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--> 12 Conclusions Summary of Findings Among Navy personnel, the primary analysis group for this study, we found that participants at the CROSSROADS nuclear test experienced higher mortality than a comparable group of nonparticipating military controls. The increase in all-cause mortality was 4.6 percent (relative risk [RR] = 1.046, 95% confidence interval, 1.020–1.074) and was statistically significant (p < 0.001).27 For malignancies, the elevation of mortality was lower—RR = 1.014 (0.96–1.068)—and was not statistically significant (p = 0.26). Similarly, leukemia mortality RR was elevated to 1.020 (0.75–1.39), but not significantly (p = 0.90) and by less than all-cause mortality. The increase in all-cause mortality did not appear to concentrate in any of the disease groups we considered. Of the 44 other specific cancers and disease categories we examined, there were no statistically significant increases in mortality. The overall elevation of mortality rate ratios for malignancies and leukemias in the participants were not statistically significant and, in fact, were lower than for many other causes of death. Navy mortality due to all malignancies and leukemia did not vary substantially among our exposure surrogate groups (i.e., those who boarded target ships after a detonation vs. those who did not, and those enlisted 27 All statistical tests are two-sided.
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--> Participants who boarded target ships were thought to be a more highly exposed than the rest of the participant group. Relative to the controls (nonparticipating comparison group), boarding participants experienced a 5.7 percent increase in all-cause mortality, RR equal to 1.057 (1.014–1.10), p-0.0093, whereas the nonboarders (less exposed participant group) experienced a 4.3 percent increase (RR = 1.043 [1.015–1.073], p = 0.0028). Aside from all cause mortality, risks for boarding participants did not significantly exceed those for controls for any of the disease categories, and risks relative to controls were similar for boarding and nonboarding participants. The increase in risk for all-malignancies among the participants was 2.6 percent (RR = 1.026 [0.94–1.12], p = 0.55) for boarders and I percent (RR = 1.010 [0.95–1.068], p = 0.73) for nonboarders. For leukemia, the increase in mortality risk for boarders was, 0.7 percent (RR = 1.007 [0.61–1.66], p = 0.98) and for nonboarders, 2.4 percent (RR = 1.024 [0.737–1.422], p = 0.89). In all cases the 95% confidence intervals overlap, suggesting the difference between boarders and nonboarders could well be due to chance. Those Navy participants holding an Engineering & Hull (E&H) occupational specialty were thought to be more highly exposed to radiation than their non-E&H counterparts. However, the E&H participants had essentially the same risk of mortality from all causes as non-E&H participants (RR = 0.99 [0.95–1.038], p = .81). For all malignancies and leukemias, the rate ratios were somewhat higher, 1.051 [0.97–1.14] and 1.51 [0.94–2.44] respectively, but both could be attributed to chance (p = 0.25 and 0.088 respectively). Risk ratios for leukemia and malignancies among E&H controls showed a similar elevation relative to non-E&H controls, suggesting that a factor specifically associated with CROSSROADS was not likely to have been the cause. These findings do not support a hypothesis that exposure to ionizing radiation was the cause of increased mortality among CROSSROADS participants. Had radiation been a significant contributor to increased risk of mortality, we should have seen significantly increased mortality due to malignancies, particularly leukemia, in participants thought to have received higher radiation doses relative to participants with lower doses and to unexposed controls. We did not observe any such effects. We note, however, that this study was neither intended not designed to be an investigation of low-level radiations effects, per se, and it should not be interpreted as such. In comparing the findings and methods employed in this study with those of other investigations of atomic veteran mortality, we have identified a possible self-selection bias in the participant cohort: participants who died of a disease (particularly cancer) may have been more likely than healthy participants to have identified themselves to the NTPR, and hence become a part of this study. Such a bias would have resulted in an apparent increase in death rates among the participants. We do not have data with which to make a good quantitative estimate of this potential bias. However, the roster of participants is nearly
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--> complete, and mortality from all malignancies and leukemia was lower, not higher, than the increase in all-cause mortality. These factors suggest that a self-selection bias was not entirely responsible for the finding of increased all-cause mortality in study participants. We believe that the elevated risk of all-cause mortality in CROSSROADS participants relative to a comparable military comparison group is probably the result of two factors. The first is an unidentified factor, other than radiation, associated with participation in, or presence at, the CROSSROADS test. The second is a self-selection bias within the participant roster. However, the relative contributions of these two explanations cannot be accurately determined within available resources for this project.
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