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OCR for page 183
APPENDIX E
Additional Analyses
The data compiled in connection with this study are numerous and varied;
they hold more information than the design of this study could absorb. In this
appendix, we first provide some greater detail of cohort characteristics (Tables
E-1 to E-44. We then present the results of descriptive analyses and discuss their
possible use in explaining relationships between participation and mortality.
DETAIL BY COHORT
We created four categories of paygrade to ensure groups of sufficient size
for valid analysis. In Table E-1, we present the individual paygrade-level distri-
bution by cohort.
In the absence of military occupation information, the analysis attempted to
explore whether the type of unit to which the participant and referent cohort
individuals were assigned could be developed as an exposure proxy. Although
this was not possible, the balance of unit types across the cohorts, shown in Ta-
ble E-2, helps to ensure some control for hazardous exposures (other than radia-
tion) that military personnel routinely face in their assignments.
DETAIL BY SERVICE AND BY SERIES
Later in this appendix, we present findings from exploratory analyses of se-
ries- and service-specific hazard rations. Tables E-3 and E-4 display the distribu-
tion of cohort member age and paygrade by selection series and branch of service.
183
OCR for page 184
184
THE FIVE SERIES STUDY
TABLE E-1. Cohort Member Characteristics: Paygrade
ParticipantsReferentsTotal
(n = 68,168)(n = 64,781)(n = 132,949)
-
Paygrade No. % No. % No. %
E1 199 0.3 223 0.3 422 0.3
E2 6,471 9.5 6,034 9.3 12,505 9.4
E3 18,397 27.0 18,504 28.6 36,901 27.8
E4 11,976 17.6 12,015 18.6 23,991 18.0
E5 8,165 12.0 7,785 12.0 15,950 12.0
E6 4,833 7.1 4,647 7.2 9,480 7.1
E7 3,381 5.0 3,298 5.1 6,679 5.0
E8 6 0.0 1 0.0 7 0.0
E9 3 0.0 0 3 0.0
W1 240 0.4 206 0.3 446 0.3
W2 268 0.4 172 0.3 440 0.3
W3 41 0.1 40 0.1 81 0.1
W4 22 0.0 1 1 0.0 33 0.0
01 1,417 2.1 1,551 2.4 2,968 2.2
02 2,490 3.7 2,469 3.8 4,959 3.7
03 3,378 5.0 3,612 5.6 6,990 5.3
04 2,612 3.8 2,161 3.3 4,773 3.6
O5 2,187 3.2 1,290 2.0 3,477 2.6
06 1,276 1.9 688 1.1 1,964 1.5
07 162 0.2 37 0.1 199 0.1
08 148 0.2 20 0.0 168 0.1
O9 13 0.0 3 0.0 16 0.0
010 10 0.0 2 0.0 12 0.0
Missing 473 0.7 12 0.0 485 0.4
SERIES-SPECIFIC ASSOCIATIONS
We display the data for all three endpoints separately by test series, by
service branch, and by paygrade. For leukemia only, for which our study results
were most interesting, we did a formal analysis of the heterogeneity of risks
among test series. We fit a baseline model including a variable that represented
the number of the five series in which an individual participated: 0 (for refer
OCR for page 185
APPENDIXE
185
ents), and 1 to 5 for participants. We then fit a model with five dummy vari-
ables, one variable for participation (yes or no) in each of the series. The differ-
ence in fit (assessed by log likelihoods) between these two nested models repre-
sents a formal test of the heterogeneity in leukemia risk between series. After
adjusting for the number of non-five series tests, the difference in fit between
these two models was 7.19, distributed as a x2 with 4 degrees of freedom. The
associated probability is .13, indicating a lack of significant difference in leuke-
mia risk among the five test series.
Notwithstanding this lack of a statistically significant difference in leu-
kemia risk among the five series, we decided to undertake further investiga-
tions to identify subgroups with high leukemia risk. Part of the reason for this
decision was to investigate further the significant excess risk among land se-
ries participants (see below). However, we must acknowledge that the identifi-
cation of high-risk subgroups is a pursuit fraught with difficulty; because there
is no clear statistical evidence of differences, one may well be studying only
statistical noise (i.e., expected random variation). However, it should also be
noted that formal statistical tests of heterogeneity tend to have little statistical
power.
