APPENDIX A
Epidemiologic Tables for Chapter 4
In Tables A-1, A-2, and A-3, respectively, studies are grouped according to whether their subjects had occupational exposures, had environmental exposures, or were specifically veterans. The tables provide an overview of design aspects of those epidemiologic studies reviewed in this and earlier reports that presented results on more than one health outcome or that investigated populations that have been repeatedly studied. The summaries include the study’s design type, the numbers of subjects in the study and comparison populations, and a synopsis of how subjects were selected, how data were collected, what inclusion criteria were used, and how exposure was determined. Results were discussed in the appropriate health outcome chapter of the Veterans and Agent Orange document in which the publication was reviewed. The references for this section are at the end of Chapter 4.
TABLE A-1 Epidemiologic Studies—Occupational Exposure
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
PRODUCTION WORKERS |
||||
NIOSH Studies Reviewed in Update 2002 |
||||
Steenland et al., 2001 |
Cohort |
A study to reexamine and compare diabetes data from the NIOSH cohort and the United States Air Force Ranch Hands in order to reconcile differences between the two study methods and protocols |
267 NIOSH workers 990 Ranch Hand subjects |
227 NIOSH comparisons 1,275 Ranch Hand comparisons |
NIOSH Studies Reviewed in Update 2000 |
||||
Calvert et al., 1999 |
Cohort |
Continuing follow-up of workers employed more than 15 years ago at two plants that manufactured substances contaminated with TCDD to evaluate associations between serum TCDD and serum glucose (diabetes), TSH, total T4, and T3 |
281 |
260 |
Steenland et al., 1999 |
Cohort |
Mortality study of workers at 12 industrial plants that produced chemicals contaminated with TCDD, using a job-exposure matrix to estimate TCDD exposure categories. Endpoints reported are all cancers, ischemic heart disease, and diabetes |
5,132 (3,538 with exposure data divided into septiles of cumulative exposure; 608 with chloracne) |
— |
Calvert et al., 1998 |
Cohort |
Continuing follow-up of workers employed more than 15 years ago at two plants that manufactured substances contaminated with TCDD to evaluate the association between TCDD exposure and cardiovascular outcomes |
281 |
260 |
Halperin et al., 1998 |
Cohort |
Continuing study of a cohort of TCDD-exposed workers at two plants that manufactured substances contaminated with TCDD to assess the association between serum TCDD and immunological outcome variables for eligible workers and matched neighborhood controls |
259 |
243 |
NIOSH Studies Reviewed in Update 1998 |
||||
Sweeney et al., 1996, 1997/1998 |
Cross-sectional |
Study of numerous noncancer end points for liver function, gastrointestinal disorders, chloracne, serum glucose, hormone and lipid levels, and diabetes in same group as Calvert et al. (1991) |
281 |
260 |
Halperin et al., 1995 |
Cross-sectional |
Study of surrogates for cytochrome P450 induction in same group as Calvert et al. (1991) |
281 |
260 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
NIOSH Studies Reviewed in Update 1996 |
||||
Calvert et al., 1994 |
Cross-sectional |
Study of porphyria cutanea tarda in same group as Calvert et al. (1991) |
281 |
260 |
Egeland et al., 1994 |
Cohort |
Study of total serum testosterone and gondadotropin levels in chemical production workers exposed to dioxin, in same group as Calvert et al. (1991) |
248 |
231 |
NIOSH Studies Reviewed in VAO |
||||
Sweeney et al., 1993 |
Cohort |
Peripheral neuropathy in same group as Calvert et al. (1991) |
281 |
260 |
Alderfer et al., 1992 |
Cohort |
Assessment of psychological variables to determine depression in same group as Calvert et al. (1991) |
281 |
260 |
Calvert et al., 1992 |
Cohort |
Assessment of liver and gastrointestinal systems in same group as Calvert et al. (1991) |
281 |
260 |
Calvert et al., 1991 |
Cohort |
Study of workers employed at one of two plants manufacturing substances contaminated with TCDD at least 15 years prior to assessment of chronic bronchitis, COPD, ventilatory function, thorax, and lung abnormalities, compared to matched neighborhood controls |
281 |
260 |
Fingerhut et al., 1991 |
Cohort |
Cancer mortality in male workers from 12 plants producing TCDD contaminated chemicals (1942–1984), compared to US population |
5,172 |
— |
Monsanto Studies Reviewed in VAO |
||||
Collins et al., 1993 |
Cohort |
Mortality of workers (through 1987) exposed and not exposed to dioxin between March 8, 1949, and November 22, 1949, as indicated by presence of chloracne, compared to local population mortality rates |
122 with chloracne; 632 without chloracne |
— |
Moses et al., 1984 |
Cohort |
Study of health outcomes in Monsanto workers (1948–1969) with chloracne reported as a surrogate to 2,4,5-T exposure compared to health outcomes in workers without chloracne as surrogate for no exposure |
117 |
109 |
Suskind and Hertzberg, 1984 |
Cohort |
Evaluation of health outcomes (1979) at clinical examination among workers exposed to 2,4,5-T (1948–1969) compared to nonexposed workers at same Monsanto plant |
204 |
163 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Zack and Gaffey, 1983 |
Cohort |
Study of mortality experience of all white male workers (1955–1977) employed at a Monsanto plant through Dec. 31, 1977, compared to mortality rates of standardized US population |
884 |
— |
Zack and Suskind, 1980 |
Cohort |
Evaluation of mortality experience among employees with chloracne exposed to TCP process accident in 1949 at Monsanto, compared to US male population standard |
121 |
— |
New Dow Studies |
||||
Bodner et al., 2003 |
Cohort |
Additional 10-year follow-up of cohort studied by Cook et al. (1986), through 1995; Dow cohort findings compared with IARC International Study and NIOSH Dioxin Registry. |
2,187 |
— |
Dow Studies Reviewed in Update 2002 |
||||
Burns et al., 2001 |
Cohort |
Study comparing mortality in a cohort of chemical workers who manufactured or formulated 2,4-D between 1945 and 1994 |
1,567 |
40,600 non-exposed chemical workers; US population |
Dow Studies Reviewed in Update 1998 |
||||
Ramlow et al., 1996 |
Cohort |
Study of mortality in a cohort of workers exposed to pentachlorophenol (PCP) |
770 |
36,804 non-exposed |
Dow Studies Reviewed in Update 1996 |
||||
Bloemen et al., 1993 |
Cohort |
Additional years of follow-up of Bond et al. (1988) study cohort through 1986 |
878 |
36,804 non-exposed workers; US population |
Dow Studies Reviewed in VAO |
||||
Bond et al., 1989a |
Cohort |
Study of incidence of chloracne among a cohort of workers potentially exposed to TCDD, and association with other risk factors |
2,072 |
Internal comparison |
Bond et al., 1989b |
Cohort |
Extension of Ott et al. (1987) study through 1984 |
2,187 |
— |
Bond et al., 1988 |
Cohort |
Study of mortality (through 1982) among workers potentially exposed to 2,4-D (1945–1983) compared to US white males and all other male employees not exposed |
878 |
36,804 employees not exposed; US white male population |
Bond et al., 1987 |
Cohort |
Extension of Cook et al. (1980) study, mortality through 1982 |
322 |
2,026 employees without chloracne; US white male population |
Cook et al., 1987; Ott et al., 1987 |
Cohort |
Expanded Cook et al. (1986) study an additional three years, through 1982 |
2,187 |
— |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Sobel et al., 1987 |
Case-control |
Study of STS among Dow chemical employees (1940–1979) compared to employees without STS for possible association with several chemical exposures |
14 |
126 |
Cook et al., 1986 |
Cohort |
Mortality experience (1940–1979) of men manufacturing chlorinated phenols compared to US white men |
2,189 |
— |
Bond et al., 1983 |
Cross-sectional |
Study of differences in workers potentially exposed and not exposed to TCDD during chemical production for (1) morbidity and (2) medical examination frequency between 1976 and 1978 |
(1) 183 (2) 114 |
(1) 732 (2) 456 |
Townsend et al., 1982 |
Cohort |
Study of adverse reproductive outcomes among wives of Dow chemical employees potentially exposed to TCDD (1939–1975) compared to reproductive outcomes among wives whose husbands were not exposed |
370 |
345 |
Cook et al., 1980 |
Cohort |
Mortality experience (through 1978) of male workers involved in a chloracne incident (1964) from TCDD exposure, compared to mortality experience of US white men |
61 |
— |
Ott et al., 1980 |
Cohort |
Mortality experience among workers exposed to 2,4,5-T in manufacturing (1950–1971) compared to mortality experience of US white men |
204 |
— |
BASF Studies Reviewed in Update 2000 |
||||
Zober et al., 1997 |
Cohort (1953 accident) Cross-sectional (1988 cohort) |
Review and summary of previous BASF studies of morbidity and mortality in workers exposed to TCDD after BASF accidents in 1953 and 1988 |
154 surviving (as of 1989) members of 1953 accident cohort 42 exposed (1988) extruder personnel |
No comparison group |
BASF Studies Reviewed in Update 1998 |
||||
Ott and Zober, 1996 |
Cohort |
Cancer incidence and mortality experience (through 1992) of workers exposed to TCDD after the BASF accident, during reactor cleanup, maintenance, or demolition (based on the cohort of Zober et al., 1990) |
243 |
— |
BASF Studies Reviewed in Update 1996 |
||||
Zober et al., 1994 |
Cohort |
Morbidity experience in the same group as Zober et al. (1990) |
158 |
161 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
BASF Studies Reviewed in VAO |
||||
Zober et al., 1990 |
Cohort |
Mortality experience of workers exposed to TCDD (1954–1987) at BASF plant compared to population of Federal Republic of Germany (FRG) |
247 |
— |
Thiess et al., 1982 |
Cohort |
Study of mortality experience among BASF employees potentially exposed to TCDD during Nov. 17, 1953, accident compared to population and other workers not exposed |
74 |
180,000 (town); 1.8 million (district); 60.5 million (FRG); two groups of 74 each from other cohort studies |
IARC Studies Reviewed in Update 2000 |
||||
Neuberger et al., 1999 |
Austrian chloracne cohort |
Morbidity up to 1993 of exposed chemical workers assessed by health insurance data and health examination, laboratory measures, and interviews with participating survivors and controls |
159, including 50 who participated in examination |
Two control groups comparable to the 50 participants—numbers not given |
Hooiveld et al., 1998 |
Cohort |
