10
Morbidity Results

OVERVIEW: SURVEY RESPONSE

The data in this section of the report come from mail questionnaires and telephone interviews, as described in Chapter 7. The total number of subjects is 12,499, which excludes a total of 159 Army, Air Force, and Coast Guard participants and controls. As explained in Chapter 5, the primary reason for excluding the non-Navy, non-Marine subjects was their small number and our inability to assemble reasonable control groups. A total of 5,106 respondents is included in the analyses in this chapter.

Table 10-1 shows the total numbers of subjects and response rates for mail questionnaires and telephone interviews by analysis group. Response rates were calculated based on number of subjects presumed alive through 2005, and in all groups, participants have substantially higher response rates within each analysis group. Except for group B controls, participant response rates are all over 60 percent, while control response rates are 45–53 percent. In addition, mail questionnaire response rates were usually higher than telephone interview response rates. Overall, the response rate was 53.1 percent.

PRIMARY OUTCOME VARIABLE: SF-36

Unadjusted SF-36 Summary Scores by Analysis Group

Table 10-2 shows the two primary morbidity outcome measures from the SF-36, the physical component summary (PCS) and mental component summary (MCS) scores, by analysis group and participation status. Participants show uniformly lower scores (worse health) than controls in total as well as across all four analysis groups, with most of the differences in SF-36 scores being relatively small, in the range of 1 to 2 points. The exception is MCS scores in groups B and D, which show differences of around 5 points, considered moderate in size. Moreover, all differences between participant and control PCS and MCS scores were statistically significant, except for MCS and PCS scores in analysis group C, which contained the subjects potentially exposed to active agents. PCS and MCS scores in our survey were generally lower than comparable national norms for males aged 55–64 and 65–74: national PCS scores were 48.16 and 45.13, respectively; national MCS scores were 52.53 and 53.66, respectively.

It is important, especially when sample sizes are large, to interpret the clinical importance of these differences as well. According to the customary rule of thumb, based on Cohen’s criteria, differences of 0.2 to 0.49 standard



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) 10 Morbidity Results OVERVIEW: SURVEY RESPONSE The data in this section of the report come from mail questionnaires and telephone interviews, as described in Chapter 7. The total number of subjects is 12,499, which excludes a total of 159 Army, Air Force, and Coast Guard participants and controls. As explained in Chapter 5, the primary reason for excluding the non-Navy, non-Marine subjects was their small number and our inability to assemble reasonable control groups. A total of 5,106 respondents is included in the analyses in this chapter. Table 10-1 shows the total numbers of subjects and response rates for mail questionnaires and telephone interviews by analysis group. Response rates were calculated based on number of subjects presumed alive through 2005, and in all groups, participants have substantially higher response rates within each analysis group. Except for group B controls, participant response rates are all over 60 percent, while control response rates are 45–53 percent. In addition, mail questionnaire response rates were usually higher than telephone interview response rates. Overall, the response rate was 53.1 percent. PRIMARY OUTCOME VARIABLE: SF-36 Unadjusted SF-36 Summary Scores by Analysis Group Table 10-2 shows the two primary morbidity outcome measures from the SF-36, the physical component summary (PCS) and mental component summary (MCS) scores, by analysis group and participation status. Participants show uniformly lower scores (worse health) than controls in total as well as across all four analysis groups, with most of the differences in SF-36 scores being relatively small, in the range of 1 to 2 points. The exception is MCS scores in groups B and D, which show differences of around 5 points, considered moderate in size. Moreover, all differences between participant and control PCS and MCS scores were statistically significant, except for MCS and PCS scores in analysis group C, which contained the subjects potentially exposed to active agents. PCS and MCS scores in our survey were generally lower than comparable national norms for males aged 55–64 and 65–74: national PCS scores were 48.16 and 45.13, respectively; national MCS scores were 52.53 and 53.66, respectively. It is important, especially when sample sizes are large, to interpret the clinical importance of these differences as well. According to the customary rule of thumb, based on Cohen’s criteria, differences of 0.2 to 0.49 standard

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) TABLE 10-1 Availability of Mail Questionnaire and Telephone Interview Data by Analysis Group and Participation Status Analysis Group and Participation Status* Mail Questionnaire Only Telephone Interview Only Any Response (includes both) Total Subjects Presumed Alive Group A, participants 834 (33.4%) 637 (25.5%) 1,545 (62.0%) 2,494 (100%) Group A, controls 725 (26.8%) 552 (20.4%) 1,325 (48.9%) 2,710 (100%) Group B, participants 192 (27.4%) 175 (24.9%) 380 (54.1%) 702 (100%) Group B, controls 85 (11.5%) 137 (18.6%) 230 (31.2%) 738 (100%) Group C, participants 174 (31.9%) 130 (23.6%) 339 (61.5%) 551 (100%) Group C, controls 209 (25.2%) 159 (19.2%) 377 (45.5%) 829 (100%) Group D, participants 218 (33.2%) 178 (27.1%) 412 (62.8%) 656 (100%) Group D, controls 261 (27.7%) 225 (23.9%) 498 (54.7%) 942 (100%) Total number of responding subjects 2,700 (28.1%) 2,193 (22.8%) 5,106 (53.1%) 9,622 (100%) *Group A = participants potentially exposed only to BG or MAA; group B = participants potentially exposed only to TOF; group C = participants potentially exposed to any active chemical or biological agent; group D = participants potentially exposed only to simulants and not in groups A or B. TABLE 10-2 Mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores, by Analysis Group and Participation Status (Sample Sizes in Parentheses), with Results of t-Test Comparisons Analysis Groupa PCS Participant (sample size) PCS Control (sample size) t-Testb MCS Participant (sample size) MCS Control (sample size) t-Test Group A 42.36 (N = 1,438) 44.20 (N = 1,220) 4.09 2,656 df P < .0001 49.32 (N = 1,438) 51.22 (N = 1,220) 3.92 2,656 df P < .0001 Group B 42.64 (N = 357) 44.93 (N = 220) 2.41 575 df P = .0163 44.54 (N = 357) 49.78 (N = 220) 4.21 575 df P < .0001 Group C 42.14 (N = 315) 42.82 (N = 345) 0.75 658 df P = .4558 48.83 (N = 315) 50.06 (N = 345) 1.24 658 df P = .2158 Group D 42.80 (N = 388) 44.59 (N = 460) 2.22 846 df P = .0269 47.90 (N = 388) 52.31 (N = 460) 5.30 846 df P < .0001 All Subjects 42.44 (N = 2,498) 44.14 (N = 2,245) 5.06 4,741 df P < .0001 48.74 (N = 2,498) 51.48 (N = 245) 7.40 4,741 df P < .0001 National norms for males age 55–64   48.16     52.53   age 65–74   45.13     53.66   NOTE: Statistically significant items are in bold. aGroup A = participants potentially exposed only to BG or MAA; group B = participants potentially exposed only to TOF; group C = participants potentially exposed to any active chemical or biological agent; group D = participants potentially exposed only to simulants and not in groups A or B. bt-test value based on pooled variance estimate.

