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Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan (2011)

Chapter: Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes

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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Appendix C

Epidemiologic Studies Cited in Chapter 6: Health Outcomes

Table C-1 includes descriptions of epidemiologic studies cited in Chapter 6. Key and supporting studies are presented alphabetically with studies of Gulf War veterans listed in a separate section at the end of the table. Text in italics reflects the section and designation (k = key, s = supporting) of each study as it is cited in the chapter.

Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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TABLE C-1 Epidemiologic Studies Cited in Chapter 6: Health Outcomes

Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
Aronson et al. 1994 Retrospective cohort study. [Respiratory-s; Circulatory-k; Cancer-k; All Cause-k] 5,414 firefighters who had worked at any time between 1950 and 1989 at six fire departments in Metropolitan Toronto. Includes 777 deaths. Employed as a firefighter (yes/ no); years since first exposure (first employment); years of exposure (years of employment). Cause of death. Compared with general male population of Ontario. Total Cohort: Brain cancer and other NS tumors (ICD9 191-192): SMR 201, 95% CI 110-337; Other Malignant Neoplasms (ICD9 195-199): SMR 238, 95% CI 145-367; Diabetes mellitus (ICD9 250): SMR 35, 95% CI 9-88; Chronic rheumatic heart disease (ICD 393-398, 424.0-424.3): SMR 15, 95% CI 0.4-85; Aortic aneurysm (ICD9 441): SMR 226, 95% CI 136-354; Symptoms/Ill-defined (ICD9 780-799): SMR 17, 95% CI 0.4-95); External Causes (ICD9 E800-999): SMR 71, 95% CI 55-90) Modified life-table approach; subjects censored at age 85 years; cata stratified by years since first employment, age, and duration of employment. Multiple testing-findings labeled as statistically significant by chance alone; healthy worker effect and survivor effect.
Age 60-84: Aortic aneurysm: SMR 245, 95% CI 140-398; Chronic bronchitis, asthma, and emphysema: 155, 95% CI 101-227; Digestive system diseases: SMR 156, 95% CI 100-232; Gallbladder diseases: 420, 95% CI 136-980; all other causes NS.
Aronson et al. 1996 Registry-based case-control study [Reproductive-s] 9,340 Fathers of all children with congenital heart defects matched to 9,340 Toronto fathers of children without an anomaly, from the Toronto birth registry 1979-1986. Father’s occupation as a firefighter in Toronto. Cardiac congenital anomalies. 11 case and 9 controls had fathers who were firefighters (OR 1.22, 95% CI 0.46-3.33). Matched on birth year, maternal age at birth, birth order, parents’ birth places (in or out of Ontario), and mother’s marital status at birth.
Bandaranayke et al. 1993 Case-control study [Neurological-s] 245 firefighters exposed to a chemical fire in 1984, and 217 unexposed firefighters matched for age and years of service in New Zealand. Presence at a chemical fire in 1984. Nervous system dysfunction. More exposed firefighters exhibited CNS dysfunction than unexposed firefighters (in 4 categories of symptoms, all p<0.025). Firefighters score poorly on more neuropsychological tests (RR 1.32, 95% CI 1.11-1.57), particularly psychomotor tests (RR 1.51, 95% CI 1.33-1.71, compared to unexposed firefighters. Matched for age and years of service. Tests conducted 4 years after the fire event; 3 cases of testicular cancer described.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
×
No differences in hospital admissions, health problems, prevalence of allergies, history of miscarriages due to abnormality or stillbirth, or birth defects, psychological histories, tobacco or alcohol use, abnormal ECGs, blood cell counts were detected between the exposed and unexposed firefighters.
Baris et al. 2001 Retrospective cohort study [Respiratory-s; Neurological-k; Circulatory-k; Cancer-k; All Cause] 7,789 Firefighters in Philadelphia employed between 1 Jan. 1925, and 31 Dec. 1986. Females excluded. 2,220 deaths. Duration of employment, company runs, and station house design were used as a surrogate for individual exposure. Categories of runs were categorized as low, medium, high. Cause of death compared with the general US white male population; RR between high and low exposure groups. Total Cohort: All causes: SMR 0.96, 95% CI 0.92-0.99; All cancers: SMR 1.10, 95% CI 1.00-1.20; Colon cancer: SMR 1.51, 95% CI 1.18-1.93; Ischemic heart disease: SMR 1.09, 95% CI 1.02-1.16; Cerebrovascular Disease: SMR 0.83, 95% CI 0.69-0.99; Respiratory diseases: SMR 0.67, 95% CI 0.55-0.82; Genitourinary diseases: SMR 0.54, 95% CI 0.36-0.81; External causes of death: SMR 0.69, 95% CI 0.59-0.80; All accidents: SMR 0.72, 95% CI 0.59-0.86; Suicide: SMR 0.66, 95% CI 0.48-0.92; All other causes NS. Age and calendar-year adjusted with a 10-year lag period; stratified by position, duration of employment, age at risk, hire period, company type (ladder, engine or both). Duration of employment, company runs and station house design as a surrogate for individual exposure may be some exposure misclassification. Healthy worker effect and survivor effect.
≤ 9 Years Employment: All cancers: SMR 1.26, 95% CI 1.07-1.49; Colon cancer: SMR 1.78, 95% CI 1.12-2.82; Lung cancer: SMR 1.52, 95% CI 1.16-2.01; Pancreatic cancer: SMR 2.33, 95% CI 1.36-4.02; Prostate cancer: SMR 2.36, 95% CI 1.42-3.91; Genitourinary disease: SMR 0.27, 95% CI 0.10-0.71; External causes of death: SMR 0.61, 95% CI 0.49-0.77; All accidents: SMR 0.56, 95% CI 0.43-0.75; All other causes NS.
10-19 Years Employment: Circulatory diseases: SMR 1.20, 95% CI 1.10-1.31; Ischemic heart disease: SMR 1.35, 95% CI 1.21-1.49; Respiratory diseases: SMR 0.68, 95%CI 0.49-0.96; Suicide: SMR 0.37, 95% CI 0.18-0.78; All other causes NS.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
×
Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
≥ 20 Years Employment: All causes: SMR 0.91, 95% CI 0.85-0.98; Colon cancer: SMR 1.68, 95% CI 1.17-2.40; Kidney cancer: SMR 2.20, 95% CI 1.18-2.49; Multiple myeloma: SMR 2.31, 95% CI 1.04-5.16; Benign neoplasms: SMR 2.54 1.06-6.11; Circulatory diseases: SMR 0.90, 95% CI 0.82-0.99; Respiratory diseases: SMR 0.59, 95% CI 0.42-0.82; Emphysema: SMR 0.39, 95% CI 0.16-0.93; All other causes NS.
Comparing High to Low (> or ≤ 3,191 cumulative runs) Exposure: All causes: RR 0.81, 95% CI 0.72-0.92; Buccal cavity and pharynx cancer: RR 0.19, 95% CI 0.04-0.96; Circulatory diseases: RR 0.78, 95% CI 0.65-0.93; Ischemic heart diseases: RR 0.77, 95% CI 0.63-0.95; External causes of death: RR 0.61, 95%CI 0.39-0.95; All other causes NS.
Bates 1987 Cohort study [Circulatory-s] 596 men who worked for 6 yrs or more in the Toronto Fire Department; hired from 1949-1959. Cardiovascular mortality ages 45 to 54 though 1984, compared to mortality rates of Toronto. 52 deaths from all causes, 21 from coronary artery diseases. Ages 45-49: SMR 1.80, 95% CI 1.01-3.19 Ages 50-54: SMR 1.75, 95% CI 0.90-3.39 Ages 45-54: SMR 1.73, 95% CI 1.12-2.66. Standardized by age, sex, and calendar year.
Bates 2007 Registry-based case-control study [Cancer-k] 3,659 firefighters with cancer and 800,448 non-firefighter controls with cancer, in from the California Cancer Registry, 1988-2003. Ever employed as firefighter. Cancer diagnosis among firefighters compared to cancer diagnoses among other occupations. Esophageal: OR 1.48, 95% CI 1.14-1.91; Melanoma skin: OR 1.50, 95% CI 1.33-1.70; Prostate: OR 1.22, 95% CI 1.12-1.33; Testicular: OR 1.54, 95% CI 1.18-2.02; Brain: OR 1.35, 95% CI 1.06-1.72; All other sites NS. Age, calendar period of diagnosis, race, socio-economic status (by census block of residence).
Bates et al. 2001 Retrospective cohort study 4,305 firefighters employed in New Zealand between 1977-1995. Ever employed as a firefighter; duration of employment as a firefighter. Cancer incidence and mortality, calculated as SIR and SMR relative to New Zealand male population, follow-up 1977 through 1995 for mortality, 1996 for cancer. Cancer incidence 1977-1996: All sites NS. Age, sex and calendar period standardized. This study follows up on a testicular cancer cluster described by Bandaranayake et al. 1993.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
×
[Cancer-s] Cancer incidence 1990-1996: Testicular cancer incidence: SIR 2.97, 95% CI 1.3-5.9; all other sites NS. Mortality 1977-1995: All causes: SMR 0.58, 95% CI 0.5-0.7; Circulatory diseases: SMR 0.54, 95% CI 0.4-0.7; Ischemic heart disease: SMR 0.58, 95% CI 0.4-0.8; External causes: SMR 0.69, 95% CI 0.3-0.8; All other causes NS. Possibly confounded by high level of awareness of testicular cancer in this population. Healthy worker effect.
Beaumont et al. 1991 Retrospective cohort study. [Respiratory-s; Neurological-s; Circulatory-k; Cancer-k; All Cause] 3,066 white male firefighters from San Francisco employed 1940-1970. 1,186 deaths. Firefighter employment (yes/ no). Length of employment. Cause of death. Compared with the general US male population. All causes: RR 0.90, 95% CI 0.85-0.95; Tuberculosis: RR 0.26, 95% CI 0.07-0.68; Diabetes melliutus: RR 0.36, 95% CI 0.14-0.75; Diseases of the heart: RR 0.89, 95% CI 0.81-0.97; Respiratory diseases: RR 0.63, 95% CI 0.47-0.83; Acute respiratory infections: RR 0.63, 95% CI 0.40-0.95; Emphysema: RR 0.52; 0.24-0.99; Digestive system diseases: RR 1.57, 95% CI 1.27-1.92; Cirrhosis and other liver diseases: RR 2.27, 95% CI 1.73-2.93; Accidental falls: RR 1.9, 95% CI 1.18-2.91; Cancer of digestive organs and peritoneum: RR 1.27, 95% CI 1.04-1.55; Esophageal cancer: RR 2.04, 95% CI 1.05-3.57; Prostate cancer: RR 0.38, 95% CI 0.16-0.75. All other causes NS. Rate ratios standardized for age, year, sex, and race. Reliability of death certificates. Potential healthy worker effect.
3-19 Years Since First Employment: All neoplasm sites NS. 20-29 Years Since First Employment: All cancer sites: RR 0.67, statistically significant (95% CI not reported); All other neoplasm sites NS 30-39 Years Since First Employment: Billiary passages, liver and gall bladder cancer: RR 3.87, statistically significant (95% CI not reported); All other neoplasm sites NS 40+ Years Since First Employment: Stomach cancer: RR 2.32, statistically significant (95% CI not reported); All other neoplasm sites NS.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
×
Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
3-9, 10-19, and 20-29 Years of Employment: All neoplasm sites NS.
