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for smoking. However, the FEV1 alone was not associated with the exposure index. Shortness of breath was significantly associated with self-reported uranium exposure (Boiano et al., 1989). People who lived close to the plant had significantly fewer cases of asthma (SPR, 85; 99% CI, 73-98), chronic bronchitis (SPR, 19; 99% CI, 14-24), and emphysema (SPR, 61; 99% CI, 41-68) compared with National Health Interview Survey rates (Pinney et al., 2003).

The committee concludes that there is inadequate/insufficient evidence to determine whether an association between exposure to uranium and nonmalignant respiratory disease exists.

Results of several of the studies support an effect of employment in uranium-processing facilities on nonmalignant respiratory disease, but their applicability to military depleted-uranium exposure is limited by the extent of concomitant coexposure of such workers to other respiratory toxicants (such as silica, asbestos, and vanadium). Results of inhalation studies of various forms of uranium in several animal species are inconsistent with respect to nonmalignant respiratory effects (see Chapter 3). On the basis of the available evidence, the committee would assign a high priority to further study of an association between exposure to depleted uranium and nonmalignant respiratory disease.

Neurologic Effects

The studies of uranium-processing workers showed no excess in neurologic-disease mortality (Polednak and Frome, 1981; Cragle and et al., 1988; Frome et al., 1990, 1997; Dupree-Ellis et al., 2000; McGeoghegan and Binks, 2000a,b, 2001; Boice et al., 2006) (see Table 8-17). As part of the Depleted Uranium Follow-up Program at the BVAMC, McDiarmid and colleagues used various traditional and automated test batteries (see Chapter 7) to assess neurocognitive performance in veterans. Results of the evaluation of Gulf War veterans suggested a statistically significant relationship between increased urinary uranium concentrations and poor performance on automated neuropsychologic tests regardless of the models used (24-hour-urine uranium in depleted-uranium–exposed veterans, p = 0.01; spot-urine uranium in all veterans, p = 0.01); traditional test measures showed no statistical differences between exposed and unexposed veterans (McDiarmid et al., 2000). However, the relationship between urinary uranium concentration and performance on automated measures observed in the 1994 and 1997 evaluations appeared to weaken and had only a marginal level of significance (p = 0.098) in high and low urinary-uranium groups in the 1999 surveillance after adjustment for intelligence (WRAT-3) and depression (Beck Depression Inventory) (McDiarmid et al., 2001). Later surveillance (2001, 2003, and 2005) found no statistically significant differences between exposure groups in neurocognitive indexes (McDiarmid et al., 2004, 2006, 2007). A modest association was seen



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