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) deviations are considered “small,” differences of 0.5 to 0.79 standard deviations are considered “moderate,” and differences greater than 0.8 standard deviations are considered “large.” Because our normed scores all have a mean of 50 and a standard deviation of 10, this means that differences in mean SF-36 scores of 2 to 4.9 points are interpreted as “small,” 5 to 7.9 points as “moderate,” and 8 or more points as “large.” Figures 10-1 and 10-2 show bar graphs of the PCS and MCS scores by analysis group and participation status. Most of the differences in the PCS scores were considered small, around 2 points, with a smaller difference of less than 1 point in group C. For MCS scores, groups A and C showed small, 2-point differences, while the group B and D differences were moderate. The next step was to examine the data for the SF-36 subscales, shown in Table 10-3. Overall, there were no striking differences in the SF-36 subscales. Group A showed small but consistent differences in all the SF-36 subscales, while group B differences were moderate in size, ranging up to 5 points; in all subscales, participants showed smaller values than controls. Group D differences were similar, but slightly smaller, than those of group B. Virtually all the SF-36 subscale differences in groups A, B, and D were statistically significant. In contrast, group C differences were relatively small, and none of them were statistically significant. SF-36 Summary Scales by Potential Confounding Variables Table 10-4 shows adjusted mean SF-36 summary scale values by analysis group for various potential confounding factors, with branch included only for group B, where there were sufficient numbers of Marines. Age was significantly associated with PCS and MCS scores in the majority of analysis groups, while race differences FIGURE 10-1 Average SF-36 physical component scores (PCS) by study group and participation status.

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) FIGURE 10-2 Average SF-36 mental component scores (MCS) by study group and participation status. were statistically significant only for group A’s PCS and MCS scores and group B’s PCS score. Pay grade differences were all statistically significant except for group B; some of the differences by pay grade in Table 10-4 are moderate to large in size. Smoking, drinking, and body mass index (BMI) all had statistically significant effects on PCS and MCS in more than one analysis group, although BMI was not statistically associated with MCS in any group. In summary, age, race, pay grade, branch, smoking, drinking, and BMI were all significantly associated with either PCS or MCS scores in at least one of the analysis groups. Therefore, further general linear model analyses will compare SF-36 summary scores within analysis groups, having adjusted for age, race, pay grade, branch, smoking, drinking, and BMI. Because statistical adjustment for source of data (mail questionnaire versus telephone interview) and for age-squared did not result in any meaningful change in estimates, we did not adjust for either of these covariates, in the interests of parsimony. Analysis of Adjusted SF-36 Summary Scores by Analysis Group Having established that age, race, pay grade, and branch are all potential confounding variables, our general linear model analyses compared SF-36 summary scores adjusted for all these variables simultaneously. Table 10-5 shows the results of our general linear models comparisons. Although participants have uniformly smaller adjusted mean SF-36 summary scores than controls, there were differences between PCS and MCS scores. Adjusted mean PCS scores all showed small differences between participants and controls, roughly two points, with the group C difference not reaching statistical significance.

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) TABLE 10-3 Mean SF-36 Subscale Scores, by Analysis Group and Participation Status, with Results of t-Test Comparisons Analysis Groupa and SF-36 Subscaleb Participant Control t-Testc Group A PF 42.30 43.78 3.14, 2,794 df, P = .0017 RP 43.79 45.74 4.17, 2,842 df, P < .0001 BP 45.88 47.59 4.05, 2,845 df, P < .0001 GH 42.73 45.40 5.79, 2,840 df, P < .0001 VT 48.56 50.97 5.34, 2,811 df, P < .0001 SF 46.25 48.09 3.99, 2,831 df, P < .0001 RE 46.41 48.63 4.72, 2,850 df, P < .0001 MH 48.95 51.07 4.67, 2,814 df, P < .0001 Group B PF 42.48 45.32 2.80, 597 df, P = .0053 RP 42.99 46.56 3.37, 601 df, P = .0008 BP 43.70 46.81 3.20, 603 df, P = .0015 GH 40.49 44.50 3.72, 605 df, P = .0002 VT 46.05 50.04 3.83, 601 df, P = .0001 SF 42.05 46.89 4.24, 605 df, P < .0001 RE 42.72 47.72 4.14, 602 df, P < .0001 MH 44.31 49.33 4.28, 598 df, P < .0001 Group C PF 42.30 42.32 0.03, 698 df, P = .9764 RP 43.48 44.06 0.61, 702 df, P = .5423 BP 45.53 45.86 0.39, 705 df, P = .6935 GH 41.92 43.36 1.61, 701 df, P = .1071 VT 47.40 48.73 1.44, 703 df, P = .1492 SF 45.93 45.48 -0.47, 706 df, P = .6378 RE 45.78 46.34 0.56, 702 df, P = .5781 MH 48.49 49.47 1.04, 706 df, P = .2999 Group D PF 42.69 44.29 1.91, 884 df, P = .0565 RP 43.87 46.35 3.02, 899 df, P = .0026 BP 45.12 47.90 3.77, 901 df, P = .0002 GH 42.20 45.09 3.52, 901 df, P = .0004 VT 47.41 50.73 4.07, 890 df, P < .0001 SF 44.90 48.36 4.29, 895 df, P < .0001 RE 45.45 49.36 4.80, 901 df, P < .0001 MH 47.18 50.64 4.17, 893 df, P < .0001 aGroup A = participants potentially exposed only to BG or MAA; group B = participants potentially exposed only to TOF; group C = participants potentially exposed to any active chemical or biological agent; group D = participants potentially exposed only to simulants and not in groups A or B. bPF = physical functioning; RP = role physical; BP = bodily pain; GH = general health; VT = vitality; SF = social functioning; RE = role emotional; and MH = mental health. ct-test value based on pooled variance estimate.

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) TABLE 10-4 Mean SF-36 Summary Scores, by Analysis Group and Various Other Factors, with Results of F-Test Comparisons Analysis Group and Factor* Mean Value PCS F-Test Mean Value MCS F-Test Group A Age — 28.70, 1 df — 12.05, 1 df     P < 0.0001   P = 0.0005 Race         White 45.40 7.64, 1 df 50.33 3.75, 1 df Nonwhite 43.00 P = 0.0078 48.46 P = 0.0529 Pay grade         E1–E3 41.58 13.13, 2 df 47.71 5.74, 2 df E4–E8 42.65 P < 0.0001 49.05 P = 0.0032 Officer 48.36   51.43   Branch         Marine 48.06 2.58, 1 df 47.29 3.43, 1 df Navy 44.72 P = 0.1080 51.51 P = 0.0643 Smoking         Yes 44.67 36.81, 1 df 48.61 6.38, 1 df No 48.11 P < 0.0001 50.18 P = 0.0116 Drinking         Yes 47.98 51.12, 1 df 50.54 21.97, 1 df No 44.80 P < 0.0001 48.25 P < 0.0001 Body Mass Index — 78.73, 1 df — 1.30, 1 df     P < 0.0001   P = 0.2540 Group B Age — 0.20, 1 df — 2.64, 1 df     P = 0.6510   P = 0.1048 Race         White 44.38 4.01, 1 df 47.28 1.93, 1 df Nonwhite 41.55 P = 0.0457 44.70 P = 0.1652 Pay grade         E1–E3 43.51 2.98, 2 df 46.00 0.56, 2 df E4–E8 44.57 P = 0.0514 46.96 P = 0.5721 Officer 40.82   45.01   Branch         Marines 42.53 0.77, 1 df 42.74 24.96, 1 df Navy 43.40 P = 0.3809 49.24 P < 0.0001 Smoking         Yes 40.94 14.51, 1 df 45.25 1.14, 1 df No 44.99 P = 0.0002 46.73 P = 0.2866 Drinking         Yes 45.11 22.12, 1 df 47.08 3.29, 1 df No 40.82 P < 0.0001 44.90 P = 0.0702 Body Mass Index — 11.25, 1 df — 0.14, 1 df     P = 0.0008   P = 0.7120