30+ Years of Employment: Billiary passages, liver and gall bladder cancer: RR 3.87, statistically significant (95% CI not reported); All other neoplasm sites NS.
Betchley et al. 1997 Cohort study [Respiratory-s] Full-time and seasonal wildland fire management workers in Region 6 of USDA Forest Service and Bureau of Land Management in Salem during the 1992 season. 76 subjects were studied for cross-shift and 53 for cross-season analysis. Shift or season of firefighting. Spirometric measurements of lung function and self administered questionnaire data were collected before and after the 1992 firefighting season. Cross-season data were collected on average 77.7 days after the last occupational smoke exposure. Cross-season analysis: Mean individual declines for FVC (p=0.28), FEV1 (p=0.03) and FEF25–75 (p=0.02) of 0.033 L, 0.104 L, and 0.275 L/sec, respectively; no significant difference in respiratory symptoms. Cross-shift analysis: The pre-shift to mid-shift decreases were 0.089 L, 0.190 L, and 0.439 L/sec, respectively; pre-shift to post-shift declines of 0.065 L, 0.150 L, and 0.496 L/sec (all p<0.01); no significant difference in respiratory symptoms.
Biggeri et al. 1996 Case-control study [Cancer-s] 755 male lung cancer deaths and 755 controls from a local autopsy registry in Trieste, Italy. Exposure model based on residential distance and direction from sources of pollution-shipyard, iron foundry, incinerator, or city center. Excess relative risk of 6.7 at zero distance (p<0.001), with risk dropping rapidly with distance (slope = –0.176). Adjusted for age, smoking, likelihood of occupational carcinogen exposures, levels of PM. Lung cancer also significantly related to distance from the city center.
Bresnitz et al. 1992 Cross-sectional study [Respiratory-s] 86 male incinerator workers at a facility in Philadelphia employed in June 1988. High or low exposure was determined by an industrial hygienist based on job description, duration, and data from personal breathing zone and Spirometry, blood and urine samples, physical exams, questionnaires used to collect health, medical, and employment information. Elevated exposure was not significantly related to biomarkers of exposure, hypertension, proteinuria, or changes in pulmonary function. Stratified by smoking and alcohol. No correction for multiple comparisons. High and low exposure groups differed by duration of employment and alcohol intake; no unexposed comparison group.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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general air sample for dioxins and furans.
Burnett et al. 1994 Retrospective cohort study [Circulatory-s; Cancer-s] 5,744 white male firefighter deaths identified from National Occupational Mortality Surveillance system (includes 27 states) from 1984-1990. Ever employed as firefighter. Cause of death Total Cohort All cancers: PMR 110, 95% CI 106-114; Rectal cancer: PMR 148, 95% CI 105-205); Skin cancer: PMR 163, 95% CI 115-223; Kidney cancer: PMR 144, 95% CI 108-189; Lymphatic and hematopoietic cancers: PMR 130, 95% CI 111-151; Non-Hodgkin’s lymphoma: PMR 132, 95% CI 102-167; Multiple myeloma: PMR 148, 95% CI 102-207; Accidental falls: PMR 149, 95% CI 109-199; and Fire-related accidents: PMR 242, 95% CI 157-357. Age, race, sex adjusted.
For deaths under age 65 All cancers: PMR 112, 95% CI 104-121; Rectal cancer: PMR 186, 95% CI 104-121); Skin cancer: PMR 167, 95% CI 107-248; Lymphatic and hematopoietic cancers: PMR 161, 95% CI 129-199; Non-Hodgkin’s lymphoma: PMR 161, 95% CI 112-224; Leukemia: PMR 171, 95% CI 118-240; Accidental falls: PMR 206, 95% CI 129-312; and Fire-related accidents: PMR 335, 95% CI 157-357.
Calvert et al. 1999 Cohort study [Circulatory-s] Deaths among 488,539 white males and 104,988 black males in the National Occupational Mortality Surveillance System (covers 27 states), 1982-1992. Employment as a firefighter. Ischemic heart disease deaths in males 16-60 for firefighting occupations. 434 white (PMR 104, 95% CI 94-114) and 26 black (PMR 169, 95% CI 110-247) deaths among firefighters due to ischemic heart disease. Age standardized. Differential reporting of ischemic heart disease may be affected by presumption of disease for certain occupational exposures (such as for firefighting); elevated PMRs reported for many other occupations.
Carozza et al. 2000 Population-based case-control study 476 cases of glioma in San Francisco adults diagnosed 1991-1994 and 462 controls. Employment as a fireman. Glioma incidence 3 cases and 1 control among those ever employed as a firemen (OR 2.7, 95% CI 0.3-26.1). No significant associations when stratified by latency, duration of employment, or tumor type. Controlled for age, gender, education, and race. Few cases and controls among firemen.
[Cancer-s]
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
Charbotel et al. 2005 Longitudinal study [Respiratory-s] 83 incinerator workers and 76 age-matched nonexposed workers followed over 3 years. Workers categorized by exposure/task. 2 incinerators in urban areas of France. Air sampling performed, presented in an earlier publication (Maitre et al. 2003). Spirometry measurements from 1st and 3rd years. Medical history and symptoms assessed by questionnaire. Baseline lung function lower in exposed workers than controls (not significant). In the third year, controls had significantly better percent predicted values for FEF50/PV (p=0.04), FEF25–75/PV (p=0.02), and FEF25–75/FVC (p=0.01), but not for other measures of lung function. No decrease in lung function (first to third year) was seen related to exposure. Adjustment for smoking, history of allergy or lung disease, and examination center. Follow-up of Hours et al. 2003.
After adjustment for smoking, medical history, and examination center, FEF25–75 in the 3rd year was lower in incinerator workers than in unexposed workers (mean±SD % predicted, 94.1±27.9 vs 105.5±25.3).
Comba et al. 2003 Case-control [Cancer-s] 37 cases of soft tissue sarcoma in diagnosed 1989-1998 and residing in Mantua, Italy, and 3 neighboring communities compared to 171 randomly selected unexposed controls from the population matched for age and sex. Residential distance from an industrial waste incinerator. No relationship between exposure and lung function change during follow-up. Soft tissue sarcoma incidence Less than 2 km: OR 31.4 (95% CI 5.6-176.1), based on 5 cases. Greater than 2 km: No significant increase from null. No significant decrease in risk observed with increasing distance from source when measuring continuously. Matched for age and sex. Few exposed cases.
Cordier et al. 2004 Ecological study [Reproductive-s] Malformed children born to residents of 194 exposed communities surrounding incinerators compared to 2678 unexposed communities. Exposure to incinerator emissions was estimated from a plume model. Interested in dioxin- and metal-contaminated PM. Obstructive uropathies; cardiac, urinary, and skin anomalies identified through population-based birth defects registry and active search of medical records. Facial cleft (RR 1.30, 95% CI 1.06-1.59) and renal dysplasia (RR 1.55, 95% CI 1.10-2.20) more frequent in exposed populations, and other renal anomalies was lower (RR 0.44, 95% CI 0.20-0.97). A dose–response trend Adjusted for year of birth, maternal age, department of birth, population density, average family income and, when available, road traffic. Few measurements of total dusts, dioxins, and metals available; rates of cardiac anomalies, obsrtuctive uropathies, and skin anomalies likely explained by road traffic density.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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was observed with increasing exposure for obstructive uropathies (p=0.07). Dose-response trends with increasing road traffic density were found for cardiac anomalies (p=0.02), skin anomalies (p=0.02), and obstructive uropathies (p=0.07).
Cresswell et al. 2003 Ecological study [Reproductive-s] 1,508 cases from total 81,255 live births, stillbirths, induced abortions and fetal death after 14 weeks gestation to mothers residing within 7 km of a waste incinerator, 1985-1999 from the Northern Regional Congenital Abnormality Survey. Based on distance from incinerator which went into operation in 1988, location within inner (3 km radius) or outer (3-7 km radius) areas and pre- vs. post-incinerator operation. Chromosomal and non-chromosomal congenital anomalies comparing the inner and outer zones. No significant overall association between number of anomalies and residential proximity to incinerator was found. Risks were not elevated pre- or post-1988, but when stratified by year, the risk was significantly elevated in 1995 (OR 1.73, 95% CI 1.10-2.72), 1998 (OR 1.56, 95% CI 1.01-2.41), and 1999 (OR 2.05, 95% CI 1.20-3.52). Adjusted for socioeconomic deprivation and year. Rate increases in later years hard to interpret without information on cumulative exposure or increases in exposure.
Demers et al. 1992a Retrospective cohort study. [Respiratory-s; Circulatory-k; All Cause] 4,546 male firefighters in Seattle and Tacoma, WA, and Portland, OR, for at least a year, 1944-1979. 1,162 deaths Employment as a firefighter (yes/ no). Duration in fire combat positions. SMR compared with the US white male population. IDR for cause of death compared with police officers from the same cities. All causes: SMR 0.81, 95% CI 0.77-0.86; Kidney cancer: SMR 0.27, 95% CI 0.03-0.97; Bladder and other urinary cancers: SMR 0.23, 95% CI 0.03-0.83; Brain and nervous system cancers: SMR 2.07, 95% CI 1.23-3.28; Heart diseases: SMR 0.79, 95% CI 0.72-0.87; Ischemis heart disease: SMR 0.82, 95% CI 0.74-0.90; All other causes NS. Age and calendar-year standardized. Stratified by years of fire combat exposure, years since first employment, and age at risk. No adjustment for smoking or other potential confounders. Large study size. Disease misclassification dependent on accuracy of death certificates. Statistical instability when comparing firefighter mortality to police due to relatively few deaths among police.
All causes: IDR 0.87, 95% CI 0.79-0.95; Other circulatory diseases: IDR 0.72, 95% CI 0.54-0.96; Cerebrovascular disease: IDR 0.65, 95% CI 0.45-0.92; All other causes NS.
<10 Years of Employment: All causes NS. 10-19 Years of Employment: Brain and nervous system tumors: SMR 3.53, 95% CI 1.5-7.0; All other causes NS 20-29 Years of Employment: All causes NS.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
×
Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
≥ 30 Years of Employment: Lymphatic and hemopatoietic cancers: SMR 2.05, 95% CI 1.1-3.6; Leukemia: SMR 2.60, 95% CI 1.0-5.4; Diseases of arteries, veins, and pulmonary circulation: SMR 1.99, 95% CI 1.3-2.9; All other causes NS.
<20 and 20-29 Years Since First Employment: All causes NS. ≥30 Years Since First Employment: Prostate cancer: SMR 1.42, 95% CI 1.0-2.0; Brain and nervous system tumors: SMR 2.63, 95% CI 1.4-4.4; Lymphatic and hematopoietic cancers: SMR 1.48, 95% CI 1.0-2.2; Diseases of arteries, veins, and pulmonary circulation: SMR 1.33, 95% CI 1.0-1.8; All other causes NS.
Demers et al. 1992b Retrospective cohort study [Cancer-k] 4,528 male firefighters and police officers in Seattle and Tacoma, WA, employed for at least 1 year between 1944 and 1979. 338 registry and 174 death certificate identified cancer cases. Employment as a firefighter or police officer (yes/no). SMR cancer deaths compared with the white male population of Washington State and SIR incident cancer cases compared with all males with malignancies in the same counties (follow-up 1945-1989). Cancer Incidence Prostate cancer: SIR 1.37, 95% CI 1.11-1.69; All others NS. Cancer Mortality Stomach cancer: SMR 2.04, 95% CI 1.05-3.56; All others NS. Standardized by age and calendar year. No adjustment for smoking or other potential confounders. Large study size. Analysis lumps firefighters and police together, limiting generalizeability.
