates and countries and thus determining eligibility and response
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From page 79... ...
These numbers cannot simply be added together to determine the eligible population denominator because they are not mutually exclusive, as described above and shown in Table 4-1, and the respondents from each era are not necessarily a subset of the populations in the CTS and Gulf War Oil Well Fire Smoke Registry files because a small number of the respondents (those who were deployed during the Stabilization period only) are not in one of those files.
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From page 80... ...
Thus, the committee identified a need to examine potential selection bias created by the process of completing the questionnaire, according to the four stages of questionnaire completion: people who accessed the registry and established a user account; people who consented to participate; people who partially completed the registry's questionnaire; and people who completed and submitted the full questionnaire. Comparisons between the eligible population and those who participated in each stage would give information about the facilitators and barriers to questionnaire completion and shed light on potential selection biases.
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From page 81... ...
For this reason, it is important to examine how representative the AH&OBP Registry respondents (1.0% and 1.7% for Gulf War and post-9/11 respondents, respectively) are of the eligible deployed veteran population.
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From page 82... ...
The categories of military characteristics, including pay grade, branch of service, and unit component were created to be mutually exclusive based on the most current information from the last deployment, according to the CTS and Gulf War Oil Well Fire Smoke Registry files. (Therefore, if a person was deployed first as an active-duty service member for one deployment then served in the reserves for the next, the person would be categorized as a reservist because this is the latest information according to the DoD administrative deployment records.)
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From page 83... ...
The distribution of the number of deployments was also markedly different, with respondents reporting more eligible deployment segments than the eligible population. For example, 15.1% of respondents had one eligible deployment compared with 26.0% of the eligible population (relative difference, −41.9%)
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From page 84... ...
84 ASSESSMENT OF THE DEPARTMENT OF VETERANS AFFAIRS AIRBORNE HAZARDS AND OPEN BURN PIT REGISTRY TABLE 4-3 Distribution of Select Demographic and Military Characteristics for All Registry Respondents N % Sex Male 41,345 89.1 Female 4,678 10.1 Missing 381 0.9 Age at questionnaire completiona 46,404 38.7 <30 years old 7,906 17.0 30–39 years old 17,983 38.8 40–49 years old 14,367 31.0 50–59 years old 5,346 11.5 ≥60 years old 802 1.7 Race White 30,214 65.1 Black 3,773 8.1 Hispanic 3,372 7.3 Other 1,480 3.2 Missing 7,565 16.3 Marital status Married 27,279 58.8 Not married 15,136 32.6 Missing 3,989 8.6 Rank Enlisted 37,520 81.5 Officer/Warrant Officer 8,507 18.4 Branch Army 30,253 65.2 Air Force 8,514 18.3 Marine Corps 5,087 11.0 Navy/Coast Guard 2,534 5.5 Missing 16 0.0 Component Active duty 29,860 64.3 Reserve/National Guard 16,167 34.8 Missing 377 0.8 Education High school or less 27,973 60.3 Some college/bachelor's degree 14,356 30.9 Postgraduate 3,105 6.7 Missing 970 2.1 Occupation Infantry, gun crews, and seamanship 11,974 25.8 Electronic equipment repair 3,144 6.8 Communications and intelligence 4,013 8.6 Health care 3,074 6.6 Other technical and allied specialists 1,374 3.0 Functional support and administration 6,520 14.1 continued
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From page 85... ...
, and among VHA enrollees, the registry underrepresented veterans in lower VA priority groups for treatment by 30%. Gulf War Respondents Versus Post-9/11 Respondents The demographic makeup of the registry population differs in significant ways between the Gulf War and the post-9/11 respondent populations for most demographic and military characteristics.
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From page 86... ...