Mortality (through 1991), using SMRs, of workers at one Dutch factory assessed in relation to work and exposure history; SMR and relative risk analyses |
562 (serum samples for 50); 140 males at accident |
567 |
Jäger et al., 1998 |
Cohort |
Preliminary data from Neuberger et al. (1999; English abstract only) |
159 in original cohort; 56 screened; 49 full data |
Matched nonexposed controls |
Neuberger et al., 1998 |
Cohort of exposed cases |
Preliminary data from Neuberger et al. (1999) |
50 |
Age- and sex-matched controls; number not given |
Vena et al., 1998 |
Cohort |
International study (36 cohorts from 12 countries) of workers producing or spraying phenoxy acid herbicides and chlorophenols, categorized into one of three TCDD or higher chlorinated dioxin categories. Noncancer mortality (1939–1992) was analyzed by standardized mortality rate comparisons and by Poisson multiple regression |
21,863 |
No comparison group |
Flesch-Janys, 1997 |
Cohort |
Mortality (1952–1984) study of German workers exposed to TCDD and other contaminants in the production of herbicides and insecticides. SMRs and Cox regression models were calculated |
1,189 |
— |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
IARC Studies Reviewed in Update 1998 |
||||
Kogevinas et al., 1997 |
Cohort |
Mortality study (through 1992) of workers engaged in the production or application of phenoxy herbicides and composed of (1) the Saracci et al. (1991) cohorts, (2) the German cohorts of Becher et al. (1996), and (3) the NIOSH cohorts of Fingerhut et al. (1991) |
26,615 total (21,863 exposed; 4,160 probably exposed; 592 unknown exposure) |
— |
Becher et al., 1996 |
Cohort |
Cancer mortality (through 1989) among German workers in four chemical factories exposed to 2,4,5-T and/or trichlorophenol (subcohorts I and II) and phenoxy herbicides and chlorophenols (subcohorts III and IV) |
2,479 |
— |
Flesch-Janys et al., 1995 |
Cohort |
Cancer and circulatory system mortality among workers in a chemical plant in Hamburg, Germany exposed in varying degrees to herbicides contaminated with PCDD/F |
1,189 |
2,528 gas workers |
IARC Studies Reviewed in Update 1996 |
||||
Kogevinas et al., 1995 |
Case-control |
Two nested case-control studies of the relationship between STS and NHL and occupational exposures in members of the IARC cohort |
STS: 11 cases NHL: 32 cases |
5 controls per case |
Kogevinas et al., 1993 |
Cohort |
Cancer incidence and mortality experience of female workers in seven countries, potentially exposed to chlorophenoxy herbicides, chlorophenols, and dioxin compared to national death rates and cancer incidence rates |
701 |
— |
Lynge, 1993 |
Cohort |
Cancer incidence in the same group as Lynge (1985), with follow-up extended through 1987 |
3,390 men 1,071 women |
— |
Kogevinas et al., 1992 |
Cohort |
Study of mortality from STS and malignant lymphomas in an international cohort of production workers and herbicide sprayers (same group as Saracci et al., 1991) |
14,439 (13,482 exposed; 416 probably exposed; 541 unknown exposure) |
3,951 non-exposed employees |
IARC Studies Reviewed in VAO |
||||
Bueno de Mesquita et al., 1993 |
Cohort |
Mortality experience of production workers exposed to phenoxy herbicides and chlorophenols in the Netherlands compared to national rates |
2,310 |
— |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Coggon et al., 1991 |
Cohort |
Mortality experience among four cohorts of workers potentially exposed (1963–1985) to phenoxy herbicides and chlorophenols compared to national (England and Wales) expected numbers and to the local population where factory is located |
1,104 Factory A 271 Factory B 345 Factory C 519 Factory D |
— |
Manz et al., 1991 |
Cohort |
Mortality experience of workers (1952–1984) at Hamburg plant of Boehringer exposed to TCDD compared to national mortality and workers from another company |
1,184 men 399 women |
(a) population (b) 3,120 gas workers |
Saracci et al., 1991 |
Cohort |
Study of mortality experience of 20 international cohorts of herbicide sprayers and production workers compared to mortality experience expected for the nation |
16,863 men 1,527 women |
— |
Coggon et al., 1986 |
Cohort |
Study of mortality experience (through 1983) among workers manufacturing and spraying MCPA (1947–1975) compared to expected numbers of deaths among men of England and Wales and for rural areas |
5,754 |
— |
Lynge, 1985 |
Cohort |
Study of cancer incidence among Danish workers exposed to phenoxyherbicides compared to expected results from the general population |
3,390 men 1,069 women |
— |
Studies from Other Chemical Plants Reviewed in Update 2000 |
||||
Hryhorczuk et al., 1998 |
Cohort |
Morbidity study of workers involved in pentachlorophenol production at one factory between 1938 and 1978 and nonexposed workers at the same factory. Assesses chloracne, prophyria, and general health status |
366 |
303 |
Jung et al., 1998 |
Cohort |
Self-selected group of former workers at pesticide-producing factory participated in physical examination, laboratory measures, and questionnaires. Associations between serum PCDD/F, infectious disease, and immunologic measures were assessed |
192 |
— |
|
|
Lymphocyte proliferation and chromate resistance tests were compared between a subgroup of the mostly highly exposed workers at the study factory and an nonexposed group of workers in another industry |
29 (highly exposed subgroup) |
28 (external nonexposed group) |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Studies from Other Chemical Plants Reviewed in Update 1998 |
||||
Tonn et al., 1996 |
Cohort |
Study of the long-term immune system effects of TCDD in industrial workers involved in production and maintenance operations at a German chemical factory producing 2,4,5-T between 1966 and 1976 |
11 |
10 |
Studies from Other Chemical Plants Reviewed in VAO |
||||
Jennings et al., 1988 |
Cohort |
Assessment of immunological abnormalities among workers exposed to TCDD during accident manufacturing 2,4,5-T compared to matched controls |
18 |
15 |
Thomas, 1987 |
Cohort |
Assessment of mortality experience as of Jan. 1, 1981, for white men employed in fragrance and flavors plant with possible exposure to TCDD, compared to US white men and for cancers compared to local men |
1,412 |
— |
May, 1982, 1983 |
Cohort |
Health outcomes among workers exposed and probably exposed to TCDD following a 1968 accident, compared to non-exposed workers |
41 exposed 54 possibly exposed |
31 |
Pazderova-Vejlupkova et al., 1981 |
Descriptive |
Study of development of TCDD intoxication among men in Prague (1965–1968) |
55 |
No comparison group |
Poland et al., 1971 |
Cross-sectional |
Assessment of porphyria cutanea tarda (PCT), chloracne, hepatotoxicity, and neuropsychiatric symptoms among 2,4-D and 2,4,5-T workers compared to other plant workers |
73 total (20 administrators; 11 production supervisors; 28 production workers; 14 maintenance workers) |
Internal comparison |
Bashirov, 1969 |
Cross-sectional |
Descriptive results of examination of workers involved in production of herbicides and study of workers at examination of cardiovascular and digestive systems compared to unexposed controls |
292 (descriptive); 50 (examined) |
20 (examined) |
AGRICULTURAL AND FOREST PRODUCTS |
||||
Cohort Studies of Agricultural Workers Reviewed in Update 2002 |
||||
Arbuckle et al., 2001 |
Cohort |
Spontaneous abortions in couples living on full-time family-run farms in Ontario, Canada |
2,110 women; 3,936 pregnancies |
none |
Masley et al., 2000 |
Cross-sectional survey |
Targeted survey of households in an agricultural-based rural area of Saskatchewan, Canada |
548 households; 1,407 individuals |
none |
Curtis et al., 1999 |
Cohort |
Time to pregnancy in couples living on full-time family-run farms in Ontario, Canada |
2,012 pregnancies |
none continues |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Savitz et al., 1997 |
Cohort |
Male pesticide exposure and pregnancy outcome among full-time family-run farms in Ontario, Canada |
1,898 couples; 3,984 pregnancies |
none |
Cohort Studies of Agricultural Workers Reviewed in Update 2000 |
||||
Arbuckle et al., 1999 |
Cohort |
Spontaneous abortions in couples living on full-time family-run farms in Ontario, Canada |
2,110 women (3,936 pregnancies) |
none |
Cohort Studies of Agricultural Workers Reviewed in Update 1998 |
||||
Gambini et al., 1997 |
Cohort |
Cancer mortality (1957–1992) among a cohort of rice growers in the Novara Province of northern Italy |
958 |
— |
Kristensen et al., 1997 |
Cohort |
Birth defects among the offspring of Norwegian farmers born after 1924 |
192,417 births |
61,351 births |
Faustini et al., 1996 |
Cohort |
Study of immune system components and function among farmers who mixed and applied commercial formulations containing the chlorophenoxy herbicides 2,4-D and MCPA |
10 |
Internal comparison |
Cohort Studies of Agricultural Workers Reviewed in Update 1996 |
||||
Dean, 1994 |
Cohort |
Study of mortality from brain and hematopoietic cancers of agricultural workers compared to nonagricultural workers in Ireland (1971–1987) |
(population size unclear) |
— |
Morrison et al., 1994 |
Cohort |
Update of mortality experience in Wigle et al. (1990) cohort through 1987, with addition of farmers from Alberta and Manitoba |
155,547 |
— |
Semenciw et al., 1994 |
Cohort |
Study of leukemia mortality in same group as Morrison et al. (1993) |
155,547 |
— |
Blair et al., 1993 |
Cohort |
Study of causes of death, including cancer, among farmers in 23 states (1984–1988) |
119,648 white men; 2,400 white women; 11,446 nonwhite men; 2,066 nonwhite women |
— |
Semenciw et al., 1993 |
Cohort |
Study of multiple myeloma mortality of male farmers compared to male population of the three prairie provinces of Canada (1971–1987) |
155,547 |
— |
Senthilselvan et al., 1992 |
Cross-sectional |
Study of the association between pesticide exposure and asthma in male farmers |
1,939 |
No comparison group |
Cohort Studies of Agricultural Workers Reviewed in VAO |
||||
Morrison et al., 1993 |
Cohort |
Mortality experience of male Canadian farmers 45 years or older in Manitoba, Saskatchewan, and Alberta, Canada, (1971–1987) compared to Canadian prairie province mortality rates |
145,383 |
— |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Eriksson et al., 1992 |
Cohort |
Study of incidence of NHL, HD, and multiple myeloma (1971–1984) among selected occupational groups in Swedish men and women, compared to expected rates of disease in general population |
Number in occupational group unknown |
