availability of large, well-identified cohorts and (2) the potential for large-scale, relatively quick-and-easy mortality follow-up. He further concludes that studies of radiation carcinogenesis in veterans are of strategic importance because very large populations must be studied over very long time intervals, and because the federal government has undertaken responsibility to compensate individuals for injuries from military service.
Finally, although a panel discussion was held on opportunities for research in military and veteran populations, formal written presentations by the panel members were not submitted. In lieu of a transcript of the panel's remarks, these proceedings include a paper kindly provided by Dr. Kang on the data sources he uses in his studies of veterans. This paper describes three automated information systems, the Beneficiary Identification and Records Locator Subsystem (BIRLS), the Patient Treatment File (PTF), and the Agent Orange Registry, and discusses not only the information these data bases provide but also their strengths and weaknesses.
The BIRLS file is a huge file of VA beneficiaries that may be used to ascertain the vital status of war veterans and to obtain copies of their death certificates; the completeness of its mortality ascertainment, however, is still under study. The PTF file is likewise a large file, but it contains only computerized VA hospital discharge information (VA hospitalization is not a “benefit,” so BIRLS and PTF are independent files). PTF has served as the source of a number of clinical studies, but the quality of its diagnostic information requires that studies include independent diagnostic verification: only about one-half of putative cancer diagnoses were verified during hard-copy record review in the examples Dr. Kang cites. The Agent Orange Registry is a different kind of file altogether, being a record of a special health examination of some 200,000 Vietnam veterans who presented themselves to a VA medical center. Each of these resources can be used either as a sampling frame for studies or a source of morbidity or mortality follow-up information.