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) Analysis Group and Factor* Mean Value PCS F-Test Mean Value MCS F-Test Group C Age — 6.05, 1 df — 0.03, 1 df     P = 0.0142   P = 0.8725 Race         White 48.63 0.42, 1 df 53.87 0.02, 1 df Nonwhite 47.67 P = 0.5185 54.10 P = 0.8888 Pay grade         E1–E3 46.10 4.07, 2 df 51.48 3.01, 2 df E4–E8 46.25 P = 0.0176 53.39 P = 0.0501 Officer 52.11   57.07   Branch         Marine 51.79 0.84, 1 df 56.41 0.29, 1 df Navy 44.52 P = 0.8597 51.55 P = 0.5894 Smoking         Yes 46.67 6.76, 1 df 52.71 3.91, 1 df No 49.63 P = 0.0095 55.26 P = 0.0486 Drinking         Yes 50.10 17.16, 1 df 55.27 6.28, 1 df No 46.28 P < 0.0001 52.70 P = 0.0125 Body Mass Index — 27.28, 1 df — 0.74, 1 df     P < 0.0001   P = 0.3914 Group D Age — 7.47, 1 df — 8.38, 1 df     P = 0.0064   P = 0.0039 Race         White 45.98 0.35, 1 df 51.95 2.32, 1 df Nonwhite 47.17 P = 0.5519 48.72 P = 0.1282 Pay grade         E1–E3 45.04 4.25, 2 df 48.67 2.17, 2 df E4–E8 44.45 P = 0.0146 49.06 P = 0.1146 Officer 50.24   53.28   Branch —   —   Marine   —   — Navy         Smoking         Yes 44.63 16.92, 1 df 48.93 7.75, 1 df No 48.52 P < 0.0001 51.73 P = 0.0055 Drinking         Yes 48.37 17.94, 1 df 52.01 15.12, 1 df No 44.78 P < 0.0001 48.66 P < 0.0001 Body Mass Index — 40.37, 1 df — 0.12, 1 df P < 0.0001 P = 0.7244 NOTE: Statistically significant items are in bold. *Group A = participants potentially exposed only to BG or MAA; group B = participants potentially exposed only to TOF; group C = participants potentially exposed to any active chemical or biological agent; group D = participants potentially exposed only to simulants and not in groups A or B.

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) TABLE 10-5 Adjusted Mean SF-36 Summary Scores, by Analysis Group, with Results of F-Test Comparisons Analysis Group and Factor* Adjusted Mean PCS Score F-Test Adjusted Mean MCS Score F-Test Group A Participants 45.32 23.54, 1 df, P < .0001 48.36 18.50, 1 df, P < .0001 Controls 47.45   50.43   Age — 28.70, 1 df, P < .0001 — 12.05, 1 df, P = .0005 Race — 7.64, 1 df, P = .0058 — 3.75, 1 df, P = 0.0529 Pay grade — 13.13, 2 df, P < .0001 — 5.74, 2 df, P = .0032 Branch — 2.58, 1 df, P = .1080 — 3.43, 1 df, P = .0643 Smoking — 36.81, 1 df, P < 0.0001 — 6.38, 1 df, P = 0.0116 Drinking — 51.12, 1 df, P < 0.0001 — 21.97, 1 df, P < 0.0001 Body mass index — 78.73, 1 df, P < 0.0001 — 1.30, 1 df, p = 0.2540 Group B Participants 42.12 3.06, 1 df, P = .0808 43.92 10.73, 1 df, P = .0011 Controls 43.81   48.07   Age — 0.20, 1 df, P = .6510 — 2.64, 1 df, P = .1048 Race — 4.01, 1 df, P = .0457 — 1.93, 1 df, P = .1652 Pay grade — 2.98, 2 df, P = .0514 — 0.56, 2 df, P = .5721 Branch — 0.77, 1 df, P = .3809 — 24.96, 1 df, P < .0001 Smoking — 14.51, 1 df, P = 0.0002 — 1.14, 1 df, P = 0.2866 Drinking — 22.12, 1 df, P < 0.0001 — 3.29, 1 df, P = 0.0702 Body mass index — 11.25, 1 df, P = 0.0008 — 0.14, 1 df, P = 0.7120 Group C Participants 47.51 2.06, 1 df, P = .1517 53.03 3.59, 1 df, P = .0587 Controls 48.79   54.94   Age — 6.05, 1 df, P = .0142 — 0.03, 1 df, P = .8725 Race — 0.42, 1 df, P = .5185 — 0.02, 1 df, P = .8888 Pay grade — 4.07, 2 df, P = .0176 — 3.01, 2 df, P = 0.0501 Branch — 0.84, 1 df, P = .8597 — 0.29, 1 df, P = .5894 Smoking — 6.76, 1 df, P = 0.0095 — 3.91, 1 df, P = 0.0486 Drinking — 17.16, 1 df, P < 0.0001 — 6.28, 1 df, P = 0.0125 Body mass index — 27.28, 1 df, P < 0.0001 — 0.74, 1 df, P = 0.3914 Group D         Participants 45.50   47.70 40.26, 1 df, P < .0001 Controls 47.88 7.56, 1 df, P = .0061 52.97   Age — 7.47, 1 df, P = .0064 — 8.38, 1 df, P = 0.0039 Race — 0.35, 1 df, P = .3519 — 2.32, 1 df, P = 0.1282 Pay grade — 4.25, 2 df, P = .0146 — 2.17, 2 df, P = 0.1146 Branch — — — — Smoking — 16.92, 1 df, P < 0.0001 — 7.75, 1 df, P = 0.0055 Drinking — 17.94, 1 df, P < 0.0001 — 15.12, 1 df, P < 0.0001 Body mass index — 40.37, 1 df, P < 0.0001 — 0.12, 1 df, P = 0.7244 NOTE: Mean SF-36 summary scores adjusted for age, race, pay grade, branch, smoking, drinking, and body mass index. Statistically significant items are in bold. *Group A = participants potentially exposed only to BG or MAA; group B = participants potentially exposed only to TOF; group C = participants potentially exposed to any active chemical or biological agent; group D = participants potentially exposed only to simulants and not in groups A or B.

