Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry (2022) / Chapter Skim
Currently Skimming:
4 Other Information Sources on Airborne Hazards
4 Other Information Sources on Airborne Hazards
Pages 103-132
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 103... ...
This chapter is not intended to be an exhaustive summary of every epidemiologic cohort study or registry of veterans or service members. Rather the focus is on those information sources that most closely match the population of interest, design, and stated purposes of the AH&OBP Registry and those that offer alternative approaches and methods to the current registry that can be used to obtain similar or better information on airborne hazards and burn pits to improve our understanding of the associations between those exposures and adverse health outcomes.
|
From page 104... ...
directed the establishment of a Persian Gulf War Veterans Health Registry (now called the Gulf War Registry) and also authorized health examinations for veterans of the 1990–1991 Gulf War.
|
From page 105... ...
Population and Methodology The Gulf War Registry covers all 1990–1991 Gulf War veterans who were deployed to the Southwest Asia1 theater of military operations, and it also covers a substantial portion of post-9/11 service members and veterans (see Table 4-1)
|
From page 106... ...
b Post-Gulf War I Registry Veterans: Veterans who served in the Gulf War region after the 1990–1991 Gulf War I, including veterans who served in the 2003 Iraq War (Operation Iraqi Freedom and Operation New Dawn) , and have completed at least phase I of the Gulf War Registry exam as of September 2017.
|
From page 107... ...
Data collected by the Gulf War Registry are regularly linked to VA electronic health records. The environmental health coordinator conducts administrative aspects of the examination and completes the registry worksheet in the VA web portal for Environmental Agent Service Registry data (VA, 2017)
|
From page 108... ...
, but the two are independent entities. The World Trade Center Health Program, but not the WTCHR specifically, provides medical surveillance and treatment for certified 9/11-related health conditions and related conditions for eligible people directly affected by the 9/11 attacks -- i.e., at the World Trade Center in New York City, in Shanksville, Pennsylvania, and at the Pentagon -- and funds related medical and epidemiologic research (CDC, 2020)
|
From page 109... ...
. Use of WTCHR Data WTCHR is the largest of four New York City–based cohorts of exposed survivors and first responders of the World Trade Center disaster (the other three are the open responder clinical cohorts of the Fire Department of New York, the general responder cohort, and the New York City Health and Hospital's survivor cohort, all of which are under the World Trade Center Health Program)
|
From page 110... ...
The WTCHR's public affairs liaison attends monthly Survivor Steering Committee meetings and the WTCHR director or medical director attends monthly Responder Steering Committee meetings. Future research using WTCHR will consist of additional survey waves and will rely heavily on linkages to other data sources such as the World Trade Center Health Program, Medicare, Medicaid, and regional health organizations.
|
From page 111... ...
. Furthermore, the 9/11 World Trade Center disaster was a single, discrete event compared with the multiple exposures experienced by service members in the Southwest Asia theater, which were highly variable in their magnitude, duration, and frequency.
|
From page 112... ...
112 FIGURE 4-1 Example of an individual's exposure summary as it appears in ILER.
|
From page 113... ...
Defense Enrollment Eligibility Reporting October 2012– Monthly NA Personnel and identification data System March 2021 Defense Manpower Data Center January 2001– Monthly 24,512,112 Individual daily location data June 2021 Defense Occupational and Environmental January 2001– Daily 2,104,589 Exposure reports, Health Readiness System–Industrial April 2021 Health risk data, Hygiene Site surveillance data Military Exposure Surveillance Library January 2000– NA 855,294 Health risk assessments, September 2017 surveillance reports Military Health System Medical Data Repository Comprehensive Ambulatory/ October 2012– Monthly 1,713,951 Clinical encounter data Professional Encounter Record March 2021 Standard Inpatient Data Record October 2012– Monthly 833,424 Inpatient medical encounter data March 2021 Theater Medical Data Store October 2012– Monthly 11,388,662 In-theater medical encounter data March 2021 Total Number of Records 50,857,920 NOTES: NA = not available; TBD = to be determined.
|
From page 114... ...
Its browser-based, graphical user interface provides an integrated, read-only view of electronic health record data from VA, DoD, and Veterans Health Information Exchange community partners within a single application, and it eliminates the need for VA and DoD clinicians to access disparate viewers. The graphical user interface retrieves clinical data from several native data sources and systems, then presents it to the user, each corresponding to a clinical data domain (VA, 2019)
|
From page 115... ...
Sampling is determined by industrial hygiene and environmental 6 Personal communication, Larry Vandergrift, Defense Health Agency, chief information officer/deputy assistant director, Information Operations.
|
From page 116... ...