<30 <0.0001 7,575 17.9 743,305 29.9 <0.0001 −40.1 30–39 17,895 42.2 1,049,801 42.3 −0.2 40–49 2,988 53.2 265,696 48.7 9.2 12,361 29.1 469,207 18.9 54.0 50–59 1,461 26.0 148,541 27.2 −4.4 4,121 9.7 188,736 7.6 27.6 ≥60 201 3.6 45,140 8.3 −56.6 465 1.1 32,208 1.3 −15.4 Missing 971 17.3 86,006 15.8 9.5 3 0.0 135 0.0 Mean age (years) a 48.6 49.9 <0.0001 37.8 35.2 <0.0001 Race White 3,852 68.5 362,828 66.5 0.0091 3.0 29,219 68.9 1,549,807 62.4 <0.0001 10.4 Black 1,280 22.8 130,311 23.9 −4.6 3,254 7.7 344,065 13.9 −44.6 Hispanic 271 4.8 27,774 5.1 −5.9 3,361 7.9 252,262 10.2 −22.5 Other 208 3.7 22,755 4.2 −11.9 1,406 3.3 128,926 5.2 −36.5 Missing 10 0.2 1,715 0.3 −33.3 5,180 12.2 208,332 8.4 45.2 Marital status Married 27,279 64.3 1,320,818 53.2 <0.0001 20.9 Not married 15,136 35.7 1,161,949 46.8 −23.7 Missing 5 0.0 625 0.0 Rank Enlisted 5,058 90.0 490,666 90.0 0.9834 0.0 34,241 80.7 2,137,892 86.1 <0.0001 −6.3 Officer/Warrant Officer 562 10.0 54,569 10.0 0.0 8,179 19.3 345,48913.9 38.8 Missing 148 0.0 11 0.0 Branch Air Force 435 7.7 56,089 10.3 <0.0001 −25.2 8,117 19.1 446,536 18.0 <0.0001 6.1 Army 4,292 76.4 306,834 56.3 35.7 27,447 64.7 1,265,848 51.0 26.9 Marine Corps 669 11.9 80,219 14.7 −19.0 4,778 11.3 316,317 12.7 −11.0 Navy/Coast Guard 225 4.0 102,241 19.0 −79.0 2,078 5.0 454,691 18.0 −73
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From page 87... ...
Unit Component Active Duty 4,657 82.9 460,153 84.4 0.0017 −1.8 26,965 63.6 1,810,150 72.9 <0.0001 −12.8 Reserve/National Guard 964 17.1 85,229 15.6 9.6 15,455 36.4 673,242 27.1 34.3 Missing 1 0.0 Education High school or less 5,320 94.6 520,324 95.4 <0.0001 −0.8 27,446 64.7 1,844,601 74.3 <0.0001 −12.9 Some college/bachelor's 224 4.0 16,272 3.0 33.3 12,224 28.8 505,986 20.4 41.2 degree Postgraduate 15 0.3 2,299 0.4 −25.0 2,136 5.0 92,578 3.7 35.1 Missing 62 1.1 6,488 1.2 −8.3 614 1.4 40,227 1.6 −12.5 Country of Deployment Iraq only 1,573 28.0 108,978 20.0 <0.0001 40.0 18,627 43.9 826,062 33.3 <0.0001 31.8 Kuwait only 716 12.7 70,658 13.0 −2.3 Iraq and Kuwait 1,339 23.8 90,734 16.6 43.4 Neither Iraq or Kuwait 1,993 35.5 275,013 50.4 −29.6 Afghanistan only 9,692 22.8 578,646 23.3 −2.1 Iraq and Afghanistan 8,292 19.5 269,378 10.8 80.6 Neither Iraq or 5,809 13.7 809,306 32.6 −58.0 Afghanistan Duty Occupation Infantry, gun crews, and 1,674 29.8 150,788 27.6 <0.0001 8.0 10,978 25.9 635,871 25.6 <0.0001 1.2 seamanship Electronic equipment 289 5.1 36,942 6.8 −25.0 2,935 6.9 191,457 7.7 −10.4 repair Communications and 521 9.3 48,351 8.9 4.5 3,647 8.6 211,558 8.5 1.2 intelligence Health care 327 5.8 27,998 5.1 13.7 2,842 6.7 141,102 5.7 17.5 Other technical and 134 2.4 11,191 2.1 14.3 1,285 3.0 59,700 2.4 25.0 allied specialists Functional support and 669 11.9 63,188 11.6 2.6 6,059 14.3 323,987 13.0 10.0 administration Electrical/mechanical 905 16.1 101,695 18.6 −13.4 5,826 13.7 419,648 16.9 −18.9 equipment repair Craft work 162 2.9 18,572 3.4 −14.7 1,552 3.7 105,227 4.2 −11.9 Service and supply 759 13.5 71,123 13.0 3.8 5,710 13.5 312,888 12.6 7.1 Nonoccupational 117 2.1 9,460 1.7 23.5 902 2.1 44,625 1.8 16.7 Missing 64 1.1 6,075 1.1 0.0 684 1.6 37,329 1.5 6.7 continued 87
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From page 88... ...
(N = 2,483,392) Relative Relative N % N % P-value Difference N % N % P-value Difference Eligible deployment segments 1 1,747 31.1 209,544 38.4 <0.0001 −19.0 6,403 15.1 646,351 26.0 <0.0001 −41.9 2 2,148 38.2 192,375 35.3 8.2 6,393 15.1 472,130 19.0 −20.5 3 1,395 24.8 110,727 20.3 22.2 4,830 11.4 284,519 11.5 −0.9 4 285 5.1 25,393 4.7 8.5 3,782 8.9 195,025 7.9 12.7 5 46 0.8 7,344 1.3 −38.5 3,752 8.8 182,661 7.4 18.9 6 3,288 7.8 157,664 6.3 23.8 7 2,821 6.7 122,092 4.9 36.7 8 2,117 5.0 87,434 3.5 42.9 9 1,687 4.0 65,763 2.6 53.8 10 1,419 3.3 51,697 2.1 57.1 More than 10 5,928 14.0 218,056 8.8 59.1 a Age at questionnaire completion (in years)
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From page 89... ...