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) Differences between participants and controls for adjusted mean MCS scores were small in groups A and C (group A’s difference was statistically significant), whereas groups B and D showed larger differences (both statistically significant). The statistical significance of age, race, pay grade, and branch varied by group and by summary score, especially the effect of branch in group B’s MCS score. We note that although group C participants were the only subjects potentially exposed to active agents, neither adjusted mean PCS or MCS scores differed from those of group C controls. Analysis of Group A “Factorial Design” The subjects in group A were exposed only to Bacillus globigii (BG) simulant agent or methylacetoacetate (MAA), which allows a natural factorial design that allows for independent estimates of the effects of BG and MAA. Table 10-6 shows the results of a general linear model analysis of PCS and MCS mean scores, based on 2,661 subjects. The first analysis is a main effects model with separate effects for BG and MAA exposure, adjusted for age at participation, race, pay grade, branch, smoking, drinking, and body mass index. The second analysis was identical to the first, except that an additional adjustment was made for number of tests, a categorical variable with level 0 for controls and levels 1, 2, or 3 for participants. In model 1, without adjustment for number of tests, potential exposure to BG or to MAA resulted in a statistically significant lowering of the PCS scores of around one point. MCS scores in model 1 were not statistically significantly different for BG exposure, but they were for MAA exposure, the difference being around 2.5 points. We also fit the same model with an interaction term added, which was not statistically significant (data not shown). In model 2, the effects of possible BG and MAA exposure were all attenuated and none were statistically significant. In model 2, the number of tests is a statistically significant factor for PCS and for MCS. For neither PCS nor MCS score is there a monotone decline in score with an increasing number of tests; that is, there is not a clear dose-response effect with number of tests. Models 1 and 2 looked at the effects of simple BG or MAA exposure as either a yes or no. In Table 10-7 we report an analysis that attempts to assign “doses” of BG and MAA. Specifically, in this model, we defined the dose for BG and MAA as the number of tests at which a particular subject might have been exposed to these agents. For example, participation in Autumn Gold yields a BG dose of 1 and an MAA dose of 0, since only BG was used in that test. Eager Belle I, Eager Belle II, and Scarlet Sage also used only BG. Tests High Low and Purple Sage used only MAA, but DTC test 69-31 used both BG and MAA. The range of observed dose for BG ranged from 0 (controls) to 3, while the range of observed dose for MAA ranged from 0 to 2. General linear model analyses of PCS and MCS scores were run using BG and MAA dose data as independent variables, adjusted for age, race, pay grade, and branch. Table 10-7 shows that both PCS and MCS scores have a statistically significant difference by BG and MAA dose, although neither exposure relationship shows a clear gradient. The maximum effect size is around 3–4 points for BG and MAA dose effects. However, it is mostly the highest exposure group for both PCS and MCS that is not strictly monotone, and this is the group whose effect estimates have the largest standard error. Thus, we did analyses for linear trends. We found statistically significant coefficients for linear trend for both BG and MAA for both PCS and MCS scores, evidence that PCS and MCS scores were statistically significantly lower with each additional test in which there was potential exposure to either BG or MAA. Analysis of Individual Exposure Data from DTC Test 69-10 As explained in detail in Chapter 8, during Project SHAD (Shipboard Hazard and Defense) test DTC 69-10, Marine troops were subjected to a simulated chemical weapons assault with the purpose of determining the “operational effects of a persistent, toxic, chemical agent spray attack on U.S. amphibious forces.” During this test, sampling was conducted on exposed personnel and their clothing to determine the extent of exposure to the simulant agent, trioctyl phosphate (TOF). DTC test 69-10 was conducted at Vieques island, east of Puerto Rico, on May 3, 4, 5, and 7, 1969. Using material from a redacted version of the DTC test 69-10 final report, we assigned individual exposure levels based on individual estimates of magnitude of contamination on an ordinal

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) TABLE 10-6 Mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores for Subjects in Group A (Standard Errors in Parentheses), by Agent, with Adjustment for Age, Race, Branch, Pay Grade, Smoking, Drinking, and Body Mass Index (Model 1) or These Factors Plus Number of Tests (Model 2) Model Factor and Level Adjusted Mean PCS Value F-Test Value and Probability Adjusted Mean MCS Value F-Test Value and Probability Model 1 BG         No 45.84 (1.25) 10.38, 1 df, P = .0013 48.80 (1.37) 2.77, 1 df, P = .0964 Yes 44.37 (1.21)   47.97 (1.33)   MAA         No 45.92 (1.20) 11.38, 1 df, P = .0008 49.58 (1.32) 20.11, 1 df, P < .0001 Yes 44.28 (1.26)   47.19 (1.39)   Age — 29.06, 1 df, P < .0001 — 6.62, 1 df, P = .0101 Race — 7.89, 1 df, P = .0050 — 3.76, 1 df, P = .0526 Pay grade — 12.88, 2 df, P < .0001 — 6.66, 2 df, P = .0013 Branch — 1.02, 1 df, P = .3123 — 4.38, 1 df, P = .0364 Smoking — 35.53, 1 df, P < .0001 — 5.86, 1 df, P = .0155 Drinking — 51.54, 1 df, P < .0001 — 21.61, 1 df, P < .0001 BMI* — 76.35, 1 df, P < .0001 — 1.47, 1 df, P = .2251 Model 2 BG         No 44.45 (1.40) 0.85, 1 df, P = .3565 47.78 (1.54) 1.23, 1 df, P = .2666 Yes 45.33 (1.35)   48.94 (1.48)   MAA         No 45.36 (1.30) 1.37, 1 df, P = .2422 49.17 (1.43) 3.35, 1 df, P = .0674 Yes 44.42 (1.40)   47.55 (1.54)   Age — 32.52, 1 df, P < .0001 — 5.52, 1 df, P = .0189 Race — 7.69, 1 df, P = .0056 — 3.58, 1 df, P = .0584 Pay grade — 14.78, 2 df, P < .0001 — 7.63, 2 df, P = .0005 Branch — 0.54, 1 df, P = .4605 — 4.87, 1 df, P = .0274 Smoking — 34.91, 1 df, P < .0001 — 5.77, 1 df, P = .0164 Drinking — 49.80, 1 df, P < .0001 — 20.67, 1 df, P < .0001 BMI* — 77.63, 1 df, P < .0001 — 1.60, 1 df, P = .2067 Number of tests 0 46.59 (1.53) 5.57, 3 df, P = .0008 49.86 (1.68) 2.74, 3 df, P = .0419 1 45.38 (1.21)   48.54 (1.33)   2 42.56 (1.37)   46.51 (1.50)   3 45.03 (2.10)   48.53 (2.31)   NOTE: Statistically significant items are in bold. *BMI = body mass index. scale: VH (very heavy), H (heavy), M (medium), L (light), VL (very light), T (trace) and N (negligible). When multiple exposures were taken into account, there were 428 individuals who had ordinal contamination data from one or more trials. Because we were unable to obtain quantitative data regarding the contamination levels, we analyzed the TOF exposure data by arbitrarily assigning the following exposure values: T (trace) and N (negligible) = 0.5; VL (very light) = 1.0; L (light) = 2.0; M (medium) = 3.0; H (heavy) = 4.0; and VH (very heavy) = 5.0. We further assigned a dose of zero to Marine controls in DTC test 69-10. A total of 260 Marine subjects in group B provided data for an analysis of SF-36 summary outcomes. After adjusting for age, race, and pay grade, SF-36 PCS did not differ significantly by assigned TOF exposure levels (F statistic = 0.01, 1 df, P = .9309) nor did mental component scores (F statistic = 0.44, 1 df, P = .5094). When we dichotomized exposure into two groups, with “high” defined as 4.0 or more and “low” defined as less than 4.0, we

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) TABLE 10-7 Mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores (Standard Errors in Parentheses) for Subjects in Group A, by “Dose” of Agent, with Adjustment for Age, Race, Pay Grade, and Branch Model Factor and Dosea Adjusted Mean PCS Value F-Test Value and Probability Adjusted Mean MCS Value F-Test Value and Probability BG         0 46.30 (1.46) 6.93, 3 df, P = .0001 48.58 (1.61) 4.12, 3 df, P = .0063 1 45.77 (1.43)   48.75 (1.57)   2 43.30 (1.47)   46.15 (1.62)   3 45.25 (2.93)   49.87 (3.22)   MAA         0 45.27 (1.36) 9.24, 2 df, P < .0001 49.48 (1.49) 12.91, 2 df, P < .0001 1 43.11 (1.45)   46.62 (1.59)   2 47.08 (2.61)   48.91 (2.87)   Age — 31.59, 1 df, P < .0001 — 5.35, 1 df, P = .0208 Race — 7.70, 1 df, P = .0056 — 3.60, 1 df, P = .0579 Pay grade — 14.42, 2 df, P < .0001 — 7.82, 2 df, P = .0004 Branch — 0.29, 1 df, P = .5907 — 6.28, 1 df, P = .0123 Smoking — 35.42, 1 df, P < .0001 — 5.73, 1 df, P = .0167 Drinking — 48.88, 1 df, P < .0001 — 19.96, 1 df, P < .0001 BMIb — 76.61, 1 df, P < .0001 — 1.45, 1 df, P = .2286 NOTE: Statistically significant items are in bold. aDose is the number of tests in which a subject was potentially exposed to an agent. bBMI = body mass index. found similar results. The SF-36 summary scores did not differ statistically significantly for either PCS (F statistic = 0.00, 1 df, P = .9937) or MCS (F statistic = 0.40, 1 df, P = .5278). SF-36 Summary In summary, we detected many statistically significant differences in SF-36 scores, although relatively few were of even moderate size. In most cases, differences in adjusted SF-36 summary scores are all around two points, with age and pay grade generally the most important covariates, although group C differences were smaller and not statistically significant. In comparison to national norms, both participants and controls had lower PCS and MCS scores (worse health), but controls had PCS and MCS scores that were nearer the national norms. In comparison, veterans aged 50–64 in the Veterans Health Study, who were receiving outpatient care from the Department of Veterans Affairs (VA), had an average PCS score of 37.2 and an average MCS score of 47.0 (Payne et al., 2005), both of which are substantially lower than the participant or control scores in our study. An analysis of the independent effects of BG and MAA exposure in group A found that neither agent was associated with a large change in SF-36 summary score, although both agents had a statistically significant effect on both PCS and MCS adjusted mean scores. We did not see a clear dose-response relationship between the number of tests in group A and either PCS or MCS, but there was a statistically significant linear trend. An analysis of the only individual exposure data available, from DTC test 69-10, showed no statistically significant association of recorded exposure level, either on an ordinal scale or dichotomized, with either PCS or MCS.