Demers et al. 1994 Retrospective cohort study [Cancer-k] 2,447 male firefighters in Seattle and Tacoma, WA, employed for at least 1 between 1944 and 1979. 224 cancer cases among firefighters. Employment as a firefighter (yes/no); Duration of active duty firefighting/ employment (years). SIR and IDR Cancer incidence (1974-1989). Compared with mortality rates for the Seattle and Tacoma areas and local police officers. Firefighters compared with local cancer incidence rates. Prostate cancer: SIR 1.4, 95% CI 1.1-1.7; All others NS. Firefighters compared with police IDR for all cancer sites NS. Adjusted for age and calendar-period; stratified by years since first employment and duration of employment; no adjustment for smoking or other potential confounders. Cohort previously reported by Heyer et al. 1990 and Demers et al. 1992. Small numbers of police cancer cases limits the precision of risk estimates.
Deschamps et al. 1995 Prospective cohort study 830 male firefighters having served at least 5 years (as of Jan. 1, 1977) for the Brigade des sapeurs- Time spent working on assignments involving active fire combat duty (as opposed to Cause of death (1977-1991); compared with the general French male population. All cause mortality: SMR = 0.52 (0.35-0.75); All causes others NS. Age and calendar adjusted SMRs; no adjustment for smoking or other potential confounders. Healthy worker effect; few deaths.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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[Respiratory-s; Circulatory-s; Cancer-s; All Cause] pompiers de Paris (BSPP). Includes 32 deaths and 11,414 person-years. office-work). This exposure was only determined for deceased persons and was evaluated from BSPP records.
Dibbs et al. 1982 Longitudinal study [Circulatory-k] 171 male firefighters and 1,475 non-firefighters participating in the Normative Aging Study at the VA outpatient clinic in Boston, MA having completed three complete medical examinations. Firefighter (yes/no). Coronary heart disease, myocardial infarction, angina pectoris after 10 years of follow-up. Compared with non-firefighters. Coronary heart disease: IRR 0.5, 95% CI 0.2-1.4. Myocardial infarction: IRR 0.5, 95% CI 0.1-1.9. Data on serum cholesterol, blood pressure, BMI, age, and cigarette smoking stratified by firefighter/ non-firefighter to detect differences in risk factors for coronary heart disease. Small sample of firefighters. Lack of exposure information.
Douglas et al. 1985 Longitudinal study [Respiratory-s] 1,006 London firefighters interviewed and in examined in 1976 and again in 1977. Years of service, whether fireman had been “punished” by smoke, and if had ever missed a week or more after such an exposure. Spirometry and prevalence of respiratory symptoms. Average levels of FEV1, FVC, and FEV1/FVC were similar to predicted values in both years; all three measures of lung function decreased with age and cigarettes; no association between lung function or respiratory symptoms with smoke exposure or duration of service was found. Controlled for age and smoking. Confidence intervals and p-values not reported.
Elci et al. 2003 Hospital-based case-control study [Cancer-k] 1,354 male lung cancer patients at a hospital in Turkey, diagnosed and 1,519 male controls diagnosed with other cancer diagnoses (including some non-cancer), 1979-1984. Employed as firefighter. Lung cancer: OR 6.8, 95% CI 1.3-37.4. Age and smoking status adjusted. Several other occupational also had increased risk of lung cancer (drivers, textile workers, water treatment plant workers, highway construction workers).
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
Eliopulos et al. 1984 Retrospective cohort study [Respiratory-s; Circulatory-k; All Cause] 990 western Australian firefighters employed between 1939 and 1978. Including 116 deaths. Employment as a full-time firefighter (yes/no). Duration of employment (years). SMR and SPMR Cause of death (followup through 1978); compared with the male population of Western Australia. All causes: SMR 0.80, 95% CI 0.67-0.96; Other accidents, poisonings, and violence: SMR 0.35, 95% CI 0.10-0.90; All other causes NS. All SPMRs listed NS. Adjusted for age and calendar year. Stratified by time since first employment and duration of employment; no adjustment for smoking or other potential confounders. Healthy worker effect.
Elliott et al. 1996 Retrospective cohort study [Cancer-k] Over 14 million residents living within 7.5 km of a municipal waste incinerator in England (1974-1986), Wales (1974-1984), and Scotland (1975-1987) compared to national cancer incidence rates. Cancer cases identified from a national registry. Proximity to incinerators (<3 km or 3-7.5 km) at 72 sites in the United Kingdom. Cancer incidence, relative to general regional population with a 10 year lag (5 year lag for lymphatic and hematopoietic cancers). Stage 1 (22-sites randomly sampled) at 0-3 km All cancers: SIR 1.08, 95% CI 1.07-1.10; Stomach: SIR 1.07, 95% CI 1.02- 1.13; Colorectal: SIR 1.11, 95% CI 1.07- 1.15; Liver: SIR 1.29, 95% CI 1.10- 1.51; Lung: SIR 1.14, 95% CI 1.11 -1.17; Bladder: SIR 1.19, 95% CI 1.13-1.26; Lymphatic and hematopoietic: SIR 1.05; 95% CI 1.01-1.09; non-Hodgkin’s lymphoma: SIR 1.11, 95% CI 1.04-1.19. Stage 1 (22-sites randomly sampled) at 0-7.5 km. Standardized by age, sex, socioeconomic status, region. Residual confounding may explain the excess of all, stomach, lung, and liver cancers near incinerators; the authors expect a substantial level of disease misclassification.
All cancers: SIR 1.05, 95% CI 1.04-1.05; Stomach: SIR 1.06, 95% CI 1.03-1.09; Colorectal: SIR 1.05, 95% CI 1.03-1.08; Liver: SIR 1.10, 95% CI 1.00- 1.20; Larynx: SIR 1.08, 95% CI 1.00-1.16; Lung: SIR 1.10, 95% CI 1.08-1.12; Bladder: SIR 1.10, 95% CI 1.07-1.14; non-Hodgkin’s lymphoma: SIR 1.04, 95% CI 1.01-1.08. Conditional p<0.005 for All cancers, stomach, colorectal, liver, lung and bladder cancers showing significant decline in risk.
Stage 2 (remaining 52 sites in the United Kingdom) at 0-3 km. All cancers: SIR 1.04, 95% CI 1.03-1.04; Stomach: SIR 1.05, 95% CI 1.03-1.08); Colorectal: SIR 1.04, 95% CI 1.02-1.06; Liver: SIR 1.13, 95% CI 1.05-1.22; Lung: SIR
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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1.08, 95% CI 1.07-1.09 Stage 2 (remaining 52 sites in the United Kingdom) at 0-7.5 km All cancers: SIR 1.02, 95% 1.02-1.02; Stomach: SIR 1.03, 95% 1.02-1.04; Colorectal: SIR 1.02, 95% 1.01-1.03; Liver: SIR 1.06, 95% 1.01-1.11; Lung: SIR 1.06, 95% 1.05-1.07; Bladder: SIR 1.02, 95% 1.00-1.03.
Across both stages, risk for any cancer and stomach, colorectal, liver, and lung cancers decreased significantly with increasing distance from source (both conditional and unconditional p<0.05).
Feuer and Rosenman 1986 Retrospective cohort study [Respiratory-s; Circulatory-s] 263 white firefighters in New Jerseyfrom 1974-1980 compared to three reference groups: U.S. general population, New Jersey general population, and white police officers. Employment as a firefighter and in the Police and Fireman Retirement System (10 years of employment or died/became disabled while on the payroll). PMR Cause of death Compared to U.S. white males: Skin cancer: PMR 2.7; Arteriosclerotic heart disease: PMR 1.22; Bone diseases: PMR 4.00; all significant (p<0.05); All other causes NS. Compared to NJ white males Bone diseases: PMR 3.94 (p<0.05); All other causes NS. Compared to Police Leukemia: PMR 2.76; Respiratory diseases: PMR 1.98; Digestive diseases: PMR 1.54; All significant (p<0.05); All other causes NS. Age standardized. Non-white and female cases omitted.
Reference: white policemen Leukemia: 4 (PMR 2.76) Respiratory diseases: 8 (PMR 1.98) Digestive diseases: 25 (PMR 1.54).
No significant correlation between duration of employment and any increased mortality.
Firth et al. 1996 Retrospective cohort study [Cancer-s] Cases of cancer among male firefighters, 1972-1984 in the New Zealand Cancer Registry, aged 15-64. Occupation listed as firefighter on cancer registration. SIR Cancer incidence. Compared to the 1981 New Zealand population; laryngeal cancer among firefighters: SIR 1074, 95% CI 279-2776. No other results reported for firefighters. Age and socioeconomic level standardized. This study only includes cancer cases diagnosed between ages 15 and 64; no information reported for other cancer sites among firefighters.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
Floret et al. 2003 Population-based case-control study [Cancer-s] 222 cases with non-Hodgkin’s lymphoma in Besancon, France, diagnosed 1980-1995 and 2,220 age- and sex-matched controls selected from the 1990 French national census. Ambient dioxin modeled concentrations at place of residence based on distance from a municipal waste incinerator, categorized into 4 exposure categories (very low, low, intermediate, and high). Non-Hodgkin’s lymphoma Compared to the very low exposure category, Low exposure: OR 1.0, 95% CI 0.7-1.5; Intermediate exposure: OR 0.9, 95% CI 0.6-1.4 High exposure: OR 2.31, 95% CI 1.4-3.8). Matched for age and sex. Adjusted for socioeconomic status (education, occupation, and household indicators) at the block level.
Glueck et al. 1996 Prospective cohort study [Circulatory-k] 806 Cincinnati firemen employed between 1984 and 1995. Participants examined every 1 to 4 years. 22 firefighters with CHD. Employment as a firefighter (yes/no). CHD (yes/no). Coronary heart disease; myocardial infarction; and risk factors (blood pressure, smoking, fasting glucose, cholesterol); firefighters with incident CHD compared to firefighters without CHD and to healthy employed men participating in the National Health and Nutrition Examination Survey with 8 years of follow-up. Adjusted for age, race, and quetelet index (a coronary risk value score). Few CHD events.
Firefighters with CHD had significantly (p<0.05) higher mean age (44 vs. 37; diastolic blood pressure (92 vs. 82 MMHg); systolic blood pressure (140 vs. 125 MMHg); cigarettes per day (12 vs. 3.3); low density lipoprotein cholesterol (148 vs. 127 mg/dl); triglycerides (203 vs. 124 mg/dl); total cholesterol (227 vs. 198 mg/dl); reporting of CHD family history (0.36 vs. 0.17); those without CHD had a longer mean length of follow-up (6.5 vs. 4.3 years). NS differences for mean quetelet score, fasting glucose, high density lipoprotein cholesterol, and length of follow-up. 26 firefighters without CHD and none of the men with CHD suffered severe smoke inhalations.