— |
Hansen et al., 1992 |
Cohort |
Study of cancer incidence among male and female Danish gardeners compared to incidence expected among the general population |
4,015 (859 women; 3,156 men) |
— |
Morrison et al., 1992 |
Cohort |
Mortality experience of male farmers 35 or older (1971–1987) compared to Canadian prairie province rates |
155,547 |
— |
Ronco et al., 1992 |
Cohort |
Study of cancer incidence (1970–1980) among male and female Danish farm workers 15 to 74 years old, compared to expected numbers of cancers among persons economically active, and study of cancer mortality (November 1981–April 1982) among male and female Italian farmers 18 to 74 years old compared to persons in other occupational groups |
No N given |
No N given |
Lerda and Rizzi, 1991 |
Cohort |
Study of farmers exposed to 2,4-D, as measured in urine, compared to unexposed men for differences in sperm volume, death count, motility, and abnormalities between March and June 1989 |
32 |
25 |
Wigle et al., 1990 |
Cohort |
Mortality experience from NHL of male farmers 35 years or older (1971–1985) in Saskatchewan, Canada, compared to age- and period-specific mortality rates expected for Saskatchewan males |
69,513 |
— |
Corrao et al., 1989 |
Cohort |
Study of cancer incidence among male farmers licensed (1970–1974) to use pesticides, compared to number of cancers expected among licensed nonusers |
642 |
18,839 |
Wiklund et al., 1988a |
Cohort |
Malignant lymphoma incidence among agricultural and forestry workers in Sweden compared to the general population of men; 1960 census |
354,620 |
1,725,845 |
Wiklund and Holm, 1986 |
Cohort |
STS incidence among agricultural and forestry workers in Sweden compared to the general population of men; 1960 census |
354,620 |
1,725,845 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Wiklund, 1983 |
Cohort |
Study of cancer incidence (diagnosed 1961–1973) among agricultural workers in Sweden compared to rates expected from the 1960 population census |
19,490 |
— |
Burmeister, 1981 |
Cohort |
Study of mortality of farmers compared to nonfarmers in Iowa (1971–1978) |
6,402 |
13,809 |
Cohort Studies of Forestry Workers Reviewed in Update 2002 |
||||
Thörn et al., 2000 |
Cohort |
Study of mortality and cancer incidence in a cohort of Swedish lumberjacks exposed to phenoxy herbicides |
261 |
243 |
Cohort Studies of Forestry Workers Reviewed in VAO |
||||
Green, 1991 |
Cohort |
Mortality experience of male forestry workers (1950–1982) in Ontario, compared to expected mortality of the male Ontario population |
1,222 |
— |
Green, 1987 |
Cohort |
Suicide experience in a cohort of Canadian forestry workers by number of years in forestry trade as a surrogate for exposure to phenoxy herbicides compared to population |
1,222 |
— |
Van Houdt et al., 1983 |
Cross-sectional |
Study of acne and liver dysfunction in a select group of Dutch forestry workers exposed to 2,4,5-T, compared to non-exposed workers |
54 |
54 |
New Cohort Studies of Herbicide and Pesticide Appliers |
||||
Flower et al., 2004 |
Prospective cohort |
Parental pesticide application and cancer risk in offspring of pesticide appliers in AHS cohort |
20,625 appliers and spouses; 21,375 children born during or after 1975 |
— |
Swaen et al., 2004 |
Cohort |
Mortality follow-up in Dutch male herbicide appliers |
1,341 |
— |
Alavanja et al., 2003 |
Prospective cohort |
Correlation between pesticide exposure (including 2,4-D and 2,4,5-T) and prostate cancer in pesticide appliers |
55,332 |
— |
Cohort Studies of Herbicide and Pesticide Appliers Reviewed in Update 2002 |
||||
Hoppin et al., 2002 |
Cohort |
Study predicting wheeze among farmers who applied pesticide in the Agricultural Health Study |
3,838 appliers with wheeze |
16,630 appliers without wheeze |
Cohort Studies of Herbicide and Pesticide Appliers Reviewed in Update 2000 |
||||
Alavanja et al., 1998 |
Cohort |
Analysis of self-reported health care visits having resulted from pesticide use by Iowa and North Carolina pesticide appliers |
35,879 |
None |
Dich and Wilkund 1998 |
Cohort |
Study of men licensed for pesticide application in Sweden. Cancer cases ascertained from cancer registry and standardized incidence ratio reported for prostate cancer |
20,025 |
— |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Cohort Studies of Herbicide and Pesticide Appliers Reviewed in Update 1998 |
||||
Heacock et al., 1998 |
Cohort |
Fertility study among British Columbia workers potentially exposed to chlorophenate wood preservatives in 14 sawmills between 1955 and 1988; includes the cohort of Hertzman et al. (1997) |
18,016 births |
1,668 births |
Hertzman et al., 1997 |
Cohort |
Mortality study among British Columbia workers potentially exposed to chlorophenate wood preservatives in 11 sawmills between 1950 and 1985 |
23,829 |
2,658 |
Dimich-Ward et al., 1996 |
Cohort; Nested case-control |
Analysis of birth defects among offspring born between 1952 and 1988 of the Hertzman et al. (1997) cohort |
19,675 births among 9,512 fathers |
5 nondefect births as controls per case |
Garry et al., 1996a |
Cohort |
Study of chromosome abnormalities based on the cohort of Garry et al. (1994) |
23 fumigant appliers; 18 insecticide appliers; 20 herbicide appliers |
33 |
Garry et al., 1996b |
Cohort |
Birth defects among the offspring of male pesticide appliers in Minnesota born between 1989 and 1992 |
4,935 births among 34,772 pesticide appliers (125 with birth anomalies) |
3,666 births with anomalies in the general population |
Zhong and Rafnsson, 1996 |
Cohort |
Cancer mortality among various subgroups of pesticide users in Iceland |
2,449 (1,860 males and 589 females) |
— |
Cohort Studies of Herbicide and Pesticide Appliers Reviewed in Update 1996 |
||||
Asp et al., 1994 |
Cohort |
Mortality and cancer morbidity experience of male chlorophenoxy herbicide appliers (same cohort as Riihimaki et al., 1982, 1983) in Finland (1955–1971), through 1989, compared to general population rates for morbidity and mortality |
1,909 |
— |
Garry et al., 1994 |
Cross-sectional |
Evaluation of health outcomes resulting from exposure to pesticides by male pesticide appliers in Minnesota |
719 |
No comparison group |
Cohort Studies of Herbicide and Pesticide Appliers Reviewed in VAO |
||||
Swaen et al., 1992 |
Cohort |
Cancer mortality experience (through 1987) among Dutch male herbicide appliers licensed before 1980, compared to total male Dutch population |
1,341 |
— |
Bender et al., 1989 |
Cohort |
Cancer mortality of Minnesota highway maintenance workers compared to expected numbers based on white Minnesota men |
4,849 |
— |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Wiklund et al., 1989a |
Cohort |
Risk of cancer in Wiklund et al. (1987) cohort through 1982 |
20,245 |
— |
Wiklund et al., 1989b |
Cohort |
Risk of STS, HD, and NHL in Wiklund et al. (1987) cohort through 1984 |
20,245 |
— |
Wiklund et al., 1988b |
Cohort |
Risk of STS in Wiklund et al. (1987) cohort through 1984 |
20,245 |
— |
Wiklund et al., 1987 |
Cohort |
Risk of HD and NHL among Swedish pesticide appliers from date of license through 1982, compared to expected number of cases in the total population |
20,245 |
— |
Blair et al., 1983 |
Cohort |
Mortality experience of white male Florida pesticide appliers compared to US and Florida men |
3,827 |
— |
Riihimaki et al., 1983 |
Cohort |
Cancer morbidity and mortality in cohort of Riihimaki et al. (1982), through 1980 |
1,926 |
— |
Riihimaki et al., 1982 |
Cohort |
Study of mortality among herbicide appliers exposed to 2,4-D and 2,4,5-T in Finland compared to mortality expected in the population |
1,926 |
— |
Smith et al., 1982 |
Cohort |
Study of adverse reproductive outcomes among chemical appliers and agricultural contractors by category of exposure: none; chemicals not 2,4,5-T; 2,4,5-T |
113 pregnancies (chemicals not 2,4,5-T); 486 pregnancies (2,4,5-T) |
401 pregnancies (not exposed) |
Barthel, 1981 |
Cohort |
Study of male agricultural production workers (1948–1972) for incidence of cancer, compared to incidence rates expected in the population |
1,658 |
— |
Smith et al., 1981 |
Cohort |
Study of chemical appliers (1973–1979) in New Zealand compared to agricultural contractors for differences in adverse reproductive outcomes |
459 |
422 |
Axelson et al., 1980 |
Cohort |
Additional years of follow-up to cohort established in Axelson and Sundell (1974) |
348 |
— |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Axelson and Sundell, 1974 |
Cohort |
Study of mortality and cancer incidence among cohorts of Swedish railroad workers spraying herbicides (>45 days) compared to the expected number of deaths (1957–1972) from Swedish age- and sex-specific rates |
348 total herbicide exposure; 207 phenoxy acids and combinations; 152 amitrole and combinations; 28 other herbicides and combinations |
— |
CASE-CONTROL STUDIES |
||||
Case-Control Studies Reviewed in Update 2000 |
||||
Ekström et al., 1999 |
Case-control |
All new cases of histologically confirmed gastric adenocarcinoma in two geographic areas in Sweden; age-and gender-matched control group randomly selected using computerized population register |
565 |
1,164 |
Hardell and Eriksson, 1999 |
Case-control |
Male cases 25 or older with histopathologically confirmed NHL during 1987–1990 in northern and mid-Sweden; age matched controls from National Population Registry |
404 |
741 |
García et al., 1998 |
Case-control |
Matched-paired study of congenital malformations or defects in an agricultural region of Spain |
261 |
261 |
Case-Control Studies Reviewed in Update 1998 |
||||
Blatter et al., 1997 |
Case-control |
Multicenter Dutch study of paternal occupation and risk of spina bifida in offspring (1980–1992) |
222 |
764 |
Liou et al., 1997 |
Case-control |
Study of occupational and environmental risk factors and Parkinson’s disease (PD) in Taiwan (1993–1995) |
120 |
240 |
Tatham et al., 1997 |
Nested case-control |
Population-based study of occupational risk factors for subgroups of NHL patients based on the CDC’s Selected Cancers Study (CDC, 1990a,b,c,d) |
1,048 |
1,659 |
Nanni et al., 1996 |
Case-control |
Population-based study in northeastern Italy of occupational and chemical risk factors for chronic lymphocytic leukemia (CLL) and NHL (1987–1990) |
187 |
977 |
Schulte et al., 1996 |
PMR analysis with nested case-control |
Study of neurodegenerative diseases and occupational risk factors from 27 states |
130,420 death certificates |
|
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Seidler et al., 1996 |
