Dataset Information

Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis survival.

ABSTRACT:

Background

Military veterans may have higher rates of amyotrophic lateral sclerosis (ALS) mortality than non-veterans. Few studies, with sparse exposure information and mixed results, have studied relationships between military-related factors and ALS survival. We evaluated associations between military-related factors and ALS survival among U.S. military veteran cases.

Methods

We followed 616 medical record-confirmed cases from enrollment (2005-2010) in the Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis study until death or July 25, 2013, whichever came first. We ascertained vital status information from several sources within the Department of Veterans Affairs. We obtained information regarding military service, deployments, and 39 related exposures via standardized telephone interviews. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals. We adjusted for potential confounding and missing covariate data biases via inverse probability weights. We also used inverse probability weights to adjust for potential selection bias among a case group that included a disproportionate number of long-term survivors at enrollment.

Results

We observed 446 deaths during 24,267 person-months of follow-up (median follow-up: 28 months). Survival was shorter for cases who served before 1950, were deployed to World War II, or mixed and applied burning agents, with HRs between 1.58 and 2.57. Longer survival was associated with exposure to: paint, solvents, or petrochemical substances; local food not provided by the Armed Forces; or burning agents or Agent Orange in the field with HRs between 0.56 and 0.73.

Conclusions

Although most military-related factors were not associated with survival, associations we observed with shorter survival are potentially important because of the large number of military veterans.

SUBMITTER: Beard JD

PROVIDER: S-EPMC5634564 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis survival.

Beard John D JD Engel Lawrence S LS Richardson David B DB Gammon Marilie D MD Baird Coleen C Umbach David M DM Allen Kelli D KD Stanwyck Catherine L CL Keller Jean J Sandler Dale P DP Schmidt Silke S Kamel Freya F

PloS one 20171010 10

<h4>Background</h4>Military veterans may have higher rates of amyotrophic lateral sclerosis (ALS) mortality than non-veterans. Few studies, with sparse exposure information and mixed results, have studied relationships between military-related factors and ALS survival. We evaluated associations between military-related factors and ALS survival among U.S. military veteran cases.<h4>Methods</h4>We followed 616 medical record-confirmed cases from enrollment (2005-2010) in the Genes and Environmenta ...[more]

PMID: 29016608

Similar Datasets

Project description:BackgroundFactors underlying a possible excess of amyotrophic lateral sclerosis (ALS) among military veterans remain unidentified. Limitations of previous studies on this topic include reliance on ALS mortality as a surrogate for ALS incidence, low statistical power, and sparse information on military-related factors.ObjectivesWe evaluated associations between military-related factors and ALS using data from a case-control study of U.S. military veterans.MethodsFrom 2005 to 2010, we identified medical record-confirmed ALS cases via the National Registry of Veterans with ALS and controls via the Veterans Benefits Administration's Beneficiary Identification and Records Locator System database. In total, we enrolled 621 cases and 958 frequency-matched controls in the Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis study. We collected information on military service and deployments and 39 related exposures. We used unconditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). We used inverse probability weighting to adjust for potential bias from confounding, missing covariate data, and selection arising from a case group that disproportionately included long-term survivors and a control group that may or may not differ from U.S. military veterans at large.ResultsThe odds of ALS did not differ for veterans of the Air Force, Army, Marines, and Navy. We found higher odds of ALS for veterans whose longest deployment was World War II or the Korean War and a positive trend with total years of all deployments (OR=1.27; 95% CI: 1.06, 1.52). ALS was positively associated with exposure to herbicides for military purposes, nasopharyngeal radium, personal pesticides, exhaust from heaters or generators, high-intensity radar waves, contaminated food, explosions within one mile, herbicides in the field, mixing and application of burning agents, burning agents in the field, and Agent Orange in the field, with ORs between 1.50 and 7.75.ConclusionsAlthough our results need confirmation, they are potentially important given the large number of U.S. military veterans, and they provide clues to potential factors underlying the apparent increase of ALS in veteran populations.

Dataset Information

Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis survival.

Background

Methods

Results

Conclusions

Publications

Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis survival.

Similar Datasets

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