Grimes et al. 1991 Retrospective cohort study 205 deaths among firemen in Honolulu, Hawaii, 1969-1988, compared to the general male population of Hawaii. Ever employed as firefighter; duration of employment. RR cause of death Total cohort Genito-urinary cancers: RR 2.28, 95% CI 1.28-4.06; Prostate cancer: RR 2.61, 95% CI 1.38-4.97; Brain and CNS cancer: RR 3.78, 95% CI 1.22-11.71; Circulatory system diseases: RR 1.16, 95% CI 1.10-1.32; Cirrhosis of the liver: Stratified by race (Caucasian or Hawaiian). Proportional mortality study. Analysis by person-years not reported. The ethnic composition of the firefighters differs greatly from that of the
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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[Respiratory-s; Neurological-s; Circulatory-s] RR 2.30, 95% CI 1.21-4.37; All other causes NS. Among Caucasian firefighters: Genito-urinary cancers: RR 3.02, 95% CI 1.49-6.15; Prostate cancer: RR 3.70, 95% CI 1.71-8.02; Brain and CNS cancer: RR 4.15, 95% CI 1.04-16.51; All other causes NS. Among Hawaiian firefighters: Genito-urinary cancers: RR 3.52, 95% CI 1.32-9.36; Prostate cancer: RR 3.35, 95% CI 1.07-10.45; Cirrhosis of the liver: RR 2.99, 95% CI 1.12-7.96; All other causes NS. general population of Hawaii.
Guidotti et al. 1993 Retrospective cohort study [Respiratory-s; Neurological-s; Circulatory-k; Cancer-k; All Cause] 3,328 male firefighters employed between 1927 and 1987 by the Edmonton or Calgary fire department. 370 deaths. Years of employment weighted by an exposure opportunity index (relative time exposed to fire by job classification). SMR Cause of death (1927-1987). Compared with the male population of Alberta, Canada. All malignant neoplasms: SMR 127, 95% CI 102-155; Kidney and ureter cancer: SMR 414, 95% CI 166-853; Mental disorders: SMR 455, 95% CI 274-711; Cerebrovascular: SMR 38.6, 95% CI 17.7-73.3; Digestive system disorders: SMR 46.9, 95% CI 21.4-89.0; External causes: SMR 65.6, 95%CI 48.5-86.7; Suicide: SMR 38.5, 95% CI 15.5-79.2; Other and unknown causes: SMR 31.2, 95% CI 8.5-80.0; All other causes NS. Age and calendar adjusted; data stratified by exposure opportunity, duration of employment, and cohort of entry (before or after 1950s); latency analysis; no adjustment for smoking or other potential confounders. Exposure opportunity index not validated empirically or by exposure monitoring; insufficient statistical power to detect lower relative risks and rarer outcomes, or across multiple strata; relies on the accuracy of death certificates; healthy worker effect.
<40 Years of Employment: Lung cancer, cardiovascular disease, obstructive pulmonary disease, and kidney and ureter cancer all NS ≥40 Years of Employment: Kidney and ureter cancer: SMR 3612 (p<0.01), all others NS. Exposure Opportunity Index=0: Obstructive pulmonary disease: SMR 742 (p<0.05); all others NS. Exposure Opportunity Index 0-35: All NS Exposure Opportunity Index ≥35: Lung cancer: SMR 408 (p<0.05); kidney and ureter cancer: SMR 3542 (p<0.01); all others NS.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
Gustavsson 1989 Retrospective cohort study [Neurological-s; Circulatory-k; All Cause] 176 Incinerator workers employed for at least 1 year between 1920 and 1985 at a plant near Stockholm, Sweden. Employment at an incinerator 15 km west of Stockholm, Sweden. Cause of death (1951-1985); compared with national and local mortality rates. Compared to local mortality rates: All causes NS. Compared to national mortality rates: Lung cancer: SMR 355, 95% CI 162-675; Liver cirrhosis: SMR 454, 95% CI 124-1164; All other causes NS. <40 Years Since First Employment: All causes, All cancers, Lung cancer, Ischemic heart disease NS. ≥40 Years Since First Employment: Ischemic heart disease: SMR 189 (p<0.01); All others NS. <30 Years of Employment: All causes, All cancers, Lung cancer, Ischemic heart disease NS. ≥30 Years of Employment: Ischemic heart disease: SMR 167 (p<0.05); All others NS Age and calendar-year adjusted; stratified by length of employment; smoking habits were similar to average Swedish men. No data on potential confounders and risk factors for disease; possible healthy worker effect.
Gustavsson et al. 1993 Cohort study [Cancer-s] 176 incinerator workers studied from 1951-1985 compared to the male population of Stockholm. Employed at a waste incinerator. Mortality from esophageal cancer. SMR 150, 95% CI 4-834. Follow-up of Gustavsson 1989.
Hansen 1990 Retrospective cohort study [Circulatory-k; All Cause] 886 firefighters out of 48,580 male civil servants and salaried employees, aged between 15 and 69, and employed on the day of the 1970 Denmark census. Public employees with title of “firefighter” or “fireman” (yes/no). Cause of death (1970-1980); compared with other civil servants and salaried employees. NS for Malignant neoplasms, lung cancer, other malignant neoplasms, ischemic heart disease, other diseases, and external causes. Includes analysis by age; no adjustment for smoking or other potential confounders. Only 10 years of follow up, may not have been sufficient to observe certain effects; healthy worker effect.
Hazucha et al. 2002 Longitudinal study [Respiratory-s] Non-smoking residents of 3 communities near incinerators and 3 control communities chosen to be similar based on Residence in a community near an incinerator and daily air quality (PM2.5) measurements for each community. Annual spirometry. There were no significant (p>0.05) differences in FVC, FEV1, FEF50 between exposed and control communities, or between the 3 sets of communities. Community, year, site pair. Same cohort as Shy et al. 1995, Lee and Shy 1999; Mohan et al. 2000.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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population density and socioeconomic characteristics over 3 years.
Heyer et al. 1990 Retrospective cohort study [Respiratory-s; Circulatory-k; Cancer-s; All Cause] 2,289 male firefighters in Seattle, WA, employed for at least 1 year between 1945 and 1980. 383 deaths. Employment as a firefighter (yes/no); active assignments (having the possibility of fire combat). Cause of death (1945-1983); compared with U.S. white males. Full cohort All causes: SMR 76, 95% CI 69-85; Circulatory system disease: SMR 78, 95% CI 68-92; Arteriosclerotic disease: SMR 75, 95% CI 63-89; Acute upper airway respiratory disease: SMR 3003, 95% CI 364-10841; Digestive system disease: SMR 43, 95% CI 19-85; Suicide: SMR 21, 95% CI 12-89; All other causes NS. Adjusted for age and calendar year; stratified by duration of exposure and time since first exposure; no adjustment for smoking or other potential confounders. Reported broad disease categories; included a sub-analysis of those surviving 30 years since first exposure.
Age <65: All causes: SMR 62, 95% CI 53-71; Circulatory system disease: SMR 68, 95% CI 54-85; Digestive system disease: SMR 37, 95% CI 11-81; All other causes NS.
Age 65+: Lung cancer: SMR 177, 95% CI 105-279; All other causes NS. <15 Years of Exposure: All causes: SMR 62, 95% CI 48-79; Circulatory system disease: SMR 63, 95% CI 39-96; All other causes NS. 15-29 Years of Exposure: All causes: SMR 75, 95% CI 65-85; Circulatory system disease: SMR 75, 95% CI 62-91; All other causes NS. 30+ years of exposure: Leukemia: 503, 95% CI 104-1,470; Other lymphatic/ hematopoietic cancer: SMR 989, 95% CI 120-3,571; All other causes NS.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
Horsfield et al. 1988a Longitudinal study [Respiratory-s] 96 West Sussex fire brigade firefighters and 69 non-smoking local men as controls followed for 4 years. Based on employment as firefighter, and self-report of smoke exposure on job. Self-reported symptoms every 6 months for first 2 years, then yearly (morning coughing, etc). A significant increasing trend in the frequency of reported respiratory symptoms across groups (controls, nonsmoking firemen, ex-smoking firemen, and current smoking firemen), p<0.0001 for all symptoms. Symptom frequency increased in firefighters who had previously been exposed to fire smoke compared to unexposed firemen (RR 1.6, p<0.001) and remained significant when stratified by smoking (non-smokers: RR 5.7, p<0.001; ex-smokers: RR 2.3, p>0.05; current smokers: RR 2.3, p<0.001). No significant difference in lung function was noted between firefighters exposed to smoke and those not exposed. Stratified by smoking status. Selection bias; results indicate a multiplicative effected of smoke exposure and cigarette smoking on reported respiratory symptom frequency.
Horsfield et al. 1988b Longitudinal study [Respiratory-s] 96 West Sussex fire brigade firefighters and 69 non-smoking local men as controls followed for 4 years. Based on employment as firefighter, and self-report of smoke exposure on job. Spirometry for lung mechanics and nitrogen washout, every 6 months for first two years, then yearly. Rate of deterioration in lung function greater in controls than in firemen for VC and RV/ TLC (both p<0.05), FEV1, FVC, PEF, V50, V25, (all p<0.01). No evidence of chronic lung damage found associated with occupation as a fireman. Results were stratified by smoking; pulmonary function measurements were adjusted for height. Same cohort as Horsfield et al. 1988; authors note that wearing of breathing equipment may be protective.
Hours et al. 2003 Case-control study [Respiratory-s] 102 male workers from 3 urban incinerators in France compared to 94 male workers from other industries matched on age. Exposure was categorized by job type: crane or equipment operators (low), furnace workers (medium) and maintenance or effluent treatment workers (high). Self-reported symptoms; physical exam; red and white blood cell counts, blood lead, liver enzymes; and pulmonary function; incinerator workers reported more symptoms of skin irritation (p<0.001), daily cough (p<0.05), coughing during specific tasks (p<0.001), and had more skin lesions at exam (p<0.05); an excess of respiratory problems was also encountered: daily coughing [maintenance and effluent groups (OR 2.55, 95% CI 0.84-7.75); furnace men (OR 6.58, 95% CI 2.18-19.85)]; a significant relationship between exposure and the decrease of several pulmonary parameters was observed between maintenance and effluent workers for expected FEV1 Regression analyses were adjusted for smoking, age, and work location. 100% participation of workers; exposed workers smoked more cigarettes on average than controls (p<0.05); many workers had previous hazardous occupational exposures. Air sampling presented in Maitre et al., 2003.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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(p<0.05), PF (p<0.001), and FEV1/FVC (p<0.05) and crane operators for expected FEV1/FVC (p<0.05) and controls. No differences in liver function tests were reported. The incinerator workers had higher levels of neutrophils (p<0.01), lymphocyte and monocyte levels (both p<0.05), and blood lead levels (p<0.05) were elevated in maintenance and effluent workers compared to non-exposed workers.
Hu et al. 2001 Longitudinal study [Respiratory-s] 1018 residents of 3 communities with incinerators or 3 control communities matched on population density and socioeconomic characteristics. Exposure assessed by community residence (exposed or unexposed), distance from an incinerator, and an incinerator exposure index for 3 months or 12 months of exposure (based on distance and direction from an incinerator). Annual Spirometry, 1992-1994. Overall, there were no significant decreases in pulmonary function between communities with and without incinerators. The 4 different models for each exposure method showed varying decreases (some significant) in percent predicted pulmonary function values for each year but no patterns were observed. Adjusted for gas oven or range use in the home, length of residence, smoking history. Exposure may have been too low to elicit any effect over the 3 year time frame.