Case-control |
Study of PD and various rural factors, including exposure to herbicides and wood preservatives in Germany |
380 |
379 neighborhood controls; 376 regional controls |
Case-Control Studies Reviewed in Update 1996 |
||||
Hardell et al., 1994 |
Case-control |
Study of the association between occupational exposures and parameters related to NHL in white males in Sweden |
105 |
335 |
Mellemgaard et al., 1994 |
Case-control |
Study of cases of renal cell carcinoma (20–79 years) in Denmark, compared to population-based sample without cancer for identification of occupational risk factors |
365 |
396 |
Nurminen et al., 1994 |
Case-control |
Study of structural defects in infants born to mothers engaged in agricultural work during the first trimester of pregnancy, compared to infants with structural defects born to mothers who did not engage in agricultural work during the first trimester |
1,306 |
1,306 |
Brown et al., 1993 |
Case-control |
Population-based case-control study of multiple myeloma in Iowa men for association with pesticide exposures |
173 |
650 |
Persson et al., 1993 |
Case-control |
Study of risk factors potentially associated with HD and NHL in males identified from the Regional Cancer Registry in Sweden |
NHL: 93 HD: 31 |
204 |
Semchuk et al., 1993 |
Case-control |
Study of cases of PD (36–90 years) in Canada, compared to population-based sample for association with occupational exposure to herbicides and other exposures |
75 men 150 men |
55 women 110 women |
Zahm et al., 1993 |
Case-control |
Study of NHL and exposure to pesticides in white women diagnosed with NHL between July 1, 1983, and June 30, 1986 |
206 |
824 |
McDuffie et al., 1990 |
Case-control |
Study of pesticide exposure in male cases of primary lung cancer in Saskatchewan, compared to control subjects matched by age, sex, and location of residence |
273 |
187 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Case-Control Studies Reviewed in VAO |
||||
Cantor et al., 1992 |
Case-control |
Population-based case-control study of NHL in Iowa and Minnesota men for association with farming exposures |
622 |
1,245 |
Smith and Christophers, 1992 |
Case-control |
Study of STS and malignant lymphomas in men diagnosed 1982–1988 in Australia, compared to other cancers for association with exposure to phenoxy herbicides and chlorophenols |
82 |
82 other cancers; 82 population controls |
Brown et al., 1990 |
Case-control |
Population-based case-control study of leukemia in Iowa and Minnesota men for association with farming exposures |
578 |
1,245 |
Eriksson et al., 1990 |
Case-control |
Study of male cases of STS (25–80 years) diagnosed 1978–1986 in central Sweden compared to population-based sample without cancer for association with occupational exposure to phenoxyacetic acids and chlorophenols |
218 |
212 |
Wingren et al., 1990 |
Case-control |
Study of male cases of STS (25–80 years) diagnosed 1975–1982 in southeast Sweden, compared to two referent groups: (1) population-based sample, (2) with other cancers, for association with phenoxyacetic acids and chlorophenols |
71 |
315 population based; 164 other cancers |
Zahm et al., 1990 |
Case-control |
Study of white men 21 years or older diagnosed with NHL (1983–1986) in Nebraska, compared to residents of the same area without NHL, HD, multiple myeloma (MM), chronic lymphocytic leukemia for association with herbicides (2,4-D) on farms |
201 |
725 |
Alavanja et al., 1989 |
PMR analysis with nested case-control |
Mortality experience of United States Department of Agriculture (USDA) forest or soil conservationists (1970–1979) evaluated for specific cancer excess; case-control study of specific cancers identified from PMR analysis |
1,411 |
— |
Boffetta et al., 1989 |
Nested case-control |
National study of MM compared to other cancer controls for association with exposures including pesticides and herbicides |
282 |
1,128 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
LaVecchia et al., 1989 |
Case-control |
Study of Italian men and women with HD, NHL, and MM (1983–1988), compared to population of Italy for association with occupations and herbicide use |
69 HD 153 NHL 110 MM |
396 |
Persson et al., 1989 |
Case-control |
Study of HD and NHL among living men and women in Sweden, compared to those without these cancers for association with occupational exposures, including phenoxy herbicides |
54 HD 106 NHL |
275 |
Woods and Polissar, 1989 |
Case-control |
Study of NHL from the Woods et al. (1987) cohort for association with phenoxy herbicides in farm workers |
576 |
694 |
Alavanja et al., 1988 |
PMR analysis with nested case-control |
Mortality experience of USDA extension agents (1970–1979) evaluated for specific cancer excess; case-control study of specific cancers identified from PMR analysis |
1,495 |
— |
Dubrow et al., 1988 |
Case-control |
Death certificate study (1958–1983) of NHL and HD among white male residents of Hancock County, Ohio, compared to a random sample of those dying from other causes for association with farming |
61 NHL 15 HD |
304 |
Hardell and Eriksson, 1988 |
Case-control |
Study of male cases of STS (25–80 years) diagnosed between 1978 and 1983 in northern Sweden compared to two referent groups: (1) population based, (2) with other cancers, for association with occupational exposure to phenoxyacetic acids and chlorophenols |
55 |
(1) 330 (2) 190 |
Musicco et al., 1988 |
Case-control |
Study of brain gliomas diagnosed 1983–1984 in men and women in Italy, compared to (1) patients with nonglioma nervous system tumors and (2) patients with other neurologic diseases, for association with chemical exposures in farming |
240 |
(1) 465 (2) 277 |
Olsson and Brandt, 1988 |
Case-control |
Study of NHL (1978–1981) in Swedish men, compared to two groups of men without NHL for association with occupational exposures including phenoxy acids |
167 |
50 same area; 80 other parts of Sweden |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Hardell et al., 1987 |
Case-control |
Study of Kaposi’s sarcoma in AIDS patients (23–53 years old) compared to controls for association with TCDD and pesticide exposure in Sweden |
50 |
50 |
Pearce et al., 1987 |
Case-control |
Expanded study (Pearce et al., 1986b) of NHL to include ICD-9 200-diagnosed cases and additional controls for association with farming exposures |
183 |
338 |
Woods et al., 1987 |
Case-control |
Study of STS or NHL in men 20–79 years old (1983–1985) in western Washington State compared to a population sample without these cancers for association with occupational exposure to phenoxy herbicides and chlorinated phenols |
128 STS 576 NHL |
694 |
Hoar et al., 1986 |
Case-control |
Study of STS, NHL, and HD in Kansas (1976–1982), compared to controls without cancer for association with 2,4-D, 2,4,5-T, and other herbicides in white men 21 years or older |
133 STS 121 HD 170 NHL |
948 |
Morris et al., 1986 |
Case-control |
Study of multiple myeloma (1977–1981) in four SEER areas compared to population controls for risk factors associated with MM, including farm use of herbicides |
698 |
1,683 |
Pearce et al., 1986a |
Case-control |
Study of male MM cases diagnosed 1971–1981 in New Zealand, compared to controls for other cancers for potential association with phenoxy herbicides and chlorophenols |
76 |
315 |
Pearce et al., 1986b |
Case-control |
Study of NHL cases (ICD-9 202) in men diagnosed between 1977 and 1981 in New Zealand, compared to sample with other cancers and population sample, for association with occupational exposure to phenoxy herbicides and chlorophenols |
83 |
168 other cancers; 228 general population |
Smith and Pearce, 1986 |
Case-control |
Update of Smith et al. (1983) with diagnoses through 1982 |
51 in update (133 when combined with Smith et al., 1983) |
315 (407) |
Vineis et al., 1986 |
Case-control |
Study of cases of STS in men and women diagnosed 1981–1983 in northern Italy, compared to population sample of controls for association with phenoxy herbicide exposure |
37 men 31 women |
85 men 73 women |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Blair and White, 1985 |
Case-control |
Study of leukemia cases by cell type in Nebraska (1957–1974) compared to nonleukemia deaths for association with agricultural practices |
1,084 |
2,168 |
Pearce et al., 1985 |
Case-control |
Study of malignant lymphoma and multiple myeloma in men diagnosed 1977–1981 in New Zealand, compared to men with other cancers for association with agricultural occupations |
734 |
2,936 |
Balarajan and Acheson, 1984 |
Case-control |
Study of STS (1968–1976) diagnosed in men in England and Wales compared to men with other cancers for association with farming, agriculture, and forestry occupations |
1,961 |
1,961 |
Donna et al., 1984 |
Case-control |
Study of ovarian cancer in women (1974–1980) for association with herbicide use, compared to women without ovarian cancer |
60 |
127 |
Hardell et al., 1984 |
Case-control |
Study of primary liver cancer diagnosed 1974–1981 in men 25–80 years old residing in northern Sweden compared to population based controls for association with occupational exposure to phenoxyacetic acids and chlorophenols |
98 |
200 |
Smith et al., 1984 |
Case-control |
Study of STS among New Zealand residents (1976–1980) compared to those without these cancers for association with occupational exposures, including phenoxy herbicides |
82 |
92 |
Burmeister et al., 1983 |
Case-control |
Study of multiple myeloma, NHL, prostate, and stomach cancer mortality (1964–1978) in white men 30 years or older compared to mortality from other causes for association with farming practices including herbicide use in Iowa |
550 MM 1,101 NHL 4,827 prostate 1,812 stomach |
1,100 2,202 9,654 3,624 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Hardell and Bengtsson, 1983 |
Case-control |
Study of HD diagnosed in men 25–85 years old, between 1974 and 1978 in northern Sweden, compared to population-based sample without cancer for association with occupational exposure to phenoxyacetic acid and chlorophenols |
60 |
335 |
Smith et al., 1983 |
Case-control |
Preliminary report of men with STS reported 1976–1980 in New Zealand, compared to controls with other cancers for association with phenoxyacetic acid exposure |
80 |
92 |
Burmeister et al., 1982 |
Case-control |
Study of leukemia deaths (1964–1978) in white men ≥ 30 years old in Iowa, compared to nonleukemia deaths for association with farming |
1,675 |
3,350 |
Cantor, 1982 |
Case-control |