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) TABLE 10-9 Mean Memory and Attention Scores, Unadjusted and Adjusted, for Participants and Controls, by Analysis Groupa   Unadjusted Adjustedc Participants Controls Participants Controls Group A Memory 8.33b 6.83 8.27b 6.64 Attention 9.09b 7.10 9.30b 7.17 Group B Memory 10.08b 7.56 10.12b 8.32 Attention 11.66b 7.93 11.41b 8.25 Group C Memory 8.46 7.59 5.74b 4.56 Attention 9.23 8.37 5.52 4.35 Group D Memory 8.53b 6.89 8.30b 6.51 Attention 9.62b 7.38 9.69b 7.23 aGroup A = participants potentially exposed only to BG or MAA; group B = participants potentially exposed only to TOF; group C = participants potentially exposed to any active chemical or biological agent; group D = participants potentially exposed only to simulants and not in groups A or B. bStatistically significant difference. cAdjusted for age, race, pay grade, branch, smoking, drinking, and body mass index. TABLE 10-10 Number of Medical Conditions for Participants and Controls, with Adjusted Odds Ratios (ORs) and 95% Confidence Intervals (CIs), by Analysis Group   Participants Controls Adjusted OR* 95% CI Group A N = 1,548 N = 1,326     Cardiovascular 1,106 892 1.31 1.05–1.62 Visual 541 418 1.21 0.98–1.50 Respiratory 648 460 1.49 1.22–1.83 Renal 245 158 1.49 1.09–1.96 Endocrine 556 421 1.26 1.01–1.56 Liver 124 89 1.11 0.76–1.62 Autoimmune 323 253 1.09 0.85–1.40 Gastrointestinal 256 179 1.28 0.97–1.68 Neurological 468 567 1.54 1.26–1.88 Psychological 375 259 1.59 1.25–2.04 Cancer 263 185 1.43 1.08–1.89 Group B N = 384 N = 230     Cardiovascular 278 154 1.47 0.83–2.60 Visual 115 55 1.02 0.57–1.84 Respiratory 177 81 1.57 0.90–2.74 Renal 63 20 1.74 0.79–3.80 Endocrine 112 68 0.96 0.53–1.76 Liver 38 20 0.66 0.24–1.81 Autoimmune 102 43 2.14 1.05–4.35 Gastrointestinal 74 28 1.75 0.82–3.74 Neurological 214 87 2.01 1.16–3.47 Psychological 161 63 2.84 1.50–5.37 Cancer 56 24 1.27 0.52–3.09

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense)   Participants Controls Adjusted OR* 95% CI Group C N = 337 N = 376     Cardiovascular 251 264 1.16 0.73–1.86 Visual 120 118 1.43 0.93–2.20 Respiratory 159 139 1.27 0.85–1.92 Renal 59 52 1.17 0.68–2.00 Endocrine 128 133 0.78 0.50–1.20 Liver 16 32 0.47 0.20–1.07 Autoimmune 68 73 1.23 0.75–2.01 Gastrointestinal 72 66 1.97 1.17–3.32 Neurological 175 166 1.16 0.77–1.75 Psychological 90 89 1.12 0.70–1.79 Cancer 69 60 1.35 0.79–2.32 Group D N = 411 N = 498     Cardiovascular 286 333 1.06 0.71–1.59 Visual 131 144 1.18 0.80–1.74 Respiratory 169 178 1.30 0.90–1.88 Renal 63 56 1.65 0.98–2.72 Endocrine 131 157 1.08 0.73–1.62 Liver 28 38 1.09 0.57–2.06 Autoimmune 83 98 0.97 0.61–1.54 Gastrointestinal 59 68 1.07 0.65–1.75 Neurological 184 221 1.04 0.72–1.50 Psychological 121 94 2.04 1.34–3.09 Cancer 71 59 1.40 0.86–2.28 NOTE: Cardiovascular: hypertension, coronary heart disease, heart attack, angina, other heart condition, stroke; Visual: cataract/lens problems, conjunctivitis; Respiratory: sinusitis, chronic bronchitis, emphysema, asthma; Renal: kidney failure, bladder infection; Endocrine: pancreatitis, diabetes, gallstones, thyroid condition; Liver: hepatitis B, hepatitis C, any other hepatitis, cirrhosis; Autoimmune: rheumatoid arthritis, lupus, multiple sclerosis; Gastrointestinal: Crohn’s disease, stomach/peptic ulcer, ulcerative colitis; Neurologic: neuropathy, seizures, Parkinson’s, amyotrophic lateral sclerosis, other neurodegenerative disease, migraines, hearing loss; Psychologic: depression, schizophrenia/ psychosis, manic depressive disorder, post-traumatic stress disorder. Sleep apnea, anemia, chronic fatigue syndrome, and dermatitis/eczema/ psoriasis did not fit into any categories. Statistically significant odds ratios in bold. *Adjusted for age, race, pay grade, smoking, drinking, and body mass index. Based on adjusted OR estimates, in group A there were significantly more cardiovascular, respiratory, renal, endocrine, gastrointestinal, neurological, and psychological medical conditions reported by participants than controls; in group B, significantly more respiratory, renal, autoimmune, gastrointestinal, neurological, and psychological conditions reported by participants; for group C, significantly more respiratory and neurological conditions; and in group D, significantly more psychological conditions. Most adjusted ORs were under 2.0. Respiratory conditions were reported at significantly higher rates among participants in all analysis groups but group D, and psychological conditions in all but group C. Table 10-11 shows a distribution of self-reported cancer by type. Skin cancer and prostate cancer are generally reported with the highest prevalences. Table 10-12 shows adjusted ORs for medical conditions as they appeared in the questionnaire, rather than grouped into broader categories. The sparser data make for larger confidence intervals (CIs) and some slightly higher ORs. All groups reported higher rates of neurodegenerative conditions, with relatively large and statistically significant ORs in groups A, B, and C. Table 10-13 shows a breakdown of these self-reported neurodegenerative