Jansson and Voog 1989 Case series report/ Ecologial study (Register study) [Reproductive-s] Kang et al. 2008 Registry-based case-control study
[Cancer-k]
Cases of cleft lip in one Swedish county. Residents 18 Swedish boroughs with incinerators for a Register study. 2,125 white, male firefighter cancer cases in the Massachusetts Cancer Registry compared to 2,763 cancers among white male police officer cancers and 156,890 cancers among all other occupations, 1986-2003. Exposure was estimated using a dispersion model and residential distance from an incinerator; residence in a borough with an incinerator for the register study. Primary occupation was firefighter at time of cancer diagnosis. Incidence of cleft lip and palate; case series: No common explanatory factor was noted for the 6 malformed children born from April to August 1987. All lived from 15-50 km from an incinerator; register study: from 1975-1983, 57 cases of cleft lip or palate were reported (48.5 expected), and 12 cases from 1984-1986 (17.6 expected); no increase in incidence of cleft lip or palate was detected. Cancer incidence Compared to police officers: Colon: SMOR 1.36, 95% CI 1.04-1.79; Brain: SMOR 1.90, 95% CI 1.10-3.26; all other sites NS. All other occupations: No significant findings. None. Age and smoking. No statistical tests (p-values) were reported. Occupational information available for 63% of MCR cases during study period.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
Kilburn et al. 1989 Longitudinal/ Case-control study [Neurological-s] 14 Firefighters exposed to burning PCBs, assessed 6 months after the fire and again 6-8 weeks after a detoxification program; and 14 non-exposed firefighters. PCBs and byproducts at a fire event. Neurophysical and neuropsychological test results. Compared to non-exposed firefighters, exposed firefighters has decreased scores for story memory; visual image; digits backward; block design; trails a and b; identifying embedded figures; design association; recognition; making trails and choice reaction times; and higher POMS for anger, depression, fatigue, and lower for vigor. PCBs in serum and fat were not associated with neurophysical or cognitive impairment. Following a detoxification program, score significantly improved for memory tests, block design, trails B, and embedded figures, and balance among exposed firefighters. None
Krishnan et al. 2003 Case-control study Cases of glioma in the San Francisco Bay area, 1991-1994 (476 cases, 462 controls) and 1997-1999 (403 Firefighter occupation (ever/ never and as longest held occupation). For longest held occupation firefighters: OR 5.88, 95% CI 0.70, 49.01. For ever employed as a firefighter: OR 2.85, 95% CI 0.77-10.58. There were no female glioma cases who were employed as firefighters. Controlled for age, sex, and ethnicity and stratified by time period. Increased risk of glioma for men employed as janitors and motor vehicle operators. Exposure
[Cancer-s] cases, 402 controls) and 864 controls matched for age, race, and gender via random digit dialing. misclassification- 40% of cases were reported by proxy.
Lee and Shy 1999 Longitudinal study [Respiratory-s] 756 Non-smoking residents of 6 communities in southwestern North Carolina, 3 located near an incinerator (<2 miles) and 3 controls communities (>2 miles from an incinerator), 1992-1993. PM10 as a surrogate for outdoor air pollution measured by one station in each community (24-hour mean levels). Respiratory health diaries and daily measurement of PEFR to determine daily variation; PM10 was not related to variations in PEFR nor were there difference between the exposed communities and non-exposed communities; regression of PM10 and selected covariates resulted in no association between daily PM10 concentrations and PEFR variation however, respiratory hypersensitivity was significantly related to PEFR (p<0.01) in both 1992 and 1993; likewise, time spent outdoors in the community was not related; sex, vacuum use, occupational air irritant exposure, age, and height were all related to PEFR (p<0.05). Adjusted for sex, age, respiratory hypersensitivity, hours spent outdoors in the community area, indicators of indoor air pollution (vacuum use and occupational irritants); control communities were selected to have similar socioeconomic characteristics and population density.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Liu et al. 1992 Longitudinal study (pre- and post-design) [Respiratory-s] 63 Seasonal and full-time wild land firefighters in Northern California and Montana. Firefighting for a season in 1989. Questionnaire, lung function and airway responsiveness tests. Firefighters’ post-season results were compared to their pre-season responses and values. Average individual declines in pulmonary function in L/sec: FVC 0.09 (95% CI 0.05-0.13); FEV1 0.15 (95% CI 0.13-0.17); and FEF25-75 0.44 (95% CI 0.26-0.62) Airway responsiveness significantly increased from pre- to post-season (p=0.02). Sex, smoking, history of asthma or allergies, years working as a firefighter, respiratory symptoms, membership to a particular firefighting crew. Small study size.
Lloyd et al. 1988 Ecological study [Reproductive-s] Single and twin births from 1975-1983 in central Scotland. Distance from an incinerator. Rates of twinning in areas exposed to an incinerator compared to non-affected neighboring areas. Only in 1980 was a cluster of twin births detected in exposed areas (p<0.01). There was an anecdotal increase in twinning in cattle during the same time period. None.
Ma et al. 1998 Retrospective cohort study [Cancer-s] 6,607 male firefighter deaths (1,883 from cancer) in 24 states, 1984-1993, from the National occupational Morality Database. Usual occupation as a firefighter on death certificate. Cancer mortality among firefighters, compared to rates of noncancer mortality in same occupational mortality database; among white firefighters. All cancer: MOR 1.11, 95% CI 1.1-1.2; Lip: MOR 5.9, 95% CI 1.9-18.3; Pancreas: MOR 1.2, 95% CI 1.0-1.5; Bronchus and lung: MOR 1.1, 95% CI 1.0-1.2; Soft tissue sarcoma: MOR 1.6, 95% CI 1.0-2.7; Melanoma: MOR 1.4, 95% CI 1.0-1.9; Prostate: MOR 1.2, 95% CI 1.0-1.3; Kidney and renal pelvis: MOR 1.3, 95% CI 1.0-1.7; Non-Hodgkin’s lymphoma: MOR 1.4, 95% CI 1.1-1.7; Hodgkin’s disease: MOR 2.4, 95% CI 1.4-4.1; All other cancer sites NS. Age, race, time period adjusted. Small number of events in some strata; exposure and disease misclassification dependant on the accuracy of death certificates; database similar to Burnett et al. 1994 but extended by 3 years and 3 states not included.
Among black firefighters All cancers: MOR 1.2, 95% CI 0.9-1.5; Brain and central nervous system: MOR 6.9, 95% CI 3.0-16.0; Colon: MOR 2.1, 95% CI 1.1-4.0; Prostate: MOR 1.9, 95% CI 1.2-3.2; Nasopharynx: MOR 7.6, 95% CI 1.3-46.4; All other cancer sites NS.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
Ma et al. 2005 Retrospective cohort study. [Respiratory-s; Neurological-s; Circulatory-s; All Cause] 34,796 male and 2,017 female professional firefighters in Florida from 1972 to 1999. 1,349 male and 38 female deaths. Certified as a firefighter (yes/no). Cause of death (1972-1999); compared with general population of Florida. Males All causes: SMR 0.57, 95% CI 0.54-0.60; Infectious diseases: SMR 0.16, 95% CI 0.11-0.22; Allergic/endocrine: SMR 0.35, 95% CI 0.35-0.52; Diabetes: SMR 0.45, 95% CI 0.26-0.73; Mental: SMR 0.41, 95% CI 0.22-0.68; Nervous system: SMR 0.41, 95% CI 0.31-0.86; Circulatory system: SMR 0.69, 95% CI 0.63-76; Cardiovascular: SMR 0.73, 95% CI 0.65-0.83; Respiratory disease: SMR 0.50, 95% CI 0.35-0.70; Pneumonia: SMR 0.34, 95% CI 0.17-0.62; Digestive diseases: SMR 0.57, 95% CI 0.43-0.73; Cirrhosis: SMR 0.49, 95% CI 0.34-0.69; Genitourinary system: SMR 0.8, 95% CI 0.14-0.83; External causes: SMR 0.45, 95% CI 0.40-0.50; All cancers: SMR 0.85, 95% CI 0.77-0.94; Buccal/pharynx cancer: SMR 0.42, 95% CI 0.17-0.87; Pancreatic cancer: SMR 0.57, 95% CI 0.29-0.99; Thyroid cancer: SMR 4.82, 95% CI 1.3-12.3; Breast cancer: SMR 7.41, 95% CI 2.0-19.0; All other causes NS. Females Circulatory system diseases: SMR 2.49, 95% CI 1.32-4.25; Cardiovascular disease: SMR 3.85, 95% CI 1.66-7.58; All other causes NS. Age, calendar year, and gender adjusted. Large study size. Disease misclassification dependant on validity of death certificates. Lacks power to detect associations among female firefighters.
Ma et al. 2006 Retrospective cohort study [Cancer-s] 34,796 male and 2,017 female professional firefighters in Florida employed between 1981 and 1999; 970 male and 52 female cancer deaths in the Florida Cancer Data System. Certification as a firefighter. Incident cancers among firefighters compared to the general population of Florida. Among male firefighters: All cancer sites: SIR 0.84, 95% CI 0.97-0.90; Buccal: SIR 0.67, 95% CI 0.47-0.91; Digestive: SIR 0.76, 95% CI 0.65-0.89; Stomach: SIR 0.50, 95% CI 0.25-0.90; Respiratory: SIR 0.67, 95% CI 0.57-0.78; Lung/bronchus: SIR 0.65, 95% CI 0.54-0.78; Bladder: SIR 1.29, 95% CI 1.01-1.62; Brain/ CNS: SIR 0.58, 95% CI 0.31-0.97; Thyroid: SIR 1.77, 95% CI 1.08-2.73; All Age and sex adjusted. Few cancers among female firefighters.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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lymphopoietic: SIR 0.68, 95% CI 0.54-0.85; Testes: SIR 1.60, 95% CI 1.20-2.09; All other sites NS.
Among female firefighters: All cancer sites: SIR 1.63, 95% CI 1.22-2.14; Thyroid: SIR 3.97, 95% CI 1.45-8.65; Hodgkin’s lymphoma: SIR 6.25, 95% CI 1.26-18.30; Cervical: SIR 5.24, 95% CI 2.93-8.65; All other sites NS.
Markowitz 1989 Longitudinal study [Respiratory-s] 64 exposed firefighters and 22 nonexposed firefighters at Time 2. Burning PVC at a fire event. Surveys and pulmonary function tests administered at 5-6 weeks and 22 months after exposure. Firefighters exposed to burning PVC reported more persistent respiratory effects at 6 weeks (cough, wheeze, shortness of breath, and chest pains; each p<0.01) and at 22 months (cough, shortness of breath, and chest pains; each p<0.01) than controls. significantly more respiratory symptoms at both time points and a physician diagnosis of asthma and/or bronchitis at 22 months for exposed firefighters. Stratified by smoking and age. Small study size.
Michelozzi et al. 1998 Ecologic study [Cancer-s] Residents of Malagrotta, Italy. Proximity (up to 10 km) to a waste disposal site, a waste incinerator, and an oil refinery operational in the area since the 1960s. SMR Cause of death (1987-1993) compared to population mortality of the metropolitan Rome area (1991). No significant increased cancer mortality observed in any of the three bands. Among men, mortality from laryngeal cancer declined with distance (p = 0.03), even after adjusting for socioeconomic status (p = 0.06). Age and sex standardized, adjusted for socioeconomic status. Pollution may have been from any of the three sources and risks could not be attributable to the incinerator alone.