Study of NHL in Wisconsin among males (1968–1976) compared to men dying from other causes for association with farming exposures |
774 |
1,651 |
Hardell et al., 1982 |
Case-control |
Study of nasal and nasopharyngeal cancers diagnosed 1970–1979 in men 25–85 years old residing in northern Sweden, compared to controls selected from previous studies (Hardell and Sandstrom, 1979; Hardell et al., 1981) for association with occupational exposure to phenoxyacetic acids and chlorophenols |
44 nasal; 27 nasopharyngeal |
541 |
Carmelli et al., 1981 |
Case-control |
Cases of spontaneous abortions occurring to women (1978–1980) compared to live births for association with paternal exposure to 2,4-D |
134 |
311 |
Eriksson et al., 1979, 1981 |
Case-control |
Cases of STS diagnosed between 1974 and 1978 in southern Sweden compared to population based sample without cancer for association with occupational exposure to phenoxyacetic acids and chlorophenols |
110 |
219 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Hardell, 1981 |
Case-control |
(1) Cases of STS (Hardell and Sandstrom, 1979) and malignant lymphomas (Hardell et al., 1981) compared to colon cancer cases (2) Colon-cancer cases compared to population-based controls for association with occupational exposure to phenoxyacetic acids and chlorophenols |
(1) 221 (2) 154 |
154 541 |
Hardell et al., 1980; Hardell et al., 1981 |
Case-control |
Cases of malignant lymphomas (HD, NHL, unknown) diagnosed in men 25–85 years old, between 1974 and 1978 in northern Sweden, compared to population-based controls for association with occupational exposure to phenoxyacetic acids and chlorophenols |
60 HD 109 NHL |
338 |
Blair and Thomas, 1979 |
Case-control |
Cases in Nebraska (1957–1974) compared to deaths from other causes for association with agricultural practices |
1,084 |
2,168 |
Hardell and Sandstrom, 1979 |
Case-control |
Cases of STS (26–80 years old) diagnosed between 1970 and 1977 in northern Sweden, compared to population-based controls for association with occupational exposure to phenoxyacetic acids and chlorophenols |
52 |
206 |
PAPER AND PULP WORKERS |
||||
Paper and Pulp Worker Studies Reviewed in Update 2000 |
||||
Schildt et al., 1999 |
Case-control |
Matched study of histopathologically verified oral cancer cases. Mailed exposure questionnaire on lifetime occupational history, oral cancer risk factors, pesticide use, smoking, SES, and place of residence |
410 |
410 |
Rix et al., 1998 |
Cohort |
Cancer incidence rates of blue-collar workers at three Danish paper mills were compared to population rates from national population and mortality registers |
14,788 (14,362 were identified for follow-up) |
— |
Paper and Pulp Worker Studies Reviewed in VAO |
||||
Jappinen and Pukkala, 1991 |
Cohort |
Cancer incidence (through 1987) among male Finnish pulp and paper workers (1945–1961), compared to rates in the local central hospital district |
152 |
Approximately 135,000 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Henneberger et al., 1989 |
Cohort |
Mortality experience through August 1985 of white men employed in Berlin, New Hampshire, paper and pulp industry, compared to expected mortality in US white men |
883 |
— |
Solet et al., 1989 |
Cohort |
Mortality (1970–1984) among white male United Paperworkers International union members, compared to expected number of deaths in US men |
201 |
— |
Robinson et al., 1986 |
Cohort |
Mortality experience through March 1977 of white male workers employed in five paper or pulp mills compared to expected number of deaths among US population |
3,572 |
— |
TABLE A-2 Epidemiologic Studies—Environmental Exposure
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
New Studies from Seveso |
||||
Baccarelli et al., 2004 |
Population based |
mRNA concentrations, AhR, ARNT, CYP1A1, CYP1B1 genes, and EROD activity in peripheral blood lymphocytes in a Seveso, Italy cohort |
62 |
59 |
Eskenazi et al., 2004 |
Cohort |
Relationship between serum TCDD concentration and age at exposure in SWHS participatants |
899 |
None |
Eskenazi et al., 2003a |
Cohort |
Association between maternal serum TCDD and birth outcome SWHS participants |
888 |
None |
Landi et al., 2003 |
Population based |
Effect of TCDD-mediated alterations in AhR-dependent pathway in Seveso zone A and B residents |
62 |
59 |
Baccarelli et al., 2002 |
Population based |
Immunologic effects in Seveso residents, compared with previous published results |
62 |
59 |
Eskenazi et al., 2002a |
Cohort |
Association between menstrual cycle characteristics and serum TCDD in SWHS participatants |
381 |
None |
Eskenazi et al., 2002b |
Cohort |
Association between endometriosis and serum TCDD concentration in SWHS participants |
601 |
None |
Studies from Seveso Reviewed in Update 2002 |
||||
Warner et al., 2002 |
Cohort |
Study to evaluate the association between individual serum TCDD levels and breast cancer risk in women who participated in the SWHS |
15 |
981 |
Studies from Seveso Reviewed in Update 2000 |
||||
Bertazzi et al., 2001 |
Cohort |
Mortality (through 1996) study of residents in industrial accident exposure-related geographic regions |
804 zone A 5,941 zone B 38,624 zone R |
232,745 |
Pesatori et al., 1998 |
Cohort |
Mortality (through 1991) study of residents in industrial accident exposure-related geographic regions |
805 zone A 5,943 zone B 38,625 zone R |
232,747 |
Studies from Seveso Reviewed in Update 1998 |
||||
Bertazzi et al., 1997, 1998 |
Cohort |
Study of cancer incidence among Seveso residents in contaminated zones (A, B, R) after 15 years of follow-up through 1991 |
45,373 total 805 zone A 5,943 zone B 38,625 zone R |
232,747 |
Mocarelli et al., 1996 |
Cohort |
Study of sex ratio among the offspring of Seveso residents born in zone A from (1) 1977 to 1984 and (2) 1985 to 1994 |
(1) 74 births (28 male, 48 female) (2) 124 births (60 male, 48 female) |
|
Studies from Seveso Reviewed in Update 1996 |
||||
Bertazzi et al., 1993 |
Cohort |
Study of cancer incidence in Seveso residents (aged 20 to 74 years) in contaminated zones (A, B, R) exposed to TCDD on July 10, 1976, compared to neighboring residents in nonexposed areas |
724 zone A 4,824 zone B 31,647 zone R |
181,579 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Pesatori et al., 1993 |
Cohort |
Evaluation of cancer incidence in Seveso residents aged 1–19 years in the first postaccident decade compared to age-matched residents of neighboring non-exposed areas |
Approximately 20,000 |
167,391 |
Studies from Seveso Reviewed in VAO |
||||
Bertazzi et al., 1992 |
Cohort |
Comparison of mortality of children (1976–1986) exposed during Seveso accident compared to children in uncontaminated areas |
306 zone A 2,727 zone B 16,604 zone R |
95,339 |
Pesatori et al., 1992 |
Cohort |
Cancer incidence (1976–1986) among those in zones A, B, R around Seveso compared to residents of uncontaminated surrounding areas |
Data given in person-years |
Data given in person-years |
Assennato et al., 1989a |
Cohort |
Comparison of dermatologic and laboratory findings in children during periodic exams following accident in Seveso |
193 with chloracne |
123 |
Assennato et al., 1989b |
Cohort |
Study of health outcomes in workers assigned to cleanup or referent group following Seveso accident |
36 |
36 |
Bertazzi et al., 1989a,b |
Cohort |
Comparison of mortality experience (1976–1986) of residents of contaminated zones (A, B, R) around Seveso to mortality experience of non-exposed residents in neighboring towns |
556 zone A 3,920 zone B 26,227 zone R |
167,391 |
Barbieri et al., 1988 |
Cohort |
Comparison of prevalence of peripheral nervous system involvement among Seveso residents with chloracne, compared to residents of unexposed areas |
152 |
123 |
Mastroiacovo et al., 1988 |
Cohort |
Comparison of birth defects occurring among zone A, B, and R mothers with live and stillbirths to birth mothers who were non-A, B, or R residents |
26 zone A 435 zone B 2,439 zone R |
12,391 (non-A, B, or R) |
Mocarelli et al., 1986 |
Cross-sectional |
Study of laboratory measures of serum and urine in Seveso zone A and B children measured over 6 years (1977–1982), compared to zone R children |
69 zone A 528 zone B 874 zone R |
241, subset of zone R |
Ideo et al., 1985 |
Cross-sectional |
Evaluation of levels of enzyme activity among residents of Seveso zone B and an noncontaminated community |
117 adults |
127 adults |
Tenchini et al., 1983 |
Cross-sectional |
Cytogenetic analysis of maternal and fetal tissue among Seveso exposed, compared to control sample |
19 |
16 |
Ideo et al., 1982 |
Cross-sectional |
Evaluation of hepatic enzymes in children exposed in Seveso compared to normal values |
16 zone A 51 zone B |
60 Bristo Assizio 26 Cannero |
Caramaschi et al., 1981 |
Cohort |
Evaluation of chloracne among children in Seveso, compared to children with no chloracne, and association with other health outcomes between chloracne and no-chloracne groups |
146 |
182 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Filippini et al., 1981 |
Cohort |
Comparison of prevalence of peripheral neuropathy on two screening examinations among Seveso residents, compared to residents in non-exposed areas |
308 |
305 |
Bisanti et al., 1980 |
Descriptive |
Descriptive report of selected health outcomes among residents of Seveso located in zones A, B, R |
730 zone A 4,737 zone B 31,800 zone R |
No comparison group |
Boeri et al., 1978 |
Cohort |
Evaluation of neurological disorders among Seveso residents exposed to TCDD on July 10, 1976, compared to residents in nonexposed areas |
470 zone A |
152 zone R |
Times Beach/Quail Run Studies Reviewed in VAO |
||||
Evans et al., 1988 |
Cross-sectional |
Comparison of retesting for skin delayed-type hypersensitivity among nonresponders in earlier test (Stehr et al., 1986) |
28 |
15 |
Stockbauer et al., 1988 |
Cohort |
Study of adverse reproductive outcomes (1972–1982) among mothers potentially exposed to TCDD-contaminated areas of Missouri (1971) compared to births among nonexposed mothers |
402 births |
804 births |
Stehr-Green et al., 1986; Hoffman et al., 1987 |
Cohort |
Health effects (1971–1984) in Quail Run Mobile Home Park residents compared with residents of noncontaminated mobile home parks |
154 |
155 |
Webb et al., 1987 |
Cross-sectional |
Pilot study of Missouri residents exposed to TCDD in the environment (1971) for health effects, comparing potentially high-exposed to low-exposed residents |
68 (high exposure) |
36 (low exposure) |
Stehr et al., 1986 |
Cross-sectional |