Among Gulf War respondents, there were few demographic differences, but respondents were more likely to have served in the Army and have been deployed to Iraq or Iraq and Kuwait than the eligible population. Post-9/11 respondents were less racially diverse and older that the eligible comparison population and were overrepresented by service in the Army, service in the reserves/ National Guard, deployment to Iraq and Iraq and Afghanistan, and having multiple deployment segments.
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From page 90... ...
Relative Difference (%) Allergies 38.5 38.1 1 Asthma 14.8 13.9 6.1 Emphysema, chronic bronchitis, or COPD 14.7 12.9 12.2 Constrictive bronchiolitis 1.2 0.9 25 Idiopathic pulmonary fibrosis 0.2 0.2 0 Functional limitation/breathing problem 27.5 25.0 9.1 High blood pressure 34.7 32.1 7.5 Coronary artery disease 2.9 2.3 20.7 NOTE: AH&OBP = Airborne Hazards and Open Burn Pit; COPD = chronic obstructive pulmonary disease.
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From page 91... ...
The considerable overlap in the distribution of propensity scores for respondents and nonrespondents suggests that the demographic and military characteristics available to the committee do a modest to weak job of distinguishing between the two groups. Adding the VA health care utilization data would likely improve the proportion of variability that could be accounted for between respondents and eligible nonrespondents, but it still would not adjust for the greater motivation of people with presumed exposure and health effects to participate.
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From page 92... ...
A lack of variability of responses also affects the ability to observe associations and draw conclusions. Questions with Limited Variability in Responses The committee examined variability in responses for six exposures of interest (burn pits, dust, construction duties, fuel exhaust, combat, and soot from oil-well fires)
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From page 93... ...
Eligible refers to the number of deployment segments or individuals, after accounting for skip patterns, that were eligible to answer the question. For example, the question about the number of hours that smoke/fumes from the burn pit entered the work site/housing is restricted to deployment segments for which a participant reported having been near a burn pit.
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From page 94... ...
206,373b 40,648 19.7 Q1.2.F Did you have any burn pit duties on any deployment? 129,192b 2,582 2.0 Q1.2.G Did smoke or fumes from the burn pit enter your work site or housing on any 129,192b 24,321 18.8 deployment?
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From page 95... ...
Q2.2.1.E Have you ever been told by a doctor or other health care professional that you 46,404 2,268 4.9 had chronic obstructive pulmonary disease also called COPD? Q2.2.1.F Have you ever been told by a doctor or other health care professional that you 46,404 2,730 5.9 had some lung disease or condition other than asthma, emphysema, chronic bronchitis or COPD?
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From page 96... ...
Q3.1.G Have you discussed this concern with your health care provider, medical 43,868 -- -- professional or team? Q3.1.H Are you concerned that in the future that your health will be affected by 46,404 3,002 6.5 something you breathed during deployment(s)
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From page 97... ...
Q8.1.A How do you prefer to receive updated information on burn pits and other airborne 46,404 513 1.1 exposures? Q8.1.B Do you use the Internet?
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From page 98... ...
The makeup of the registry population differs in significant ways between the Gulf War and the post-9/11 respondent populations, as well as between each era of respondents and their respective eligible populations, for most demographic and military characteristics. When comparing registry participants either to nonrespondents only or to all eligibles it is important to recognize these differences, and examine outcomes separately by era of service as well as for the aggregated population.
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From page 99... ...
206,373b 129,192 62.6 36,533 17.7 40,648 19.7 Q1.2.F Did you have any burn pit duties on any deployment? 129,192b 66,087 51.2 60,523 46.8 2,582 2.0 Q1.2.G Did smoke or fumes from the burn pit enter your work site or housing on 129,192b 103,234 79.9 1,637 1.3 24,321 18.8 any deployment?
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From page 100... ...
Q2.2.1.D Have you ever been told by a doctor or other health care professional that 46,404 5,921 12.8 37,606 81.0 2,877 6.2 you had chronic bronchitis? Q2.2.1.E Have you ever been told by a doctor or other health care professional that 46,404 1,524 3.3 42,612 91.8 2,268 4.9 you had chronic obstructive pulmonary disease also called COPD?
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From page 101... ...
of any kind? NOTE: COPD = chronic obstructive pulmonary disease; GWA = Gulf War Area.
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From page 102... ...
2016. Responses from the Department of Veterans Affairs to questions from the Committee on the Review of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry.
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From page 103... ...
Prepared by Westat in response to a request from the Committee on the Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Received October 3.
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