Miedinger et al. 2007 Cross-sectional study [Respiratory-s] 101 professional firemen and 735 male controls in Basel, Switzerland. Employment as a firefighter. Questionnaire, spirometry, skin-prick tests, and bronchial challenge to methacholine. The frequency of reported respiratory symptoms and physician diagnosed asthma did not differ between firefighters and controls but they did report significantly more symptoms while at work (burning eyes, running nose, itchy throat, cough, dyspnea, and headache; all P<0.01). Also elevated rates of sensitization and atopy to several allergens (p<0.001). Increased reactivity to mathancholine was significantly related to being a firefighter (OR 2.25, 95% CI 1.12-4.48); and having an FEV1/ FVC ratio <0.7, wheezing in the last This study seems to be focused on acute, not chronic, effects. Lack of baseline data for firefighters before exposure.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
12 months, or doctor diagnosed asthma (all p<0.01). Bronchial hyperreactivity was more common among firefighters but could not be linked to acute exposure or duration of employment.
Milham and Ossiander 2001 Cohort study [Circulatory-s] All deaths among male Washington State residents from 1950-1999. 3145 deaths among firefighters. Occupation as a firefighter or fire protection worker. Cause of death compared to deaths among other occupations. Significantly (p<0.05) decreased PMRs for: Disorders of Character, Behavior & Intelligence (PMR 15); Infective and Parasitic Diseases (PMR 47); Senility & Ill-defined Diseases (PMR 0); AIDS (PMR 28); Tuberculosis of Respiratory System (PMR 15); Tuberculosis (total) (PMR 25); Significantly (p<0.05) increased PMRs for: Malignant Melanoma of Skin (PMR 228); Bronchiectasis (PMR 319); MN Lymphatic & Hematopoietic Tissues (PMR 132); Diseases of Other Endocrine Glands (PMR 394); Malignant Neoplasms (total) (PMR 108); Cerebral Hemorrhage and other Vascular Lesions (PMR 115); Lymphosarcoma (PMR 195); All other causes NS. Age. Results are able to be queried online at https://fortress.wa.gov/doh/ occmort/OMQuery.aspx.
Mohan et al. 2000 Cross-sectional study [Respiratory-s] 4,205 survey respondents from 4 communities in North Carolina and 1 in South Carolina located near incinerators and 4 control communities similar to exposed communities based on socioeconomic and density characteristics. Residential distance from an incinerator, measured PM10 in each community. Prevalence of reported respiratory symptoms. ORs comparing each study community to its control community or the combined control group. Significantly fewer (p<0.05) Community A respondents reported two or more (OR 0.7), or three or more (OR 0.6) short duration symptoms (eye irritation, sore throat, cough, runny nose, nasal irritation for ≥1 day in the last month) compared with the control community but not against the combined control group; no differences were noted for reporting of long duration symptoms; reporting of long or short duration symptoms did not differ between Community B and the control community or combined control group. Community C more frequently reported awakening at night (OR 1.3) vs. the control community but not the combined control Adjusted for age, gender, ethnicity, length of stay within 2 miles of present residence, education, smoking, use of nonelectric source for cooking or heating, central air conditioning, mold in the home, use of humidifier, pets, occupational chemical exposure, perceived air quality. Analysis combines data previously reported by Shy et al. 1995 and Feigley et al. 1994.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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group; there were no differences for other symptoms; community D residents reported significantly more (p<0.05) wheeze (OR 1.5), morning cough and phlegm or wheeze (OR 1.7), awakening at night (OR 1.8), and two or more (OR 1.6) which remained significant when compared with control community the combined control group; and three or more (OR 1.6) short duration symptoms than the control community but not against the combined control group.
Musk et al. 1982 Prospective cohort study [Respiratory-k] 951 while male firefighters in Boston, MA, studied 1970 to 1976. Employment as a firefighter (yes/ no); calculated and estimated number of fires fought; and by rank or active status. Pulmonary function, objective cough, and standardized respiratory symptom questionnaires; at the end of follow-up, FEV1 was 98.3% of expected; FVC was 97.8% of expected; changes in pulmonary function were not related to firefighting exposure. The authors attribute the results to selection biases and increased use of breathing apparatus in firefighting. Analysis considered age, height, and smoking. No levels of significance/statistical tests were reported; follow-up of Peters et al. 1974.
Mustacchi 1991 Longitudinal study [Neurological-s] 14 firefighters and 14 controls. Chemical fires-15-30 minutes of exposure to burning PCBs. Neurobehavioral functioning measured in 22 tests; exposed firefighters scored significantly differently from controls on profile of mood states (POMS) Total Mood Disturbance Scores; with higher scores for fatigue, and lower scores for vigor (both p<0.05). Corrected for multiple comparisons. Data previously reported by Kilburn et al. 1989.
Mustajbegovic et al. 2001 Cross-sectional study [Respiratory-s] 128 full-time firefighters and 88 factory workers in Zagreb, Croatia. Employed as a firefighter, duration of employment, and number of fires fought. Spirometry and prevalence of acute and chronic respiratory symptoms. Dyspnea, nasal catarrh, sinusitis and hoarseness were reported more frequently among firefighters than in control workers (p<0.01); among firefighters, chronic cough, chronic phlegm, chronic bronchitis, and sinusitis were significantly more common among smokers than non-smokers (p<0.01). Increased reporting of chronic phelgm and dyspnea were significantly (p<0.05) associated with length of employment; only chronic bronchitis was associated with increasing age (p<0.05). Smoking, age.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
Pulmonary function was significantly decreased among firefighters from expected values for FVC (p<0.05), FEV1 (p<0.01), FEF50 (p<0.01), and FEF75 (p<0.01). After controlling for smoking, FEV1, FEF50, and FEF75 remained significantly (all p<0.005) related to employment as a firefighter.
Olshan et al. 1990 Population-based case-control study [Reproductive-s] 22,192 live births with birth defects in the British Columbia Health Surveillance registry, 1952-1973; Firefighters fathered 281 live births, 89 with birth defects; police officers fathered 749 live births, 174 with birth defects; among fathers of all other occupations there were 21,929 live births. Paternal occupation as a firefighter at time of birth surrogate for exposure. OR Birth defects in 20 categories. All births Compared to other occupations: Ventricular septal defect: OR 2.7, 95% CI 1.02-7.18; Atrial septal defect: OR 5.91, 95% CI 1.60-21.83; All others NS. Compared to Police: Ventricular septal defect: OR 4.68, 95% CI 1.66-13.17; Atrial septal defect: OR 3.76, 95% CI 1.40-10.01; All others NS. Among children with only cardiac defects Compared to other occupations: Atrial septal defects: OR 6.81, 95% CI 1.40-33.16; Ventricular septal defects and Patent ductus arteriosus NS. Compared to Police: Ventricular septal defects: OR 5.05, 95% CI 1.43-17.82; Atrial septal defects: OR 3.82, 95% CI 1.19-12.33; Patent ductus arteriosis: OR 14.60, 95% CI 1.03-206.16. Matched on date and hospital of birth. Conditional logistic regression for matched controls from all occupations; unconditional logistic regression for comparison with policemen; controlled for father’s age and race, and mother’s age. No consideration of maternal exposures.
Peters et al. 1974 Prospective cohort study [Respiratory-k] 1,430 Boston firefighters studied 1970-1972. Employment as a firefighters (yes/no); frequency of fire exposures; number of “shellackings,” times overcome at a fire, and frequency of black sputum, and oxygen use. Percent change in average FVC and FEV1: self-reported respiratory symptoms over 1 year; FVC and FEV1 decreased with the number of fires fought (p<0.01 and p<0.02, respectively); decreases were not able to be explained by age, smoking, or ethnicity; other indicators of exposure (number of shellackings, times overcome at a fire, and frequency of black sputum) were not associated with the decreasing rate of FVC and FEV1. Multiple regression analysis adjusting for age, smoking habits, ethnicity. Assessment only follows firefighters for 1 year.
Prezant et al. 1999 More than 11,000 New York City firefighters Employment as a firefighter (yes/no). Duration of Annual incidence and point prevalence of biopsy-proven sarcoidosis (1985-1998); compared with nearly 3,000 EMS workers. Bivariate correlations between presence of sarcoidosis and length No exposure free interval.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Retrospective cohort study [Respiratory-s] employed between 1985 and 1998 and more than 3,000 EMS workers. employment (years). Company type (engine, ladder, both). 5 cases of biopsy proven sarcoidosis in firefighters and 1 among EMS health care workers; average annual incidence (1995-1998): 12.9 cases/100,000 person-years among firefighters; 0 cases/100,000 person-years among EMS workers; point prevalence on July 1, 1998: 222 cases/100,000 person-years among firefighters; 35 cases/100,000 person-years among EMS workers; no correlations or differences were found for pulmonary function with duration of employment or engine company type for firefighters. of employment as firefighter and company type.
Rosenstock et al. 1990 Cohort study [Respiratory-s] 4,392 male firefighters (886 deaths) and 2,074 police officers in Seattle, Tacoma, and Portland, OR, employed for at least a year between 1945-1980. Employment as a firefighter. Respiratory deaths 1945-1984; compared to U.S. mortality: All cause mortality: SMR 82, 95% CI 11-87; Non-malignant respiratory disease: SMR 81 (95% CI 73-89); malignant respiratory disease and lung, trachea and bronchus cancer NS. Compared to police: All IDR NS. Adjusted for age and year. Strong healthy worker effect.
Rydhstroem 1998 Ecological study [Reproductive-s] 17,067 twin births in Sweden 1973-1990 from the Medical Birth Registry. Parental residence in a parish or municipality in the vicinity of one of 14 incinerators. Incidence of twin deliveries for each year and each municipality; compared to national twinning rates in Sweden; and pre- and post-incinerator implementation twinning rates; by population size: municipalities designated as rural, towns, and other cities were all NS, the 3 largest cities had significantly elevated twining rates (RR 1.05, 95% CI 1.01-1.10); 6 municipalities (out of 284) had significantly higher twinning rates (p<0.05) in a particular year while two had decreased rates (p<0.05); of the 14 municipalities having an incinerator commissioned between 1973 and 1990, two had significantly reduced (p≤0.05) twinning rates after the plant was commissioned, while one had a higher rate (p<0.01). Standardized for year of deliver and maternal age.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
Sama et al. 1990 Registry-based case-control study [Cancer-k] 321 cancer cases among firefighters, compared to 392 police and 29, cases of other occupations identified in the Massachusetts Cancer Registry from 1982-1986. Employed as a firefighter (yes/no). Cancer incidence of rectal; pancreatic; lung, bronchus and trachea; melanoma of the skin; bladder; brain and other nervous system; non-Hodgkin’s lymphoma; and leukemia. Compared to the other occupations in MA: Melanoma of the skin: SMOR 292, 95% CI 170-503; Bladder: SMOR 159, 95% CI 102-250; all others NS. Compared to Police: Bladder: SMOR 211, 95% CI 107-414; Non-Hodgkin’s lymphoma: SMOR 327, 95% CI 119-898; all others NS. 18-54 Years of Age compared to Police: Melanoma, Bladder cancer, and Lymphoma all NS. 55-74 Years of Age compared to Police: Melanoma: SMOR 513, 95% CI 150-1750; Lymphoma: SMOR 538, 95% CI 150-1924; Bladder cancer NS. 75+ Years of Age: Melanoma, Bladder cancer, and Lymphoma all NS. Age standardized. Occupational information is only available for about half of Massachusetts Cancer Registry registrants.