Pilot study of Missouri residents exposed to TCDD in the environment (1971) for health effects, comparing potentially high-exposed to low-exposed residents |
68 (high exposure) |
36 (low exposure) |
Studies of Vietnamese Reviewed in Update 1996 |
||||
Cordier et al., 1993 |
Case-control |
Study of cases of hepatocellular carcinoma (1989–1992) in males living in Vietnam, compared to other hospitalized patients for association with a range of exposures including herbicides |
152 |
241 |
Studies of Vietnamese Reviewed in VAO |
||||
Dai et al., 1990 |
Cohort |
Study of infant mortality (1966–1986) in two South Vietnam villages exposed to Agent Orange spraying compared to infant mortality in unsprayed area |
5,609 |
3,306 |
Phuong et al., 1989a |
Case-control |
Study of deformed babies and hydatidiform mole compared to normal births (1982) in Ho Chi Minh City for association with mother’s exposure to Agent Orange and TCDD in Vietnam conflict |
15 birth defects 50 hydatidiform moles |
104 134 |
Phuong et al., 1989b |
Cohort |
Comparison of reproductive anomalies among births to women (May 1982–June 1982) living in areas heavily sprayed with herbicides in southern Vietnam, to women from Ho Chi Minh City |
7,327 births |
6,690 births |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Constable and Hatch, 1985 |
Review |
Summaries of reproductive outcomes among Vietnamese populations, includes nine unpublished studies |
|
|
Other New Environmental Studies |
||||
Fierens et al., 2003 |
Population-based, cross-sectional |
Association between serum dioxin, prevalence of diabetes, endometriosis in several Belgian towns |
194 |
63 |
Fukuda et al., 2003 |
Ecologic cohort |
Correlation between incinerator dioxin emissions and mortality in 803 Japanese municipalities |
426 Municipalities with plants |
164 Municipalities without plants |
Other Environmental Studies Reviewed in Update 2002 |
||||
Revazova et al., 2001 |
Cohort |
Cytogenetic effects in women exposed to different levels of dioxin while living in Chapaevsk, Russia |
15 possibly exposed workers |
30 nonexposed but living close to plant |
Revich et al., 2001 |
Cohort |
Study of dioxin exposures in Chapaevsk, Russia which looked at various health outcomes in children and adults |
Children and adults in Chapaevsk, Russia |
Samara region and all of Russia |
Other Environmental Studies Reviewed in Update 2000 |
||||
Schreinemachers, 2000 |
Cross-sectional |
Study of cancer mortality rates in four northern wheat-producing states using wheat acreage per county as surrogate for exposure |
— |
— |
Other Environmental Studies Reviewed in Update 1998 |
||||
Gallagher et al., 1996 |
Case-control |
Community-based study of primary basal cell carcinoma (BCC) and patients with primary squamous-cell carcinoma (SCC) in Alberta, Canada |
BCC: 226 SCC: 180 |
406 |
Lovik et al., 1996 |
Cohort |
Study of immune system parameters in hobby fishermen in the Frierfjord in southeastern Norway |
24 |
10 |
Masala et al., 1996 |
Case-control |
Multicenter study of NHL, HD, MM, and AML in Italy by region |
HD: 421 NHL: 1,822 MM: 325 AML: 263 |
Internal comparison by region |
Svensson et al., 1995 |
Cohort |
Mortality and cancer incidence experience in two cohorts of Swedish fishermen |
East coast: 2,896 |
West coast: 8,477 |
Weisglas-Kuperus et al., 1995 |
Cohort |
Study of the immunological effects of prenatal andpostnatal PCB or TCDD exposure in 207 Dutch infants from birth to 18 months |
105 breast-fed |
102 bottle-fed |
Wolf and Karmaus, 1995 |
Cross-sectional |
Study of the effects of inhalation exposure to TCDD and related compounds in wood preservatives on cell-mediated immunity in German day care center employees |
221 |
189 |
Other Environmental Studies Reviewed in Update 1996 |
||||
Butterfield et al., 1993 |
Case-control |
Study of possible environmental risk factors associated with young-onset Parkinson’s disease |
63 |
68 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Peper et al., 1993 |
Descriptive |
Study of environmental exposure to dioxins and furans and potential association with adverse neuropsychological effects in Germany |
19 |
None |
Other Environmental Studies Reviewed in VAO |
||||
Lampi et al., 1992 |
Nested case-control/cohort |
Study of cancer incidence among a community in Finland exposed to water and food contaminated with chlorophenols (1987), compared to other communities; study of several cancers compared to population controls for association with potential risk factors including food and water consumption |
56 colon cancer; 40 bladder cancer; 8 STS; 7 HD; 23 NHL; 43 leukemia |
688 |
Vineis et al., 1991 |
Ecological design |
Presentation of rates (1985–1988) of NHL, HD, and STS in men and women 15–74 years old living in provinces in Italy where phenoxy herbicides are used in rice weeding and defined in two categories |
63 HD 253 NHL 49 STS |
No non-exposed controls |
Fitzgerald et al., 1989 |
Cohort |
Health outcomes in group exposed to electrical transformer fire in 1981 compared to standardized rates among upstate New York residents |
377 |
— |
Jansson and Voog, 1989 |
Cohort/case study |
Case study of facial cleft (April–August 1987) and study of facial clefts (1975–1987) compared to the rates expected in Swedish county with incinerators |
20,595 births after incineration 6 case studies |
71,665 births before incineration |
Cartwright et al., 1988 |
Case-control |
Study of living cases of NHL (1979–1984) in Yorkshire, England, compared to other hospitalized patients for association with a range of exposures including fertilizers or herbicides |
437 |
724 |
Michigan Department of Public Health, 1983 |
Descriptive |
Comparison of Michigan county rates of mortality for STS and connective tissue cancer (1960–1981), compared to state and national rates for potential excess in areas where dioxin may be in the environment |
County rates |
State and national rates |
Gordon and Shy, 1981 |
Case-control |
Study of agricultural chemical exposures and potential association with cleft palate or lip in Iowa and Michigan, compared to other live births |
187 |
985 |
Hanify et al., 1981 |
Ecological design |
Study of adverse birth outcomes occurring 1960–1966, compared to 1972–1977 for association with 2,4,5-T spraying in the later period |
9,614 births |
15,000 births |
Nelson et al., 1979 |
Ecological design |
Study of prevalence of oral cleft palates in high, medium, and low 2,4,5-T sprayed areas in Arkansas (1948–1974) |
— |
— |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
US EPA, 1979 |
Ecological design |
Study of spontaneous abortions occurring during 1972–1977 in herbicide-sprayed areas around Alsea, Oregon, compared to spontaneous abortions occurring in unsprayed areas |
2,344 births |
1,666 births—unsprayed area; 4,120 births—urban area |
aThe dash (—) indicates the comparison group is based on a population (e.g., US white males, country rates), with details given in the text for specifics of the actual population. ABBREVIATIONS: 2,4,5-T, 2,4,5-trichlorophenoxyacetic; AhR, arylhydrocarbon receptor; AML, acute myelogenous leukemia; ARNT, arylhydrocarbon receptor nuclear transporter; BCC, basal cell carcinoma; CYP1A1, cytochrome p450 1A1; CYP1B1, cytochrome p450 1B1; EROD, 7-ethoxyresorufun-O-deethylase; HD, Hodgkin’s disease; MM, multiple myeloma; NHL, non-Hodgkin’s lymphoma; PCB, polychlorinated biphenyls; PD, Parkinson’s disease; SCC, squamous cell carcinoma; SWHS, Seveso Women’s Health Study; STS, soft-tissue sarcoma; TCDD, 2,3,7,8-tetrachlorodibenzo-p-dioxin; Update 2000, Veterans and Agent Orange: Update 2000 (IOM, 2001); Update 1998, Veterans and Agent Orange: Update 1998 (IOM, 1998); Update 1996, Veterans and Agent Orange: Update 1996 (IOM, 1996); US EPA, United States Environmental Protection Agency; and VAO, Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam (IOM, 1994). |
TABLE A-3 Epidemiologic Studies—Veterans’ Exposure
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
UNITED STATES STUDIES |
||||
New Ranch Hand Studies |
||||
Akhtar et al., 2004 |
Cohort |
Follow-up to Ketchum et al. (1999), comparing cancer incidence among Ranch Hands with Vietnam veterans who served in Southeast Asia but did not spray herbicides and with US national cancer rates |
1,189 Ranch Hands for external analysis; 1,009 Ranch Hands for internal analysis |
1,776 Comparison subjects for external analysis; 1,429 comparison subjects for internal analysis |
Barrett et al., 2003 |
Cohort |
Serum TCDD measurement and psychological functioning among Ranch Hand veterans |
1,109 |
1,493 |
Michalek et al., 2003 |
Cohort |
Correlation for TCDD elimination and Ranch Hands with diabetes |
343 |
No comparison group |
Pavuk et al., 2003 |
Cohort |
Study to examine the relationship between serum TCDD and thyroid function in Ranch Hand veterans |
1,009 |
1,429 |
Ranch Hand Studies Reviewed in Update 2002 |
||||
Barrett et al., 2001 |
Cohort |
Based on tests of cognitive function in 1982, and dioxin levels measured in 1987 and 1992; analyzed association between serum dioxin levels and cognitive function among Ranch Hand veterans |
937 |
1,052 |
Michalek et al., 2001a |
Cohort |
Based on physical examination through 1992 and medical records reviewed through March of 1993; analyzed association between serum dioxin levels and hepatic abnormalities among Ranch Hand veterans |
1,109 |
1,493 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Michalek et al., 2001b |
Cohort |
Based on physical examination in 1982, 1985, 1987, 1992, and 1997 and medical records through 1997; analyzed association between serum dioxin levels and peripheral neuropathy among Ranch Hand veterans |
761 |
1,086 |
Michalek et al., 2001c |
Cohort |
Based on physical examination in 1982, 1985, 1987, and 1992 and medical record through 1997; analyzed association between serum dioxin levels and hematologic function among Ranch Hand veterans |
953 |
1,280 |
Steenland et al., 2001 |
Cohort |
A study to reexamine and compare diabetes data from the NIOSH cohort and the US Air Force Ranchs Hands in order to reconcile differences between the two study methods and protocols |
267 NIOSH workers |
227 NIOSH comparisons |
990 Ranch Hands |
1,275 Ranch Hand comparisons |
|||
Ranch Hand Studies Reviewed in Update 2000 |
||||
AFHS, 2000 |
Cohort |
Evaluation of 266 health-related end points, including assessments of 10 clinical areas: general health, neoplasia, neurological, psychological, gastrointestinal, cardiovascular, hematologic, endocrine, immunologic, and pulmonary |
995 |
1,299 |
