Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry (2022) / Chapter Skim
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6 Use for Population Health Surveillance
6 Use for Population Health Surveillance
Pages 165-184
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From page 165... ...
The AH&OBP Registry collects data on a group of service members and veterans who deployed to the Southwest Asia theater after August 2, 1990. The committee focused on the AH&OBP Registry's capability for health surveillance of the population deployed to Southwest Asia using a framework of four criteria that a population health surveillance system would, at a minimum, have to meet.
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: 1. Decide on the overarching goals to address the prevalence or incidence of a potentially harmful exposure or occurrence of a disease in a defined population; 2.
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TABLE 6-1 Examples of National Population Health Surveillance Systems or Surveys Surveillance System or Survey Description Owner Medical Expenditures Panel Survey Collects data on health service use, costs, and health insurance; includes AHRQ questions about self-reported health status, health conditions, and medical events. Behavioral Risk Factor Surveillance Annually collects self-reported health risk behaviors, chronic conditions, and CDC System (BRFSS)
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, indi rect costs (resulting from preparedness and response to surveillance findings) , and prevention benefits or costs from a societal perspective (e.g., effects of the information generated on decision making and population health)
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. An illustrative example of an exposure registry that contributes to population health surveillance is the World Trade Center Health Registry (WTCHR)
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Identifying Specific Environmental Exposures As discussed in the Chapter 5 section on Exposure Assessment of Adequate Quality, identifying and characterizing exposures to a specific airborne hazard is difficult because of the many challenging requirements, including the need to obtain adequate information on the composition, duration, frequency, and concentration of the airborne hazard. Furthermore, many airborne hazards are combinations of chemicals, and exposure to a hazard such as smoke from a burn pit may be only one of many concurrent exposures, including those in the ambient air, which may have its own hazardous components.
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This selective participation can result in spurious signals or BOX 6-4 Example: Occupational Surveillance using the Ontario Cancer Registry Although Canada benefits from a single-payer health system and centralized comprehensive adminis trative databases that makes surveillance for health conditions more feasible than in some other countries, information about exposures, occupations, and industries is lacking. Surveillance is conducted by linking industrial and occupational information collected as part of worker compensation claims with health infor mation in administrative databases.
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From page 172... ...
, none of which focused on surveillance, but rather addressed disease etiology by providing descriptive statistics of characteristics and disease risk factors among participants. Although not explicitly population health surveillance, information on the frequency of participants' symptoms or health conditions may help detect trends or identify emerging health care needs at a population level despite registry participants being self-selected.
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From page 173... ...
The legislation specifies that the registry include any information VA "determines necessary to ascertain and monitor the health effects of the exposure of members of the Armed Forces to toxic airborne chemicals and fumes caused by open burn pits." The AH&OBP Registry was not created as a population health surveillance system, but rather was developed as a mechanism to collect selected self-reported information about exposures and health from service members and veterans who had deployed to the Southwest Asia theater. Although neither the legislative language nor VA's description of the registry's purposes require VA to specifically conduct surveillance, the committee believes that this function is implied by both the legislative language and VA's actions.
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; and • regular data interpretation (lack of a comparison group and an ever expanding population of registry participants makes it difficult to detect signals in health outcomes, and the lack of longitudinal data makes it difficult to identify signals or trends in the reported health outcome data)
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. The second issue with interpreting registry data as part of a population health surveillance system is the lack of a mechanism for prospective, ongoing data collection on participants.
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The committee finds that the AH&OBP Registry does not satisfy all four of the criteria -- overarching goals, regular data collection and analysis, dissemination of information, and using the information to improve health -- necessary to conduct population health surveillance for service members and veterans potentially exposed to burn pits or other airborne hazards in the Southwest Asia theater. Furthermore, given its fundamental design, the committee concludes that refinements or improvements will not allow the AH&OBP Registry to serve as a population health surveillance system.
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From page 177... ...
may fulfill some of the requirements of such a system through longitudinal data collection from representative samples and by building on the other national service member and veteran epidemiologic surveys described in Chapter 4. But epidemiologic studies cannot serve as alternative surveillance mechanisms for health outcomes without major changes as they were designed for and are more optimally suited to etiologic research than for routine surveillance; consequently, they will not be discussed further as viable alternatives for population health surveillance.
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From page 178... ...
ILER In Chapter 5: Use for Etiologic Research, the features of ILER that make it unsuitable for conducting etiologic research on the health effects of burn pits and other airborne hazards exposures were described in detail. Several of those factors are also relevant when considering ILER's use for population health surveillance.
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Therefore, it is not and should not be looked to or promoted as a population health surveillance system for burn pits and airborne hazards. The committee finds that ILER could serve as a component of a future population health surveillance system for airborne hazards.
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From page 180... ...
The committee finds that the AH&OBP Registry does not satisfy all four of the criteria necessary to conduct population health surveillance for service members and veterans potentially exposed to burn pits or other airborne hazards in the Southwest Asia theater. Furthermore, given its fundamental design, the committee concludes that refinements or improvements will not allow the AH&OBP Registry to serve as a population health surveillance system.
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From page 181... ...
ILER has the potential to include a large number of service members and veterans and may include both exposed and unexposed individuals for comparisons, but it is not suitable to population health surveillance related to burn pits and airborne hazards exposures. Thus, ILER has potential value for capturing some deploymentrelated exposures in the future and for those who served in the armed forces after 2012.
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2012. A population health surveillance theory.
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2021d. Reponse to the Committee to Reassess the Department of Veterans Affairs Airborne Hazards and Open Burn Pits Registry information and data request.
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