Table E-5 shows standardized mortality ratios (SMRs) and hazard ratios for
the three primary mortality endpoints (all cause, all malignancies, and leuke-
mia ~ by test series. SMR ratios are significantly less than 1.0 for all-cause
mortality in series UPSHOT-KNOTHOLE and PLUMBBOB. The correspond-
ing relative hazard for UPSHOT-KNOTHOLE is significantly less than 1.0,
whereas the one for PLUMBBOB is not. In test series REDWING, all-cause and
all-malignancy hazard ratios are significantly greater than 1.0.
Although none of the SMR ratios or relative hazards for leukemia is sig-
nificantly different from 1.0, the values are highest for series UPSHOT-
KNOTHOLE, CASTLE, and PLUMBBOB. The SMR ratio for leukemia for
the GREENHOUSE series is low, partly because the SMR for participants is
low, but mostly because the SMR for referents is high, relative to all of the
other series.
Table E-6 shows similar data by service branch. Other than all-cause mor-
tality among Air Force and Army servicemen (which is significantly lower
among participants), no other SMR ratios are significantly different from 1.0.
Marines show the highest SMR ratios for all three mortality endpoints, com-
pared to other service branches, and it appears that these ratios are elevated be-
cause participant SMRs are high, rather than referent SMRs being low.
ICD-9 codes 204 through 208 apply to types of leukemia. In these analyses, based
on current understanding of leukemia radiogencity, we exclude chronic lymphoid leuke-
mia (ICD-9 code 204.1) from the grouping identified as leukemia.
OCR for page 186
186
THE FIVE SERIES STUDY
TABLE E-2. Cohort Member Characteristics: Type of Military Unit
Participants
(n = 68,168)
Unit Category No. %
ADMIN
AIRDEF
AIRDEVCEN
AIRDIV
ANTITANK
ARMOR
ARTILLERY
AVIATION
BASE
BATTALION
BOMB
CAMP/STA
CARGO
CARRIER
CENTER
COMBAT
COMMAND
COMPANY
COMSTAF
CONTROL
DESTROYR
DETACHMT
ENGINEER
ESCORT
FIGHTER
FORT
HELO
HQTRS
INFANTRY
LAB
4,948 7.3 4,202
78
49
47
0.1
0.1
0.1
180
256
45
0 3
Referents
(n = 64,781)
No. %
6.5
0.3
0.4
0.1
0.0
1.2
5.4
4.8
3.6
0.2
1.2
0.0
1.2
4.6
0.2
3.8
2.1
0.4
3.0
1.3
3.7
943
3,646
2,5g2
4,817
125
559
15
853
1,814
141
2,568
1,199
287
2,317
323
2,432
8
1,340
664
370
26
486
890
1.4
5.4
3.8
47.1
0.2
0.8
0.0
1.3
2.7
0.2
3.8
1.8
0.4
3.4
0.5
3.6
0.0
2.0 1,374
1.0
0.5
0.0
0.7
1.3
7.8
94 0.1
766
3,513
3,082
2,307
111
767
795
2,948
112
2,439
1,362
259
1,929
825
2,397
7
537
307
o
245
837
5,582
76
Total
(n= 132,949)
No. %
9,150
258
305
92
3
1,709
7,159
5,674
7,124
236
1,326
17
1,648
4,762
253
5,007
2,561
546
4,246
1,148
4,829
0.0 15
2.1 2,714
0.8 1,201
677
26
731
1,727
10,904
170
6.9
0.2
0.2
0.1
0.0
1.3
5.4
4.3
5.4
0.2
1.0
0.0
1.2
3.6
0.2
3.8
1.9
0.4
3.2
0.9
3.6
0.0
2.0
0.9
0.5
0.0
0.6
1.3
8.2
0.1
OCR for page 187
APPENDIX E
TABLE E-2. Continued
187
Participants
(in = 68,168)
Unit Category No. %
LCRAFT
MAINT
MAPCHART
MATERIEL
MEDICAL
MISC
OPERATION
ORDNANCE
REPAIR
SALVAGE
SERVICE
SIGNAL
SQUADRON
STORESHIP
SUBMARINE
TACTICAL
TANKERS
TECHNICAL
TENDERS
TEST
TRAINING
TRANSPORT
TUGS
UNKNOWN
WEATHER
WING
Referents
(n = 64,781)
No. %
Total
(in= 132,949)
No. %
1,237
51
o
319
939
181
241
75
55
445
4,634
2,968
808
236
226
3,229
3,155
4,358
636
246
2,866
879
765
663
o
0.5
1.4
0.3
0.4
0.1
0.1
0.7
6.8
4.4
0.0
1.2
0.4
0.3
4.7
4.6
6.4
0.9
0.4
4.2
1.3
1.1
1.0
1.8 1,209
199
21
315
1,240
8
85
66
142
258
3,882
2,794
167
843
91
449
2,956
2,155
4,421
198
389
3,435
555
893
654
91
1.9
0.3
0.0
0.5
1.9
0.0
0.1
0.1
0.2
0.4
6.0
4.3
0.3
1.3
0.1
0.7
4.6
3.3
6.8
0.3
0.6
0.9
1.4
1.0
0.1
2,446
250
21
634
2,179
189
326
141
197
703
8,516
5,762
170
1,651
327
675
6,185
5,310
8,779
834
635
6,301
1,434
1,658
1,317
91
1.8
0.2
0.0
0.5
1.6