Longnecker and Michalek, 2000 |
Cohort |
Based on physical examination and medical record review through 1992, analyzed association between serum dioxin concentrations and diabetes mellitus among the comparison group (no Ranch Hands) |
— |
1,281 1,197 |
Ketchum et al., 1999 |
Cohort |
Based on physical examination and medical record review through 1992, analyzed association between serum dioxin levels and cancer, skin cancer, and other than skin cancer among Ranch Hand veterans |
980 |
1,275 |
Michalek et al., 1999a |
Cohort |
To further elucidate the relationship between dioxin and diabetes mellitus, this analysis studies the effect of dioxin body burden on the relationship between sex hormone-binding globulin and insulin and fasting glucose among Ranch Hand veterans |
871 |
1,121 |
Michalek et al., 1999b |
Cohort |
Based on physical examinations in 1982, 1985, 1987, and 1992, examination of immunologic response and exposure to dioxin among Ranch Hand and comparison cohorts |
914 |
1,186 |
372 (lymphocyte counts conducted) |
491 (lymphocyte counts conducted) |
|||
Burton et al., 1998 |
Cohort |
Based on physical examination and medical record review through 1992, analyzed association between serum dioxin levels and occurrence and timing (relative to Southeast Asia service) of chloracne and acne among Ranch Hand veterans |
930 |
1,200 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Michalek et al., 1998b |
Cohort |
Updates all-cause and cause-specific postservice mortality (through 1993) among veterans of Operation Ranch Hand, using standardized mortality ratios |
1,261 |
19,080 |
Michalek et al., 1998c |
Cohort |
Prospective study of exposure and long-term health, survival, or reproductive outcome |
1,208 veterans 903 offspring |
1,549 veterans 1,254 offspring |
Michalek et al., 1998d |
Cohort |
Third report in a series investigating dioxin body burden and preterm birth, intrauterine growth retardation, and infant death among offspring of Ranch Hand veterans |
859 |
1,223 |
Ranch Hand Studies Reviewed in Update 1998 |
||||
Michalek et al., 1998a |
Cohort |
Paternal serum dioxin concentrations and infant death among offspring of Ranch Hands |
859 children: 323 background exposure, 267 low exposure, 269 high exposure |
1,223 children |
Henriksen et al., 1997 |
Cohort |
Study of the relationship between serum dioxin and glucose levels, insulin levels, and diabetes mellitus in Ranch Hands through 1992 |
989 |
1,276 |
AFHS, 1996; Michalek et al., 1998b |
Cohort |
Mortality update of Ranch Hands through the end of 1993 in the same cohort as AFHS (1983, 1984b, 1985, 1986, 1989, 1991a, 1995) |
1,261 |
19,080 |
Henriksen et al., 1996 |
Cohort |
Study of serum dioxin and reproductive hormones in Ranch Hands in 1982, 1985, 1987, and 1992 |
1,045 (participants, 1982) 474 (provided semen) |
1,224 (participants, 1982) 532 (provided semen) |
Ranch Hand Studies Reviewed in Update 1996 |
||||
AFHS, 1995 |
Cohort |
Mortality updates of Ranch Hands compared with Air Force C-130 air and ground crew veterans in Southeast Asia who did not participate in herbicide spraying missions |
1,261 (original cohort) |
19,101 (original cohort) |
Wolfe et al., 1995 |
Cohort |
Paternal serum dioxin levels and reproductive outcomes of Ranch Hand veterans compared with Air Force veterans from Southeast Asia who did not participate in herbicide spraying missions |
932 |
1,202 |
Ranch Hand Studies Reviewed in VAO |
||||
AFHS, 1992 |
Cohort |
Reproductive outcomes of participants in the Air Force Health Study (AFHS) |
791 |
942 |
AFHS, 1984a, 1987, 1990, 1991b, 1995 |
Cohort |
Baseline morbidity and follow-up exam results of the AFHS |
1,208 (baseline) |
1,668 (baseline) |
AFHS, 1983, 1984b, 1985, 1986, 1989, 1991a |
Cohort |
Mortality updates of Ranch Hands compared with Air Force C-130 air and ground crew veterans in Southeast Asia who did not participate in herbicide spraying missions |
1,261 (original cohort) |
19,101 (original cohort) |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Michalek et al., 1990 |
Cohort |
Mortality of Ranch Hands compared with Air Force C-130 air and ground crew veterans in Southeast Asia |
1,261 |
19,101 |
Wolfe et al., 1990 |
Cohort |
Health status of Ranch Hands at second follow-up, compared with Air Force C-130 air and ground crew veterans in Southeast Asia |
995 |
1,299 |
Centers for Disease Control (CDC) Studies Reviewed in VAO |
||||
Decoufle et al., 1992 |
Cohort |
Association between self-reported health outcom es and perception of exposure to herbicides based on Vietnam Experience Study (VES) |
7,924 |
7,364 |
O’Brien et al., 1991 |
Cohort |
Interview report and mortality for NHL based on VES |
8,170 |
7,564 |
CDC, 1990a |
Case-control |
Selected Cancers Study—population-based case-control study of all men born between 1921 and cancer registries and controls selected by 1953; cases diagnosed area covered by eight random-digit dialing |
1,157 NHL; 342 STS; 310 HD; 48 nasal carcinoma; 80 nasopharyngeal carcinoma; 130 primary liver cancer |
1,776 |
CDC, 1990b |
Case-control |
Selected Cancers Study—population-based case-control study of all men born between 1921 and 1953; cases diagnosed area covered by eight cancer registries and controls selected by random-digit dialing: NHL |
1,157 |
1,776 |
CDC, 1990c |
Case-control |
Selected Cancers Study: soft-tissue sarcoma |
342 |
1,776 |
CDC, 1990d |
Case-control |
Selected Cancers Study: HD, nasal cancer, nasopharyngeal cancer, and primary liver cancer |
310 HD; 48 nasal carcinoma; 80 nasopharyngeal carcinoma; 130 primary liver cancer |
1,776 |
CDC, 1989b |
Cohort |
Vietnam Experience Study—random sample of US Army enlisted men 1965–1971 |
2,490 |
1,972 |
CDC, 1988a |
Cohort |
VES—random sample of US Army enlisted men 1965–1971: psychosocial outcomes |
2,490 |
1,972 |
CDC, 1988b |
Cohort |
VES: physical health outcomes |
2,490 |
1,972 |
CDC, 1988c |
Cohort |
VES: reproductive outcomes |
12,788 children |
11,910 children |
CDC, 1987; Boyle et al., 1987 |
Cohort |
VES: mortality |
9,324 |
8,989 |
Erickson et al., 1984 a,b |
Case-control |
CDC birth defects study of children born in the Atlanta area between 1968 and 1980, comparing fathers’ Vietnam experience and potential Agent Orange exposure between birth defects cases and normal controls |
7,133 |
4,246 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Department of Veterans Affairs (VA) Studies Reviewed in Update 2002 |
||||
Kang et al., 2001 |
Cohort |
Study evaluating the health of Army Chemical Corps Vietnam veterans compared to Army Chemical Corps veterans who did not serve in Vietnam |
2,872 |
2,737 |
Kang et al., 2000a |
Cohort |
Self-report pregnancy outcomes for female Vietnam veterans compared to contemporary female veterans not deployed to Vietnam. Odds ratios were calculated for reproductive history and various birth defects |
3,392 women; 1,665 women with an indexed pregnancy |
3,038 women; 1,912 women with an indexed pregnancy |
Kang et al., 2000b |
Cohort |
Study of gynecologic cancers among female Vietnam veterans compared to femae veteran controls |
484 |
5,946 |
Department of Veterans Affairs (VA) Studies Reviewed in Update 1998 |
||||
Dalager and Kang, 1997 |
Cohort |
Morbidity and mortality experience (1968–1987) of Army Chemical Corps Vietnam veterans compared to US men; extension of Thomas and Kang (1990) |
2,872 |
2,737 |
Mahan et al., 1997 |
Case-control |
Study of lung cancer among Vietnam veterans (1983–1990) |
329 |
269 men hospitalized without cancer; 111 patients with colon cancer |
McKinney et al., 1997 |
Cross-sectional |
Study of the smoking behavior of veterans and nonveterans using the 1987 National Medical Expenditure Survey (NMES) |
15,000 |
— |
Bullman and Kang, 1996 |
Cohort |
Mortality study of veterans with nonlethal (combat and noncombat) wounds sustained during the Vietnam war |
34,534 |
— |
Watanabe and Kang, 1996 |
Cohort |
Mortality experience (1965–1988) of Army and Marine Corps Vietnam veterans; extension of Breslin et al. (1988) and Watanabe et al. (1991) |
33,833 |
36,797 |
Dalager et al., 1995b |
Case-control |
Cases of HD-diagnosed 1969–1985 among Vietnam era veterans |
283 |
404 |
Watanabe and Kang, 1995 |
Cohort |
Postservice mortality among Marine Vietnam veterans |
10,716 |
9,346 |
VA Studies Reviewed in Update 1996 |
||||
Dalager et al., 1995a |
Cohort |
Update of Thomas et al. (1991) through December 31, 1995 |
4,586 |
5,325 |
Bullman et al., 1994 |
Case-control |
Study of the association between testicular cancer and surrogate measures of exposure to Agent Orange in male Vietnam veterans |
97 |
311 |
VA Studies Reviewed in VAO |
||||
Bullman et al., 1991 |
Case-control |
PTSD cases in Vietnam veterans compared to Vietnam veterans without PTSD for association with traumatic combat experience |
374 |
373 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Dalager et al., 1991 |
Case-control |
Cases of NHL diagnosed 1969–1985 among Vietnam-era veterans compared to cases of other malignancies among Vietnam-era veterans for association with Vietnam service |
201 |
358 |
Eisen et al., 1991 |
Cohort |
Health effects of male monozygotic twins serving in the armed forces during Vietnam era (1965–1975) |
2,260 |
2,260 |
Thomas et al., 1991 |
Cohort |
Mortality experience (1973–1987) among women Vietnam veterans compared to women non-Vietnam veterans and for each cohort compared to US women |
4,582 |
5,324 |
Watanabe et al., 1991 |
Cohort |
Mortality experience (1965–1984) of Army and Marine Corps Vietnam veterans compared to: (1) branch-specific (Army and Marine) Vietnam-era veterans; (2) all Vietnam-era veterans combined; (3) the US male population |
24,145 Army, 5,501 Marines |
(1) 27,145 Army, 4,505 Marines (2) 32,422 STET/OIC (3) US male population |
Bullman et al., 1990 |
Cohort |
Mortality experience of Army I Corps Vietnam veterans compared to Army Vietnam-era veterans |
6,668 deaths |
27,917 deaths |
Farberow et al., 1990 |
Case-control |
Psychological profiles and military factors associated with suicide and motor vehicle accident (MVA) fatalities in Los Angeles County Vietnam-era veterans (1977–1982) |
22 Vietnam suicides; 19 Vietnam-era suicides |
21 Vietnam MVA; 20 Vietnam-era MVA |
Thomas and Kang, 1990 |
Cohort |
Morbidity and mortality experience (1968–1987) of Army Chemical Corps Vietnam veterans compared to US men |
894 |
— |
True et al., 1988 |
Cross-sectional |
PTSD and Vietnam combat experience evaluated among Vietnam-era veterans |
775 |
1,012 |
Breslin et al., 1988 Burt et al., 1987 |
Cohort |