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) TABLE 10-11 Summary of Cancer Types by Group and Participant Status   Participant Control Group A (N = 263) (N = 185) Skin 15.2% (40) 12.4% (23) Prostate 12.5% (33) 19.5% (36) Colon 4.2% (11) 2.7% (5) Lung 2.3% (6) 3.8% (7) Other 6.1% (16) (includes 3 kidney, 4 leukemia, 2 bladder, 2 multiple myeloma, 2 NHL, 1 liver, 2 testicular) 7.0% (13) (includes 1 esophageal, 3 kidney, 2 leukemia, 2 NHL, 2 bone, 1 bladder, 1 lip, 1 throat) Unspecified 59.6% (157) 66.1% (101) Group B (N = 56) (N = 24) Skin 17.9% (10) 37.5% (9) Prostate 8.9% (5) 4.2% (1) Colon 3.6% (2) 8.3% (2) Lung 5.4% (1) 8.3% (2) Other 7.5% (3) (includes 1 kidney, 1 bladder, 1 testicular) 25.0% (6) (includes 3 bladder, 1 liver, 1 throat, 1 testicular) Unspecified 62.5% (35) 16.7% (4) Group C (N = 69) (N = 60) Skin 34.7% (24) 13.3% (8) Prostate 7.2% (5) 16.7% (10) Colon 1.4% (1) 3.3% (2) Lung 0% (0) 3.3% (2) Other 7.2% (5) (includes 2 bladder, 1 NHL, 1 kidney, 1 thyroid) 11.7% (7) (includes 3 bladder, 2 throat, 1 lymphoma, 1 leukemia) Unspecified 49.3% (34) 51.7% (31) Group D (N = 71) (N = 59) Skin 16.9% (12) 13.6% (8) Prostate 14.1% (10) 8.5% (5) Colon 0% (0) 5.1% (3) Lung 2.8% (2) 3.4% (2) Other 2.8% (2) (includes 1 NHL, 1 bladder) 8.5% (5) (includes 2 throat, 1 kidney, 1 leukemia, 1 testicular) Unspecified 63.4% (45) 61.0% (36) NOTE: NHL = non-Hodgkin’s lymphoma. conditions. Most of the entries were unspecified, some overlap the categories in Table 10-12 (e.g., neuropathy), and the inclusion of conditions such as arthritis calls into doubt the utility of these data for further analyses. Table 10-14 shows self-reported symptoms, rather than medical conditions, for participants and controls, along with adjusted ORs. In contrast to the data on medical conditions, nearly every symptom is reported at higher prevalence among participants than nonparticipants, even though not all differences are statistically significant. Among these is included “earlobe pain,” an item without a clear medical basis, included to obtain data on possible overreporting of medical problems.

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) TABLE 10-12 Ungrouped Medical Conditions by Analysis Group, Comparing Participants to Controls (Navy and Marine Only) Analysis Group and Medical Condition Participants (N = 1,548) Controls (N = 1,326) Adjusted OR for Age, Race, Pay Grade, Smoking, Drinking, and BMI 95% CI Group A N N     Hypertension 949 766 1.24 1.00–1.53 Coronary heart disease 338 242 1.30 1.01–1.68 Heart attack 265 186 1.23 0.93–1.62 Angina 374 261 1.31 1.02–1.67 Other heart condition 157 112 1.59 0.61–4.13 Cataracts/eye lens 497 397 1.14 0.92–1.42 Conjunctivitis 85 36 2.85 1.54–5.25 Sinusitis 455 290 1.63 1.30–2.04 Chronic bronchitis 230 156 1.56 1.15–2.12 Emphysema 106 139 1.28 0.89–1.83 Asthma 157 115 1.20 0.85–1.69 Kidney failure 16 13 0.78 0.22–2.75 Bladder infection 235 148 1.48 1.09–1.99 Pancreatitis 33 28 1.17 0.59–2.31 Diabetes 363 279 1.24 0.96–1.59 Gallstones 163 110 1.15 0.82–1.61 Hepatitis B 37 25 0.88 0.41–1.86 Hepatitis C 26 23 0.91 0.42–1.97 Any other hepatitis 46 37 0.85 0.50–1.47 Cirrhosis 33 23 1.54 0.73–3.26 Rheumatoid arthritis 303 244 1.06 0.82–1.37 Lupus 14 10 0.96 0.32–2.88 Multiple sclerosis 5 4 0.91 0.06–14.63 Crohn’s disease 13 9 1.43 0.46–4.1 Stomach/peptic ulcer 214 154 1.24 0.92–1.67 Ulcerative colitis 51 44 0.94 0.53–1.66 Hearing loss 567 405 1.31 1.06–1.61 Migraines 171 112 1.86 1.28–2.71 Stroke 107 71 1.27 0.82–1.96 Neuropathy 320 203 1.69 1.30–2.20 Seizures 32 34 1.05 0.53–2.09 Sleep apnea 319 222 1.31 1.00–1.70 Anemia 75 52 1.29 0.79–2.11 Thyroid condition 98 82 1.12 0.76–1.66 Cancer 263 185 1.43 1.08–1.89 Chronic fatigue syndrome 100 41 2.55 1.51–4.30 Depression 350 234 1.68 1.30–2.16 Schizophrenia 19 11 4.34 0.95–19.89 Manic depressive disorder 42 29 1.42 0.70–2.88 PTSD 105 88 0.99 0.65–1.50 Dermatitis, eczema, psoriasis 269 135 1.83 1.36–2.45 Parkinson’s 9 5 2.39 0.48–12.02 ALS 2 1 1.70 0.15–18.89 Other neurodegenerative disease 61 18 3.77 1.81–7.84

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) Analysis Group and Medical Condition Participants (N = 384) Controls (N = 230) Adjusted OR for Age, Race, Pay Grade, Smoking, Drinking, and BMI 95% CI Group B N N     Hypertension 241 138 1.12 0.64–1.96 Coronary heart disease 74 37 1.28 0.59–2.79 Heart attack 57 25 1.29 0.56–2.97 Angina 108 48 2.12 1.06–4.16 Other heart condition 42 29 2.07 0.06–72.76 Cataracts/eye lens 101 46 1.01 0.55–1.87 Conjunctivitis 23 10 1.64 0.49–5.50 Sinusitis 121 53 1.86 1.00–3.44 Chronic bronchitis 68 32 1.68 0.70–4.04 Emphysema 41 14 1.21 0.43–3.42 Asthma 46 22 0.98 0.45–2.14 Kidney failure 6 0 —   Bladder infection 61 20 1.66 0.78–3.65 Pancreatitis 12 3 3.43 0.35–34.09 Diabetes 88 50 0.87 0.45–11.66 Gallstones 27 20 1.22 0.43–3.72 Hepatitis B 15 4 1.77 0.19–16.33 Hepatitis C 14 8 0.62 0.17–2.34 Any other hepatitis 11 5 0.86 0.15–5.06 Cirrhosis 5 6 0.66 0.05–8.16 Rheumatoid arthritis 99 41 2.28 1.09–4.74 Lupus 4 1 —   Multiple sclerosis 2 0 —   Crohn’s disease 2 1 0.92 0.08–11.04 Stomach/peptic ulcer 62 25 1.93 0.81–4.56 Ulcerative colitis 17 2 2.63 0.53–13.03 Hearing loss 154 55 2.08 1.14–3.79 Migraines 70 25 3.15 1.16–8.58 Stroke 23 12 1.05 0.30–3.67 Neuropathy 88 34 1.46 0.70–3.3 Seizures 18 6 1.14 0.28–4.69 Sleep apnea 91 52 0.98 0.51–1.86 Anemia 20 12 2.83 0.56–14.26 Thyroid condition 19 9 2.55 0.55–11.87 Cancer 56 24 1.27 0.52–3.09 Chronic fatigue syndrome 31 12 9.27 1.12–76.80 Depression 136 56 2.55 1.33–4.91 Schizophrenia 12 4 1.68 0.33–8.66 Manic depressive disorder 24 8 3.20 0.67–15.41 PTSD 91 28 5.87 1.99–17.33 Dermatitis, eczema, psoriasis 52 28 1.85 0.71–4.82 Parkinson’s 6 0 —   ALS 1 0 —   Other neurodegenerative disease 18 4 2.85 0.31–25.93