Sardinas et al. 1986 Retrospective cohort study [Circulatory-s] 306 Firefighter and 401 policemen deaths in Connecticut from 1960 to 1978. Firefighter or policeman listed as “Usual occupation” on death certificates. 115 Ischemic heart disease deaths among firefighters. Comparing firefighters to Connecticut census data, SMR 1.52, 95% CI 1.23-1.81. Comparing firefighters to the standard population, MOR 1.07, 95% CI 0.91-1.23. Comparing firefighters directly to policemen, MOR 0.62, 95% CI 0.56-0.68). Analysis used weighted averages for 6 time periods. Only premature deaths between the ages of 25 to 59 were considered.
Schnitzer et al. 1995 Population-based case-control study [Reproductive-s] Cases are infants with major birth defects registered with Atlanta Congenital Defects Program 1968-1980; controls were infants born without defects in same period frequency matched on race, year and hospital of birth. Parental occupation used as surrogate for occupational exposure to firefighting compared to fathers of other occupations. Major birth defects Firemen (55 exposed cases) associated with other heart abnormalities (OR 4.7, 95% CI 1.2-17.8), cleft lip (OR 13.3, 95% CI 4.0-44.4), hypospadias (OR 2.6, 95% CI 1.1-6.3), and clubfoot (OR 2.9, 95% CI 1.4-6.0). Adjusted for mothers alcohol use, smoking, occupation, age, and education; father’s smoking and age; and gravidity. Study identifies several other occupations associated with elevated risks of birth defects.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Serra et al. 1996 Cross-sectional study [Respiratory-s] 95 firefighters based at the Sassari Department in Sardinia and a reference group 51 policemen in same province. Length or service, number of fires fought, pervious work, hobbies, smoking, details about fire stations from questionnaires. Spirometry, permeability of alveolar-capillary barrier. Significant reduction in some pulmonary function tests among exposed firefighters: FEV1 (p<0.05), FEV1/FVC (p<0.001), FEF75 (p<0.05), FEF50 (P<0.01), FEF25 (p<0.001), and RV (p<0.01) but not for FVC, TLC, DLco or DLco/TLC. Lung function was not correlated with years of service, numbers of fires, respiratory data, hobbies or previous professional exposures. Controlling for age, height, pack-years, and ex-smoker status. Mostly forest fires, few industrial fires. Limited personal exposure data.
Shy et al. 1995 Cross-sectional study [Respiratory-s] 3475 residents of 3 communities having incinerators and 3402 residents of 3 comparison communities. Direct measurements and modeled estimates of PM2.5 and routinely monitored air pollutants. Residents were members of exposed or unexposed communities; assigned average community exposure measurements; or assigned household exposure estimates determined by residential distance to an incinerator and wind speed/ direction. Pulmonary function, acute or chronic respiratory effects. Normal individuals in exposed and control communities did not have significantly different mean percent predicted FEV1 and PEFR results; among sensitive individuals, those exposed to a biomedical waste incinerator had significantly lower mean PEFR results compared to the control community and those exposed to a municipal waste incinerator had significantly higher mean FEV1 and PEFR results than the control community (both p<0.05). Comparison communities had similar socioeconomic characteristics and population densities (subjectively determined by neighborhood appearance) and were no closer than 5 km from the incinerator; adjusted for age, sex, height, and race. This reports on the first year of a multi-year study.
Sparrow et al. 1992 Longitudinal study [Respiratory-k] 168 firefighters and 1,474 non-firefighters participating in the Normative Aging Study at the VA in Boston, MA. Employment as a firefighter (yes/no). Mean annual change in pulmonary function (FVC and FEV1); compared to non-firefighters; greater loss in FVC and FEV1 than non-firefighters (p=0.007 and p=0.054, for FVC and FEV1, respectively). Multiple regression models adjusted for smoking status group, age, height, and initial pulmonary function. Possible healthy worker effects.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
Tango et al. 2004 Ecological study [Reproductive-s] 225,215 live births, 3,387 fetal deaths, and 835 infant deaths among residents living within a 10 km radius around incinerator with dioxin emissions >80 ng/TEQ/m3, 1997-1998, in Japan. Distance from municipal waste incinerators as a surrogate for exposure; determined from addresses on birth and death certificates. Congenital malformations, fetal and infant deaths compared to national rates; none of the reproductive outcomes showed statistically significant excess within 2 km of incinerators; a peak-decline in risk from 1-2 km to 10 km was detected for infant deaths (p=0.023) and infant deaths (p=0.047) from all congenital malformations combined. Adjustment factor to take account of regional differences between study region (all municipalities) and the smaller study area in which study population located. Lack of detailed exposure information means trend has to be interpreted cautiously.
Tepper et al. 1991 Longitudinal study [Respiratory-s] 632 Baltimore firefighters. Self-reported exposure and fire department records for respiratory use, amonia or chlorine exposure, smoke inhalation, having been overcome by toxic fumes or gases, respiratory symptoms after fires, and months in exposed jobs. Pulmonary function (FEV1). Baseline measurements taken 1974-1977 and followed-up 1983-1984; among all firefighters assessed, only work status was associated with significantly decreased FEV1 such that active firefighters had lower FEV1 measurements than inactive firefighters; firefighters who ever wore a mask when extinguishing a fire had a significantly smaller mean annual decline in FEV1 that those that never wore a mask among non-repeater participants but the difference was not significant among all firefighters studied. Controlled for exposure variables, age, weight, baseline cigarette smoking, and blood type. Effort to characterize exposure beyond employment; considers issue of respirator use.
Tornling et al. 1994 Retrospective cohort study [Neurological-s; Circulatory-k; Cancer-k; All Cause] 1,116 male firefighters in Stockholm, Sweden, employed for at least 1 year between 1931 and 1983. 316 deaths. Exposure index based on the number of fires fought by each individual. Cause of death (1958-1986); compared with the greater Stockholm male population. All causes: SMR 82, 95% CI 73-91; Circulatory diseases: SMR 84, 95% CI 71-98; Asthma, bronchitis, and emphysema: SMR 0, 95% CI 0-48; Violent death and poisoning: SMR 52, 95% CI 30-85; Stomach cancer: SMR 192, 95% CI 114-304; All hematopoietic cancers: SMR 32, 95% CI 6-92; All other causes NS. 65+ Years of Age: Brain cancer: SMR 435, 95% CI 140-1015. <30 Years Latency: Ischemic heart disease: SMR 19, 95% CI 4-56; Stomach cancer: SMR 481, 95% CI 155-1122. 30-40 Years Latency: Stomach cancer: SMR 606, 95% CI 313-1059. Age and calendar year adjusted; stratified by age, employment time, latency period, fire exposure index, and episodes using SCBA; no adjustment for smoking or other potential confounders. Healthy worker effect; disease misclassification dependant on reliability of death certificate information.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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>30 Years Employment: Stomach cancer: SMR 289, 95% CI 149-505. >1,000 Fires Fought: Stomach cancer: SMR 264, 95% CI 136-461; Brain cancer: SMR 496, 95% CI 1.35-12.70. Other strata by age group, latency, duration of employment, and number of fires all NS for ischemic heart disease, respiratory diseases, stomach cancer, and brain cancer.
Unger et al. 1980 Cohort study [Respiratory-s] 30 Texan firefighters exposed to severe smoke in a chemical fire outside of Houston. Severe smoke exposure at particular fire. Spirometry immediately after exposure, after 6 weeks, and 18 months later. Significant (p<0.05) decreases in FVC compared to predicted values immediately after exposure and after 6 weeks, differences were not significant after 18 months; compared to controls, firefighters had significantly decreased FVC (p<0.01) and FEV1 (p<0.05) immediately after exposure compared with matched controls. Healthy controls matched for age, height, and smoking history selected from other laboratory case files. No consideration of disease or exposure prior to the chemical fire or potentially confounding variable such as smoking. Small number of participants.
Vena and Fiedler 1987 Retrospective cohort study. [Respiratory-s; Neurological-s; Circulatory-k; Cancer-k; All Cause] 1,867 white male municipal employees in Buffalo, NY, with at least 5 years of service with at least 1 year as a firefighter between 1950 and 1979. 470 deaths. Employment as a firefighter (yes/no); length of service (years). Cause of death (1950-1979); compared with the general U.S. white male population. Colon cancer: SMR 1.83, 95% CI 1.05-2.97; Bladder cancer: SMR 2.86, 95% CI 1.30-5.40; benign neoplasms: SMR 4.17, 95% CI 1.34-9.73; Respiratory diseases: SMR 0.48, 95% CI 0.26-0.80; All external causes: SMR 0.67, 95% CI 0.44-0.98; All other causes NS. 1-9 Years Employed: All causes: SMR 0.59 (p<0.05); Circulatory diseases: SMR 0.41 (p<0.05); 10-19 Years Employed: All causes: SMR 0.70 (p<0.05); 20-29 Years Employed: Brain cancer: SMR 3.75 (p<0.05); 30-39 Years Employed: Respiratory diseases: SMR 0.34 (p<0.05); 40+ Years Employed: All causes: SMR 1.29 (p<0.05); Digestive cancer: SMR 3.08 (p<0.05); Colon cancer: SMR 4.71 (p<0.05); Bladder cancer: SMR 5.71 (p<0.05); All other causes NS. Stratified by length of service, age, latency, calendar year of death and first employment. No adjustment for smoking or other potential confounders. Potential healthy worker effect.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
Viel et al. 2000 Retrospective cohort study [Cancer-s] Residents of Doubs, France, 1980-1995. Proximity to municipal solid waste incinerator. Soft-tissue sarcoma, non-Hodgkin’s lymphoma, Hodgkin’s disease. Spatial clusters of increased risk were observed for soft-tissue sarcoma (SIR 1.44, p=0.12) and non-Hodgkin’s lymphoma (SIR 1.27, p= 0.0003), but not Hodgkin’s disease (SIR 1.42, p=0.95) Age and sex standardized.
Viel et al. 2008a Population-based case-control [Cancer-s] 2,147 males and 1,827 females with non-Hodgkin’s lymphoma in France, 1990-1999, in 2,270 census block groups (cases/ controls determined by high/low dioxin exposure). Exposure to emissions from 13 incinerators was modeled from 1972-1985 (allowing for a 10-year latency period); the exposure model considered incinerator characteristics (capacity, functioning, dust control, fume treatment, operating years), atmospheric diffusion modeling, and distance to estimate the dioxin exposure level of each of the census block groups. Non-Hodgkin’s lymphoma. Highly-exposed block groups relative to lowest exposed: RR 1.12, 95% CI 1.00-1.25. Risks were elevated among women: RR 1.178, 95% CI 1.01-1.37 in the multivariate model. Population density, urbanization, socioeconomic level, airborne traffic pollution, and industrial pollution.
Vincenti et al. 2008 Ecological study [Reproducive-s] All females aged 16-49 living in the area at any time and females working for at least 1 week from 2003-2006 in 3 municipal areas near Modena, Italy; cases are congenital anomalies and stillbirths identified within 28 days Residential address and work location history are used as surrogate for exposure and estimated concentration levels. Estimated concentrations are based on estimated fall-out of dioxins and furans in the Spontaneous abortions, birth defects, still births. No excess risk of miscarriage (RR 1.00, 95% CI 0.65-1.48) or birth defects (RR 0.64, 95% CI 0.20-1.55) in two areas closest to incinerator; also no indication of dose–response trend. No higher risk of spontaneous abortions in females working in factories in exposed areas (RR 1.04, 95% CI 0.38-2.30), but increased prevalence of birth defects (RR 2.26, 95% CI 0.57-6.14). None. Likely exposure misclassification. No data on confounders such as smoking, diet, occupation, and reproductive history; small number of cases due to scarcity of exposed women and low number of outcomes.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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of birth using a regional birth defects registry. lower part of the atmosphere, with 2 areas characterized as having higher levels.