. ILER will eventually contain self-reported health information from other VA exposure registries, including the Gulf War Registry, Ionizing Radiation Registry, Toxic Embedded Fragments Registry, and Depleted Uranium Registry (VA, 2021f)
|
From page 117... ...
, priority of the exposure 8 Personal communication, Dr. Eric Shuping, director, Post-9/11 Era Environmental Health Program, Health Outcomes Military Exposures, VA.
|
From page 118... ...
Dashboard Search by Individual System Notifications Count: 0 Search by Location Posted Date Notification Type Message Resources No data available in table Contact Help Desk Occupational Medicine Specialist Showing 0 to 0 of 0 entries Previous Next Resources System Data User Generated Reports Data Transfer Schedule Deployment History and Exposure Information Available Library Acronyms Data Source Date Range of Data Last Data Transfer Next Data Transfer Periodic Occupational and Environmental Monitoring Summary 202 Frequently Asked Questions AFHSB 09/01/2012 to 12/31/2017 06/19/2019 00:00 N/A Registry: 9 DO[HRS-4] Library DMDC 01/1/2001 to 12/31/2017 08/15/2019 00:00 N/A Incident Reports: 1,309 DOCHRS 01/01/2006 to current 09/24/2020 04:20 09/24/2020 04:20 Exposure Pathways: 16,313 My Profile MDR 10/01/2012 to current 08/25/2020 10:19 09/24/2020 10:19 Health Assessments: 4,641,926 Details Request Role Updates Industrial Hygiene: 832,981 Medical Exposure Indicator: 1,476,253 Content Administration Individual Deployment History: 20,022,072 System Notifications Resources Resources Count: 10 OccMed Resource Maintenance Title URL Disclaimer Maintenance Agency for Toxic Substances and Disease Registry [ATSDR]
|
From page 119... ...
Its major benefit is providing a platform for accessing disparate data sources from both VA and DoD, but its usefulness as a tool for toxic exposures research, conducting population heath surveillance, improving health care, and aiding 11 Personal communication and spreadsheet, Dr. Eric Shuping, director, Post-9/11 Era Environmental Health Program, Health Outcomes Military Exposures, VA.
|
From page 120... ...
This section is not intended to be a compendium of every epidemiologic cohort study conducted on exposures to open burn pit emissions or other airborne hazards exposures, but rather an overview of these major epidemiologic cohort studies. Millennium Cohort Study Study Origins In response to concerns about the health effects of veterans deployed to the 1990–1991 Gulf War, the Institute of Medicine13 recommended that DoD conduct prospective epidemiologic research to evaluate the impact of military exposures, including deployment, on long-term health outcomes of service members (IOM, 1999)
|
From page 121... ...
These linkages allow investigators to study additional associations, adjust for potential confounding, or factor additional covariates into the analyses of health outcomes. The TABLE 4-3 Response Rates for Initial Enrollment and Follow-Up Surveys for Millennium Cohort Study Panels Total Enrolled (initial panel)
|
From page 122... ...
. Thus far, only a few studies of burn pits using the Millennium Cohort Study and DMDC exposure data for these service members have been published (Jones et al., 2012; Powell et al., 2012; Sharkey et al., 2016; B
|
From page 123... ...
Strengths and Challenges The Millennium Cohort Study offers several advantages for the study of deployment-related airborne hazards and burn pits health effects research. First, it provides a large and representative sample of military service members from all service branches and service components.
|
From page 124... ...
Additionally, because there are only nine questions on hazardous exposures and responses are self-reported and validated by deployment status or proximity, the Millennium Cohort Study does not have accurate information on the magnitude, frequency, or duration of the exposures. As with most large databases, the variety of information sources on active-duty service members and veterans, such as electronic health records, personnel files, pharmacy records, and deployment status and locations, each of which will have some level of data errors, may affect the strength of any associations between exposure and health outcomes.
|
From page 125... ...
. The three STAMPEDE studies are detailed in Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations (NASEM, 2020)
|
From page 126... ...
Such means might include the Individual Longitudinal Exposure Record (ILER) and the Millennium Cohort Study." Thus, this chapter presents an overview of the various data sources (surveys, studies, registries, and compilers)
|
From page 127... ...
: World Trade Center Health Pro gram (WTC) : FAQs for several areas of the WTC Health Program.
|
From page 128... ...
2021. World Trade Center Health Registry.
|
From page 129... ...
military service women in the Millennium Cohort Study, 2003–2015. Medical Surveillance Monthly Report 27(7)
|
From page 130... ...
2012. The effects of exposure to documented open-air burn pits on respiratory health among deployers of the Millennium Cohort Study.
|
From page 131... ...
C., and the Millennium Cohort Study Team.
|
From page 132... ...
2015. Evaluation of non-response bias in a cohort study of World Trade Center terrorist attack survivors.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.