subjects such as Hodgkin's disease, tuberculosis, prisoners or war, and Buerger's disease (thromboangiitis obliterans).

The prisoner of war study (see Box 2), designated R-4, which was to focus a great deal of attention on the agency, involved examining an environmental situation rather than a disease entity, for which the record approach was better suited than the clinical approach. The study itself focused on the mortality expe-

BOX 2 Mortality Studies of Former Prisoners of War

Almost as old as the Medical Follow-up Agency (MFUA) is the series of follow-up studies, now seven in number, of former prisoners of war (POW) from World War II and the Korean War. Some of the studies have focused on mortality and others on morbidity (see Box 8). Work began with a study, published in 1955, which presented findings on mortality, morbidity, and disability after liberation, as well the recollections of prison experience. The study showed, for example, that former POWs of the Japanese suffered markedly higher mortality, due primarily to tuberculosis and accidents, following their repatriation than did a group of comparison veterans; this was not the case for prisoners of the Germans. In the second study of the series, the original sample was augmented through the addition of POWs from the Korean War and combat comparison individuals, as well as a group of malnourished World War II POWs. This brought the mortality sample to more than 19,000 men and the morbidity sample, which was smaller because morbidity follow-up was more expensive, to more than 5,000. By the time of the study, which was published in 1970, the excess mortality among World War II Pacific prisoners, relative to the U.S. general population, had practically disappeared, whereas the mortality rate of POWs of the Korean War remained significantly higher than that of the U.S. population for more than a decade. The results of the next mortality study, the fourth overall, were published in 1975. It was clear by this time that the early increased risk of dying among former POWs had waned, although excess deaths due to cirrhosis of the liver appeared as a late effect. As the MFUA entered its sixth decade, a seventh study of former POWs was begun. This mortality study will provide 50 years of follow-up data, capping the literally decades-long MFUA efforts.

Selected References

Cohen, B.M., Cooper, M.Z. A Follow-up Study of World War II Prisoners of War. VA Medical Monograph. Washington, D.C.: U.S. Government Printing Office, 1955.

Keehn, R.J. Follow-up studies of World War II and Korean Conflict prisoners. III.

Mortality to 1 January 1976. American Journal of Epidemiology 111:194–211, 1980.

Nefzger, M.D. Follow-up studies of World War II and Korean War prisoners. I. Study plan and mortality findings. American Journal of Epidemiology 91:123–138, 1970.



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