Mortality experience (1965–1982) of Army and Marine Corps Vietnam veterans, compared to Vietnam-era veterans who did not serve in Southeast Asia standardized by age and race; nested case-control study of NHL |
24,235 |
26,685 |
Kang et al., 1987 |
Case-control |
STS cases (1975–1980) diagnosed at the Armed Forces Institute of Pathology, compared to controls identified from patient logs of referring pathologists or their departments for association with Vietnam service and likelihood of Agent Orange exposure |
217 |
599 |
Kang et al., 1986 |
Case-control |
STS cases (1969–1983) in Vietnam-era veterans for association with branch of Vietnam service as a surrogate for Agent Orange exposure |
234 |
13,496 |
American Legion Studies Reviewed in VAO |
||||
Snow et al., 1988 |
Cohort |
Assessment of PTSD in association with traumatic combat experience among American Legionnaires serving in Southeast Asia (1961–1975) |
2,858 |
Study group subdivided for internal comparison |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Stellman SD et al., 1988 |
Cohort |
Assessment of physical health and reproductive outcomes among American Legionnaires who served in Southeast Asia (1961–1975) for association with combat and herbicide exposure |
2,858 |
3,933 |
Stellman JM et al., 1988 |
Cohort |
Assessment of social and behavioral outcomes among American Legionnaires who served in Southeast Asia (1961–1975) for association with combat and herbicide exposure |
2,858 |
3,933 |
State Studies Reviewed in Update 1998 |
||||
Clapp, 1997 |
Case-control |
Selected cancers identified (1988–1993) among Massachusetts Vietnam veterans, compared to Massachusetts Vietnam-era veterans with cancers of other sites; update of Clapp et al. (1991) |
245 |
999 |
State Studies Reviewed in Update 1996 |
||||
Visintainer et al., 1995 |
Cohort |
Mortality experience (1965–1971) among male Michigan Vietnam veterans, compared to non-Vietnam veterans from Michigan |
3,364 deaths |
5,229 deaths |
State Studies Reviewed in VAO |
||||
Fiedler and Gochfeld, 1992; Kahn et al., 1992a,b,c |
Cohort |
New Jersey study of outcomes in select group of herbicide-exposed Army, Marine, and Navy Vietnam veterans, compared to veterans self-reported as unexposed |
10 Pointman I 55 Pointman II |
17 Pointman I 15 Pointman II |
Clapp et al., 1991 |
Case-control |
Selected cancers identified (1982–1988) among Massachusetts Vietnam veterans, compared to Massachusetts Vietnam-era veterans with cancers of other sites |
214 |
727 |
Deprez et al., 1991 |
Descriptive |
Study of Maine Vietnam veterans compared to atomic test veterans and general population for health status and reproductive outcomes |
249 |
113 atomic test veterans |
Levy, 1988 |
Cross-sectional |
Study of PTSD in chloracne as indicator of TCDD-exposed and control Vietnam veterans in Massachusetts |
6 |
25 |
Anderson et al., 1986a |
Cohort |
Mortality experience of Wisconsin veterans compared to nonveterans (Phase 1); mortality experience of Wisconsin Vietnam veterans and Vietnam-era veterans compared to nonveterans and other veterans (Phase 2) |
110,815 white male veteran deaths; 2,494 white male Vietnam-era veteran deaths; 923 white male Vietnam veteran deaths |
342,654 white male non-veteran deaths 109,225 white male other veteran deaths |
Anderson et al., 1986b |
Cohort |
Mortality experience of Wisconsin Vietnam-era veterans and Vietnam veterans compared to US men, Wisconsin men, Wisconsin nonveterans, and Wisconsin other veterans |
122,238 Vietnam-era veterans 43,398 Vietnam veterans |
— |
Goun and Kuller, 1986 |
Case-control |
Cases of STS, NHL, and selected rare cancers compared to controls without cancer for Vietnam experience in Pennsylvania men (1968–1983) |
349 |
349 deceased |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Holmes et al., 1986 |
Cohort |
Mortality experience (1968–1983) of West Virginia veterans, Vietnam veterans, and Vietnam-era veterans compared to nonveterans; Vietnam veterans compared to Vietnam-era veterans |
615 Vietnam veterans 610 Vietnam-era veterans |
— |
Pollei et al., 1986 |
Cohort |
Study of chest radiographs of New Mexico Agent Orange Registry Vietnam veterans compared to radiographs of control Air Force servicemen for pulmonary and cardiovascular pathology |
422 |
105 |
Kogan and Clapp, 1985, 1988 |
Cohort |
Mortality experience (1972–1983) among white male Massachusetts Vietnam veterans, compared to non-Vietnam veterans and to all other nonveteran white males in Massachusetts |
840 deaths |
2,515 deaths of Vietnam-era veterans |
Lawrence et al., 1985 |
Cohort |
Mortality experience of New York State (1) Vietnam-era veterans compared to nonveterans and (2) Vietnam veterans compared to Vietnam-era veterans |
(1) 4,558 (2) 555 |
17,936 941 |
Rellahan, 1985 |
Cohort |
Study of health outcomes in Vietnam-era (1962–1972) veterans residing in Hawaii associated with Vietnam experience |
232 |
186 |
Wendt, 1985 |
Descriptive |
Descriptive findings of health effects and potential exposure to Agent Orange among Iowa veterans who served in Southeast Asia |
10,846 |
None |
Greenwald et al., 1984 |
Case-control |
Cases of STS in New York State compared to controls without cancer for Vietnam service and herbicide exposure including Agent Orange, dioxin, or 2,4,5-T |
281 |
281 live controls 130 deceased controls |
Newell, 1984 |
Cross-sectional |
Preliminary (1) cytogenetic, (2) sperm, and (3) immune response tests in Texas Vietnam veterans compared to controls |
(1) 30 (2) 32 (3) 66 |
30 32 66 |
Other US Veteran Studies Reviewed in VAO |
||||
Tarone et al., 1991 |
Case-control |
Study of cases between January 1976 and June 1981 with testicular cancer (18–42 years old) compared to hospital controls for association with Vietnam service |
137 |
130 |
Aschengrau and Monson, 1990 |
Case-control |
Study of cases with late adverse pregnancy outcomes compared to normal control births for association with paternal Vietnam service (1977–1980) |
857 congenital anomalies 61 stillbirths 48 neonatal deaths |
998 |
Goldberg et al., 1990 |
Cohort |
Study of male twin pairs who served in Vietnam era (1965–1975) for association between Vietnam service and PTSD |
2,092 |
2,092 |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Aschengrau and Monson, 1989 |
Case-control |
Association between husband’s military service and women having spontaneous abortion at or by 27 weeks compared to women delivering at 37 weeks |
201 |
1,119 |
AUSTRALIAN STUDIES |
||||
Australian Studies Reviewed in Update 2000 |
||||
AIHW, 1999 |
Cohort |
Validation of the male veterans study (CDVA, 1998a) using medical documents, doctors’ certification and records on a disease or death registry |
6,842 |
— |
CDVA, 1998a |
Cohort |
Self-reported data on male members of the Australian Defence Force and the Citizen Military Force who landed in Vietnam or entered Vietnamese water. Questions on physical (including reproductive history) and mental health, and that of their partner(s) and children |
49,944 mailed; 39,955 responded |
— |
CDVA, 1998b |
Cohort |
Self-reported data on female members of the Australian Defence Force and the Citizen Military Force who landed in Vietnam or entered Vietnamese water. Questions on physical (including reproductive history) and mental health, and that of their partner(s) and children |
278 mailed 225 responded |
— |
Australian Studies Reviewed in Update 1998 |
||||
Crane et al., 1997a |
Cohort |
Mortality experience (through 1994) of Australian veterans who served in Vietnam |
59,036 males 484 females |
— |
Crane et al., 1997b |
Cohort |
Mortality experience (through 1994) of Australian national servicemen who served in Vietnam |
18,949 |
24,646 |
O’Toole et al., 1996a,b,c |
Cross-sectional |
Survey of self-reported health status (1989–1990) of Australian Army Vietnam veterans |
641 |
— |
Australian Studies Reviewed in VAO |
||||
Field and Kerr, 1988 |
Cohort |
Study of Tasmanian Vietnam veterans compared to neighborhood controls for adverse reproductive and childhood health outcomes |
357 |
281 |
Fett et al., 1987a |
Cohort |
Australian study of mortality experience of Vietnam veterans compared to Vietnam-era veterans through 1981 |
19,205 |
25,677 |
Fett et al., 1987b |
Cohort |
Australian study of cause-specific mortality experience of Vietnam veterans compared to Vietnam-era veterans through 1981 |
19,205 |
25,677 |
Forcier et al., 1987 |
Cohort |
Australian study of mortality in Vietnam veterans by job classification, location, and time of service |
19,205 |
Internal comparison |
Reference |
Study Design |
Description |
Study Group (N) |
Comparison Group (N)a |
Donovan et al., 1983, 1984 |
Case-control |
Australian study of cases of congenital anomalies in children born (1969–1979), compared to infants born without anomalies for association with paternal Vietnam service |
8,517 |
8,517 |
OTHER VIETNAM-VETERANS’ STUDIES |
||||
Other New Vietnam-Veterans’ Studies |
||||
Kim H-A et al., 2003 |
Cohort |
Immunotoxicologic effects of Agent Orange exposure on Korean Vietnam veterans |
51 (24 Veterans–patient; 27 veterans–normal) |
36 |
Kim J-S et al., 2003 |
Cross–sectional |
Agent Orange exposure and Korean Vietnam veterans |
1,224 |
154 |
Mo et al., 2002 |
Cohort |
Skin and general disease patterns among Korean Vietnam veterans |
332 |
None |
Other Vietnam Veterans Studies Reviewed in Update 1998 |
||||
Chinh et al., 1996 |
Cohort |
Study of antinuclear antibodies and sperm autoantibodies among Vietnamese veterans who served 5–10 years in a “dioxin-sprayed zone” |
25 |
63 age-matched controls; 36 additional male controls |
a The dash (—) indicates the comparison group is based on a population (e.g., US white males, country rates), with details given in the text for specifics of the actual population. ABBREVIATIONS: 2,4,5-T, 2,4,5-trichlorophenoxyacetic; AFHS, Air Force Health Study; CDC, Centers for Disease Control and Prevention; CDVA, Commonwealth Department of Veterans’ Affairs; HD, Hodgkin’s disease; MVA, mother vehicle accidents; NIOSH, National Institute for Occupational Safety and Health; NHL, non-Hodgkin’s lymphoma; NMES; National Medical Expenditure Survey; PTSD, posttraumatic stress disorder; SMR, standardized mortality ratio; STS, soft-tissue sarcoma; TCDD, 2,3,7,8-tetrachlorodibenzo-p-dioxin; Update 2000, Veterans and Agent Orange: Update 2000 (IOM, 2001); Update 1998, Veterans and Agent Orange: Update 1998 (IOM, 1998); Update 1996, Veterans and Agent Orange: Update 1996 (IOM, 1996); and VAO, Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam (IOM, 1994). |