Study

Design

Population

Outcomes

Results

Adjustments

Comments

Gray et al., 1996 (Vol. 4)

Hospitalizations from August 1991 through September 1993

547,076 active-duty GWVs, 618,335 non-GWVs

Hospital-discharge diagnoses of testicular cancer (ICD-9-CM Code 186)

GWVs vs nondeployed Last 5 months of 1991: 29 cases vs 14 cases, SRR 2.12 (95% CI 1.11-4.02)

1992: SRR 1.39 (95% CI 0.91-2.11)

1993: SRR 0.89 (95% CI 0.54-1.44)

Prewar hospitalization, sex, age, race, service branch, marital status, rank, length of service, salary, occupation

Limitations: restricted to persons remaining on active duty after the war, and thus does not include veterans who may have left the service due to poor health; no adjustment for other potential confounders

All cancers

Kang and Bullman, 2001 (Vol. 4)

Cohort mortality study; follow-up from 1991 through 1997

Deployed GWVs (n = 621,902) compared to random sample of nondeployed era veterans (n = 746,248)

Overall cancer mortality ascertained from BIRLS, death certificates, and NDI

Males:

GWVs (cases = 477) vs controls (cases = 860): RR 0.90 (95% CI 0.81-1.01)

Females:

GWVs (cases = 49) vs controls (cases = 103): RR 1.11 (95% CI 0.78-1.57)

Age, race, branch of service, unit component, marital status

Short latency; low age range; death certificates

Macfarlane et al., 2003 (Vol. 4)

Cohort (follow-up of Macfarlane et al., 2000)

51,721 UK GWVs, 50,755 NDVs; random samples Subgroup of 28,518 GWVs and 20,829 era veterans with records of smoking and alcohol use

Cancers identified from National Health Service Central Register; first diagnosis 4/1/1991-7/31/2002

GWVs (cases = 270) vs NDVs (cases = 269)

Main study: RR 0.99 (95% CI 0.83-1.17)

Subgroup: RR 1.12 (95% CI 0.86-1.45)

Main analysis: sex, age group, service branch, rank Subgroup: smoking, alcohol use

Follow-up period shorter than expected latency for most cancers; low age; grouped all cancer sites due to low numbers of occurrences

Gray et al., 2000 (Update)

Retrospective cohort, hospitalizations from August 1991 through December 1994

652,979 GWVs, 652,922 randomly selected NDVs 182,164 DoD hospitalizations; 16,030 VA hospitalizations; 5,185 COSHPD hospitalizations

Hospital-discharge diagnoses of neoplasms in DoD, VA, and COSHPD hospital systems

DoD PMR 0.98 (95% CI 0.94-1.01)

VA PMR 0.88 (95% CI 0.78-0.98)

COSHPD PMR 0.86 (95% CI 0.61-1.1)

Age, sex, race

Able to assess only illnesses that resulted in hospitalization; possible undetected confounders



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