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) Analysis Group and Medical Condition Participants (N = 337) Controls (N = 376) Adjusted OR for Age, Race, Pay Grade, Smoking, Drinking, and BMI 95% CI Group C N N     Hypertension 211 232 1.06 0.69–1.65 Coronary heart disease 67 82 0.91 0.55–1.50 Heart attack 50 66 0.85 0.49–1.46 Angina 71 90 0.93 0.58–1.51 Other heart condition 36 38 0.64 0.06–6.61 Cataracts/eye lens 106 104 1.20 0.77–1.86 Conjunctivitis 23 19 2.52 0.98–6.47 Sinusitis 115 86 1.46 0.93–2.28 Chronic bronchitis 57 45 1.18 0.62–2.24 Emphysema 35 36 1.21 0.61–2.38 Asthma 42 32 1.44 0.74–2.82 Kidney failure 5 3 1.59 0.09–27.74 Bladder infection 56 50 1.14 0.66–1.97 Pancreatitis 13 8 1.81 0.49–6.69 Diabetes 80 90 0.68 0.41–1.13 Gallstones 41 39 0.82 0.43–1.55 Hepatitis B 5 11 0.33 0.08–1.36 Hepatitis C 4 10 0.40 0.08–2.05 Any other hepatitis 6 9 0.97 0.29–3.29 Cirrhosis 4 6 0.28 0.03–2.61 Rheumatoid arthritis 66 69 1.30 0.78–2.15 Lupus 1 4 0.35 0.04–3.45 Multiple sclerosis 0 0 —   Crohn’s disease 4 3 1.68 0.28–10.26 Stomach/peptic ulcer 57 60 1.79 1.04–3.08 Ulcerative colitis 19 7 4.99 1.29–19.30 Hearing loss 119 121 0.99 0.64–1.53 Migraines 45 41 1.21 0.66–2.24 Stroke 18 21 1.46 0.60–3.53 Neuropathy 70 62 1.31 0.79–2.19 Seizures 14 9 2.02 0.57–7.15 Sleep apnea 74 73 0.97 0.57–1.65 Anemia 28 21 1.69 0.76–3.77 Thyroid condition 25 23 1.17 0.52–2.65 Cancer 69 60 1.35 0.79–2.32 Chronic fatigue syndrome 26 25 1.65 0.78–3.60 Depression 86 84 1.19 0.74–1.91 Schizophrenia 2 9 0.16 0.02–1.77 Manic depressive disorder 8 9 0.72 0.14–3.58 PTSD 17 27 0.54 0.20–1.48 Dermatitis, eczema, psoriasis 66 49 1.71 0.96–3.03 Parkinson’s 6 8 0.79 0.23–2.72 ALS 0 1 —   Other neurodegenerative disease 17 6 3.25 0.84–12.59

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) Analysis Group and Medical Condition Participants (N = 411) Controls (N = 498) Adjusted OR for Age, Race, Pay Grade, Smoking, Drinking, and BMI 95% CI Group D N N     Hypertension 254 290 0.92 0.62–1.35 Coronary heart disease 80 86 1.21 0.73–2.01 Heart attack 61 63 1.34 0.78–2.31 Angina 91 94 1.45 0.92–2.27 Other heart condition 48 41 0.95 0.12–7.86 Cataracts/eye lens 118 135 1.16 0.78–1.72 Conjunctivitis 22 22 0.96 0.42–2.22 Sinusitis 114 119 1.02 0.68–1.52 Chronic bronchitis 66 54 1.91 1.08–3.38 Emphysema 42 42 1.21 0.65–2.26 Asthma 41 52 1.33 0.75–2.37 Kidney failure 3 2 1.77 0.29–10.83 Bladder infection 61 54 1.68 0.99–2.87 Pancreatitis 6 20 0.28 0.07–1.02 Diabetes 85 108 1.17 0.75–1.83 Gallstones 27 35 0.79 0.39–1.61 Hepatitis B 9 19 0.73 0.27–1.96 Hepatitis C 5 9 1.00 0.26–3.86 Any other hepatitis 8 10 1.48 0.44–4.44 Cirrhosis 8 5 1.85 0.48–7.08 Rheumatoid arthritis 80 92 0.99 0.62–1.58 Lupus 4 2 4.14 0.42–41.20 Multiple sclerosis 4 5 1.67 0.36–7.70 Crohn’s disease 3 1 2.25 0.20–25.20 Stomach/peptic ulcer 51 59 1.00 0.59–1.71 Ulcerative colitis 16 14 1.81 0.71–4.63 Hearing loss 122 147 1.01 0.68–1.51 Migraines 59 53 1.70 0.98–2.94 Stroke 24 32 0.67 0.28–1.58 Neuropathy 81 80 1.25 0.79–1.98 Seizures 10 11 2.05 0.59–7.18 Sleep apnea 101 92 1.43 0.91–2.24 Anemia 26 30 0.83 0.41–1.69 Thyroid condition 40 31 1.84 0.95–3.53 Cancer 71 59 1.40 0.86–2.28 Chronic fatigue syndrome 29 21 2.46 1.19–5.10 Depression 115 88 1.91 1.25–2.93 Schizophrenia 8 2 8.04 0.95–68.01 Manic depressive disorder 18 10 2.49 0.81–7.64 PTSD 32 30 2.06 1.04–3.09 Dermatitis, eczema, psoriasis 79 70 1.52 0.93–2.47 Parkinson’s 2 2 —   ALS 0 0 —   Other neurodegenerative disease 17 14 2.74 1.00–7.53 NOTE: PTSD = post-traumatic stress disorder; ALS = amyotrophic lateral sclerosis (Lou Gehrig disease). Statistically significant odds ratios in bold.

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) TABLE 10-13 Reports of Other Neurodegenerative Diseases by Participant and Group Status   Participant Control Group A (N = 61) 46 unspecified, 8 spinal problems/degenerative discs, 1 meningitis, 1 myasthenia gravis, 1 dementia, 1 erectile dysfunction, 1 diverticulitis, 1 gout, 1 polio (N = 18) 13 unspecified, 2 spinal/degenerative discs, 1 arthritis, 1 dementia, 1 neuropathy Group B (N = 18) 8 unspecified, 7 spinal problems/degenerative discs, 2 arthritis, 1 diverticulitis (N = 4) 1 unspecified, 2 osteoporosis, 1 anxiety Group C (N = 17) 12 unspecified, 3 tremors, 1 hearing loss, 1 attention deficit disorder (N = 6) 4 unspecified, 1 dementia, 1 neuropathy Group D (N = 17) 15 unspecified, 1 arthritis, 1 anxiety (N = 14) 8 unspecified, 2 neuropathy, 1 myasthenia gravis, 1 Guillan-Barre syndrome, 1 brain tumor, 1 spinal problem Hospitalizations Since Discharge from Active Duty Table 10-15 shows self-reported data on hospitalizations since discharge from active duty. Roughly two-thirds of participants and controls reported a hospitalization, across all analysis groups; there were no statistically significant differences. Data on the mean number of hospitalizations (those not reporting a hospitalization were assigned zero number of hospitalizations) showed nearly equal rates between participants and controls across analysis groups, with no statistically significant differences. Birth Defects Table 10-16 shows data on self-reported birth defects. To calculate these rates, we divided the number of subjects who reported children with birth defects by the number of “eligible fathers.” Eligible fathers are defined as men who answered “yes” to the following question, “Have you ever been the biological father of any pregnancy, regardless of whether there was a live birth outcome from that pregnancy?” and also answered one or more to the following question, “How many of the pregnancies ended in live births, even if the infant died shortly after birth?” Table 10-16 shows that roughly 10–16 percent of participants reported birth defects among their children born live. The corresponding rate among participant subjects was larger in group D, while the mean number of children born with birth defects showed no statistically significant differences. REFERENCES O’Donnell, W. E., C. B. DeSoto, and J. L. DeSoto. 1993. Validity and reliability of the revised Neuropsychological Impairment Scale (NIS). Journal of Clinical Psychology 49:372-382. Payne, S. M., A. Lee, J. A. Clark, W. H. Rogers, D. R. Miller, K. M. Skinner, X. S. Ren, and L. E. Kazis. 2005. Utilization of medical services by Veterans Health Study (VHS) respondents. Journal of Ambulatory Care Management 28:125-140.