0.1
0.3
0.1
0.2
0.5
6.4
4.3
0.1
1.2
0.3
0.5
4.7
4.0
6.6
0.6
0.5
4.7
1.1
1.3
1.0
0.1
OCR for page 188
188
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OCR for page 194
194
THE FIVE SERIES STUDY
Table E-7 shows data by paygrade. Except for a significantly low SMR ratio
for all-cause mortality among officers, none of the SMR ratios differs from 1.0.
We also see that officers, whether participants or referents, have lower SMRs than
enlisted men, a finding to be expected, given the known effects of rank on mortal-
ity (Seltzer and Jablon, 1977~. Subjects with unknown paygrade appear anomalous
in that the SMRs of participants resemble those of officers, whereas the SMRs of
referents resemble those of enlisted men. Regardless, the number of subjects with
unknown paygrade is small (469 participants and 12 referents).
Investigating Leukemia Risk Among Single Series Participants
We thus began our investigation of subgroup risks by looking further at
differences among the test series. Our first analysis of differences among series
(Table E-5) was hampered by the fact that although the first of the five series at
which a participant was present defines his "official" test series, in actuality
participants could have been present at more than one of the five or indeed at
other tests that were not part of the five series.
Table E-8 shows participation status by assigned series. Participants are
divided into two mutually exclusive participation categories: participation at
assigned series or post-series only and all other (i.e., multiple series) participa-
tion. The two land series, UPSHOT-KNOTHOLE and PLUMBBOB, are char-
acterized by their relatively high percentage of participants who were only at
their assigned series or post-series (i.e., relatively little multiple series participa-
tion). On the other hand, GREENHOUSE and REDWING have the highest
multiple participation rates, with roughly one-quarter of their participants having
been present at other than their assigned series or post-series.
In an attempt to get sharper estimates of leukemia and cancer mortality risk
across series, we took the additional step of confining the analysis to individuals
who participated only in their assigned series and at no other series. Limiting the
analysis to participants who were at only one of the five series has the advantage
of permitting an unconfounded comparison of mortality risks across test series,
although the number of participants is reduced by roughly 15 percent, from
68,208 to 57,532. Table E-9 shows that among single series participants, the risk
of leukemia mortality is elevated 25 percent or more among participants of all
but two test series, GREENHOUSE and REDWING. Compared to all partici-
pants, single series participants in UPSHOT-KNOTHOLE and CASTLE had
lower leukemia risks, while there was little difference for PLUMBBOB (which
had the highest proportion of single series participants).
OCR for page 195
195
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196
THE FIVE SERIES STUDY
TABLE E-8. Number of Participants and Percentage by Assigned Series and
Type of Participation
Type of Participation
At Series or Post-
Series Only
Remainder Total
Assigned Series No. % No. % No. %
GREENHOUSE 7,134 74.92,394 25.1 9,528 100
UPSHOT-KNOTHOLE 16,632 90.01,841 10.0 18,473 100
CASTLE 12,989 82.82,696 17.2 15,685 100
REDWING 10,093 78.12,830 21.9 12,923 100
PLUMBBOB 10,684 92.4875 7.6 11,559 100
Total 57,532 84.410,636 15.6 68,168 100
That is, participation in more than one series.
OCR for page 197
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Representative terms from entire chapter:
five series