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) TABLE 10-14 Numbers of Symptoms by Group Comparing Participants to Controls, with Adjusted Odds Ratios (ORs)   Participants Controls Adjusted OR* 95% CI Group A (N = 1,548) (N = 1,326)     Severe headache 201 115 1.73 1.25–2.38 Diarrhea 284 143 1.90 1.43–2.52 Rash/skin ulcer 282 137 2.00 1.51–2.63 Sore throat 309 168 1.58 1.21–2.06 Frequent bladder infections 61 32 1.55 0.84–2.85 Cough 511 323 1.62 1.30–2.01 Fever 150 90 1.42 1.00–2.01 Unexplained hair loss 71 32 1.77 1.00–3.15 Earlobe pain 53 35 1.15 0.65–2.01 Sleepy all the time 321 207 1.52 1.16–1.98 Night sweats 373 253 1.34 1.05–1.70 Chest pain 325 191 1.79 1.38–2.34 Unusual muscle pains 483 286 1.77 1.41–2.21 Shortness of breath 592 414 1.53 1.24–1.89 Trouble sleeping 625 416 1.50 1.22–1.84 Unusual fatigue 444 309 1.42 1.13–1.78 Forgetfulness 561 399 1.71 1.38–2.12 Confusion 214 130 1.71 1.25–2.35 Group B (N = 384) (N = 230)     Severe headache 88 27 1.63 0.77–3.44 Diarrhea 91 28 2.41 1.10–5.28 Rash/skin ulcer 74 33 1.35 0.67–2.69 Sore throat 85 39 1.36 0.70–2.62 Frequent bladder infections 3 20 3.06 0.36–26.05 Cough 132 58 1.50 0.85–2.64 Fever 51 19 2.76 0.99–7.73 Unexplained hair loss 27 12 3.40 0.69–16.80 Earlobe pain 17 13 1.01 0.32–3.17 Sleepy all the time 124 37 3.73 1.71–8.41 Night sweats 149 52 3.10 1.58–6.07 Chest pain 106 46 1.59 0.83–3.06 Unusual muscle pains 160 61 1.35 0.77–2.37 Shortness of breath 154 73 1.65 0.94–2.91 Trouble sleeping 199 89 1.86 1.08–3..18 Unusual fatigue 164 52 2.87 1.55–5.30 Forgetfulness 176 71 2.45 1.34–4.74 Confusion 96 31 3.79 1.61–8.94

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense)   Participants Controls Adjusted OR* 95% CI Group C (N = 337) (N = 376)     Severe headache 46 49 1.14 0.63–2.07 Diarrhea 68 66 1.28 0.76–2.15 Rash/skin ulcer 73 48 2.20 1.29–3.76 Sore throat 76 64 1.32 0.79–2.20 Frequent bladder infections 15 20 0.75 0.29–1.95 Cough 115 105 1.24 0.80–1.92 Fever 29 27 1.77 0.82–3.82 Unexplained hair loss 13 15 1.97 0.62–6.26 Earlobe pain 11 11 0.90 0.77–3.03 Sleepy all the time 81 78 1.07 0.66–1.76 Night sweats 74 87 1.07 0.66–1.72 Chest pain 71 79 1.02 0.62–1.68 Unusual muscle pains 132 90 2.51 1.62–3.90 Shortness of breath 135 143 1.15 0.76–1.75 Trouble sleeping 152 141 1.48 0.98–2.22 Unusual fatigue 119 102 1.88 1.21–2.92 Forgetfulness 136 123 1.73 1.13–2.64 Confusion 53 56 1.35 0.73–2.50 Group D (N = 411) (N = 498)     Severe headache 63 50 1.81 1.07–3.07 Diarrhea 63 78 1.10 0.69–1.77 Rash/skin ulcer 84 58 2.16 1.37–3.42 Sore throat 74 58 1.70 1.05–2.78 Frequent bladder infections 16 14 1.74 0.67–4.47 Cough 133 132 1.51 1.03–2.22 Fever 36 34 1.28 0.71–2.34 Unexplained hair loss 15 11 3.89 1.22–12.38 Earlobe pain 14 13 1.48 0.57–3.87 Sleepy all the time 98 73 2.03 1.28–3.23 Night sweats 95 95 1.36 0.89–2.08 Chest pain 82 74 1.61 1.01–2.55 Unusual muscle pains 133 110 1.85 1.25–2.75 Shortness of breath 169 143 1.81 1.23–2.66 Trouble sleeping 172 164 1.70 1.16–2.48 Unusual fatigue 135 116 1.72 1.16–2.54 Forgetfulness 148 143 1.68 1.15–2.46 Confusion 68 50 2.10 1.23–3.56 Note: Statistically significant odds ratios in bold. *Adjusted for age, race, and pay grade.

OCR for page 45
Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) TABLE 10-15 Proportion of Subjects Hospitalized Since Discharge from Active Duty Comparing Participants to Controls, with Adjusted Odds Ratios (ORs)   Participants Controls Adjusted OR* 95% CI Group A 68.0% (484) 66.0% (396) 1.10 0.87–1.39 Group B 65.3% (124) 62.5% (91) 1.04 0.64–1.69 Group C 71.2% (116) 67.9% (114) 1.20 0.74–1.95 Group D 69.3% (133) 64.4% (152) 1.19 0.78–1.81 Mean # of Hospitalizations Participants Controls Adjusted Means (95% CI) Participants Adjusted Means (95% CI) Controls Group A 3.18 3.23 2.82 (2.17–3.47) 2.86 (2.17–3.55) Group B 3.69 3.23 3.17 (2.24–4.10) 3.45 (2.30–4.59) Group C 3.69 3.61 3.95 (2.40–5.49) 4.12 (2.47–5.77) Group D 2.81 3.40 2.97 (1.62–4.35) 2.35 (0.86–3.84) NOTE: Percentages are based on those who answered question—not total number. *Adjusted for age, race, and pay grade. TABLE 10-16 Birth Defects Among Those Who Fathered a Child Comparing Participants to Controls, with Adjusted Odds Ratios (ORs)   Participants Controls Adjusted OR* 95% CI Group A 10.8% (59) 13.0% (61) 0.82 0.56–1.21 Group B 14.8% (19) 16.5% (19) 1.11 0.55–2.27 Group C 16.1% (20) 9.3 (12) 1.02 0.96–1.09 Group D 13.3% (20) 5.6% (10) 2.42 1.07–5.48 Mean # of Birth Defects Participants Controls Adjusted Means (95% CI) Participants Adjusted Means (95% CI) Controls Group A 0.14 0.15 0.10 (0.03–0.18) 0.12 (0.04–0.200 Group B 0.19 0.25 0.19 (0.06–0.31) 0.21 (0.05–0.37) Group C 0.18 0.14 0.19 (0.04–0.35) 0.16 (-0.01–0.32) Group D 0.18 0.08 0.28 (0.10–0.45) 0.18 (-0.01–0.37) NOTE: Percentages and means are based on those who answered and had fathered a child. Statistically significant odds ratios in bold. *Adjusted for age, race, and pay grade.