Williams et al. 1992 Ecological study [Reproducive-s] Residents of several Scottish districts near two incinerators that ceased operation in 3 “at risk” districts and 7 comparison districts were chosen for study. Districts were determined to be of a priori interest using 3-D mapping techniques based on the probability of exposure incorporating wind direction and strength, influence of topography, anecdotal evidence from residents, and concentrations of pollutants in soil. Sex ratios (male:female) for 1975-1979 and 1981-1983. In one “at risk” district (FK4), the m:f ratio was 87, significantly reduced from 100 (p<0.05) showing an excess of female births. None. Unable to account for potentially confounding variables (parental exposures, etc).
Young et al. 1980 Cross-sectional study [Respiratory-s] 193 New South Wales firefighters. Length of service (minus time in nonactive fire duty) as a firefighter (years). Questionnaire to determine the prevalence of chronic respiratory symptoms and disease, and pulmonary function testing. Firefighters with chronic bronchitis had a longer average length of exposure (p<0.05) and were more likely to be smokers and smoke more (both p<0.05) than firefighters without disease but exposure was not related to chronic bronchitis or chronic obstructive airway disease. Changes in pulmonary function were not related to exposure. Age, smoking, height. Smoking identified as more significant health risk than fire exposure among this population. This is a pilot study only using 10% of the total cohort.
Zambon et al. 2007 Case-control study [Cancer-s] 172 cases of soft tissue sarcoma diagnosed from 1990-1996 compared with 405 controls matched on age and sex randomly selected from the general population. Modeled dioxin exposure based on distance between residence and waste incinerators or sources of industrial pollution. Soft tissue sarcoma. For cases/controls experiencing ≥6 fgr/m3 average exposure compared with <4fgr/m3: OR 2.08, 95% CI 1.19-3.64. For cases/controls experiencing ≥6 fgr/m3 average exposure for ≥32 years compared with <4 fgr/m3: OR 3.30, 95% CI 1.24-8.73. STS risk increased with average exposure among females (p trend = 0.04) but not for men. Matched on age and sex.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
Studies of Gulf War veterans
Barth et al. 2009 Cohort study 621,902 U.S. GW veterans and 746,248 nondeployed era veterans followed through 2004. Estimated oil-well fire smoke modeled. 123,478 GW Veterans were exposed to oil-well fire smoke. Increased risk of brain cancer among veterans exposed to oil-well fire smoke compared to non-exposed veterans (OR 1.67, 95% CI 1.05-2.65) and after controlling for 2+ days of exposure to nerve agents at Khamisiyah (OR 1.81, 95% CI 1.00-3.27). Controlling for sex, race, age, and unit type. Follow-up of Kang and Bullman 2001.
Bullman et al. 2005 Cohort study 100,487 U.S. Army GW veterans exposed to chemical warfare agents at Khamisiyah; 224,980 unexposed Army GW veterans; exposure determined from the DoD plume model. Exposure to oil-well fires and nerve agents determined by plume model. Brain cancer mortality Oil-well fire smoke was not significantly related to brain cancer deaths. Controlling for sex, race, age, and unit type. Follow-up of Kang and Bullman 2001.
Cowan et al. 2002 Case-control study 873 cases of asthma compared to 2464 controls using a DoD registry, among GW veterans. Modeled oil-well fire smoke. Physician-diagnosis of asthma 3-6 years after war. Asthma associated with cumulative exposure (<0.1 mg/m3/day referent) between 0.1-1.0 mg/m3/day (OR 1.24, 95% CI 1.00-1.55); for exposure of 1mg/m3/day or greater (OR 1.40, 95% CI 1.11-1.75); and as a continuous variable, OR 1.08, 95% CI 1.01-1.15. Number of days at >65 µg/m3 compared to 0 days of exposure: 1-5 days of exposure (OR 1.22, 95% CI 0.99-1.51); 6-30 days of exposure (OR 1.41, 95% CI 1.12-1.77); and as a continuous variable (OR 1.03, 95% CI 1.01-1.05). Sex, age, race, military rank, smoking history, self-reported exposure. Pre-exposure asthma status of participants unknown.
Iowa Persian Gulf Study Group 1997 Population-based cross-sectional study 3,695 GW veterans and non-GW veterans living in Iowa. Oil-well fire smoke exposure collected by questionnaire. Prevalence of self-reported symptoms and illnesses. Many reported exposures were significantly related to multiple self-reported symptoms or illnesses; 85.2% of regular military and 96% of National Guard/Reserve GW veterans reported Stratified for age, sex, rank, race, and branch of service. Study not designed to investigate the effects of exposure to oil-well fire smoke.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
×
exposure to smoke or combustion products. Exposure to smoke/combustion products was associated with depression, cognitive dysfunction, and fibromyalgia (all p<0.001).
Kang et al. 2000 Cross-sectional study 15,000 GW veterans and 15,000 non-GW veterans, selected by stratified random sample. Exposure to oil-well fires assessed by questionnaire. Prevalence of selected self-reported medical conditions. 65% of GW veterans, and 73% veterans in the VA Health Registry reported exposure to oil-well fire smoke but no significant differences in prevalence of self-reported medical conditions was reported. Stratified by sex and component. Study not designed to investigate the effects of exposure to oil-well fire smoke.
Lange et al. 2002 Cross-sectional study 1,560 GW veterans. Self-reported and modeled exposure to oil-well fire smoke. Asthma and bronchitis symptoms collected by structured interviews conducted 5 years after the war. No association between modeled exposure and asthma or bronchitis symptoms. Self-reported exposure >30 days was significantly related to asthma (OR 2.83) and bronchitis (OR 4.78) symptoms. Sex, age, race, military rank, smoking history, military service, level of preparedness for war. Used symptom-based case definition of bronchitis and asthma (possible disease misclassification).
Proctor et al. 1998 Longitudinal study Stratified random sample of 220 GW veterans from Ft. Devens and 71 from New Orleans, and 50 Era veterans deployed to Germany, assessed 1994-1996. Combustion products. Smoke from oil well fires was not significantly related to any system diseases but smoke from burning human waste was related to cardiac symptoms (p<0.001) and pulmonary symptoms (p<0.015). Controlled for age, sex, education, study site, PTSD status, and war-zone exposure. Vehicle exhaust related to cardiac and neurological symptoms; and smoke from tent heaters related to cardiac, neurological and pulmonary outcomes.
Smith et al. 2002 Cohort study 405,142 active-duty GW veterans who were in theater during the time of Kuwaiti oil-well fires. Modeled PM exposure to represent oil-well fire smoke exposure used to create 7 categories of exposure. 1: average daily exposure of 1-260 µg/m3 for 1-25 days; Exposure level 2: average daily exposure of 1-260 µg/m3 for 26-50 days; Exposure level 3: average daily DoD hospitalizations 1991-1999. Hospitalization rates among those in exposure groups 1-6 were compared to personnel determined to be unexposed. Only exposure level 4 was at increased risk of hospitalization (RR 1.03, 95% CI 1.00-1.05), risks for all other exposure levels NS. Causes for hospitalization and levels of exposure: Infections and parasitic diseases: level 2 (RR 0.87, p<0.05); Endocrine, nurtitional, and metabolic disorders: level 1 (RR 0.89, p<0.05); level 4 (RR 0.87, p<0.05); level 5 (RR 0.84, p<0.05); level 6 (RR 0.84, p<0.05); Mental disorders: level 6 (RR 1.11, p<0.05); Adjusted for “influential covariates,” defined as demographic or deployment variables with p values less than 0.15. Objective measure of disease not subject to recall bias; no issues with self-selection; however, only DoD hospitals, only active duty, no adjustment for potential confounders such as smoking.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
×
Study and Design Population Exposure Outcomes Adjustments Limitations and Comments
exposure of 1-260 µg/m3 for >50 days; Exposure level 4: average daily exposure of >260 µg/m3 for 1-25 days; Exposure level 5: average daily exposure of >260 µg/m3 for 26-50 days. Exposure level 6: average daily exposure of >260 µg/m3 for >50 days. Circulatory diseases: level 2 (RR 0.88, p<0.05); level 4 (RR 0.87, p<0.05); level 5 (RR 0.90, p<0.05); Respiratory diseases: level 3 (RR 0.69, p<0.05); Digestive diseases: level 5 (RR 0.92, p<0.05); Genitourinary diseases: level 5 (RR 0.91, p<0.05); Pregnancy complications: level 2 (RR 0.86, p<0.05); level 3 (RR 0.48, p<0.05); level 6 (0.84, p<0.05); Skin diseases: level 3 (RR 1.35, p<0.05); level 5 (RR 0.87, p<0.05); Musculoskeletal disease: level 2 (RR 0.91, p<0.05); Symptoms, signs, and ill0defined conditions: level 4 (RR 0.92, p<0.05); level 5 (RR 0.90, p<0.05); Injury and poisoning: level 4 (RR 1.11, p<0.05); All other causes and levels of exposure NS.
Spencer et al. 2001 Case-control study 241 veterans meeting the criteria for unexplained illness in Washington or Oregon and 113 health veterans as controls. GW combat (heat stress, chemical exposures, oil-well fire smoke). Prevalence of unexplained illness (by PEHRC or CDC definitions) assessed by survey and clinical study; burned latrine waste exposure was associated with unexplained illness (OR 2.51, 95% CI 1.58-3.98); many exposures were significantly related to unexplained illness, most strongly being sun exposure, conditions of combat, and medical problems/treatment sought while deployed. Controlled for other simultaneous exposures.
Unwin et al. 1999 Cross-sectional study 8,195 GW veterans and Bosnia and other era veterans deployed elsewhere from the United Kingdom, conducted in 1997-1998. Combustion product exposure assessed by questionnaire. Prevalence of self-reported symptoms and illnesses. Among all three groups of veterans, exposure to oil-well fire smoke was not significantly associated with physical functioning. For CDC syndrome, risks were increased among GW veterans (OR 1.8, 95% CI 1.5-2.1) and era veterans (OR 1.8, 95% CI 1.1-2.9). Risks were increased for PTSD among GW veterans (OR 2.3, 95% CI 1.7-2.9), Bosnia veterans (OR 3.2, 95% CI 1.6-6.8) and era veterans (OR 3.0, 95% CI 1.4-6.5). Stratified for age, rank, and deployment to Bosnia.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
×
Verret et al. 2008 Cross sectional and nested case-control study 5.666 French GW veterans. Oil-well fire. Fertility disorders, miscarriage, birth defects assessed by questionnaire in 2002-2004. 0.9% reported infertility, 12% reported one or more miscarriages among partners of male veterans, 2.4% fathered children with a birth defect conceived after returning from the Persian Gulf. Case-control study comparing exposures experienced by fathers with and without children having birth defects- No exposure (time of mission, location of mission, oil-well fire smoke, sandstorm, chemical arms, and pesticides) was related to birth defects. Incidence of birth defects among veterans was similar to that of the French population (except for Down syndrome, RR 0.36, 95% CI 0.13-0.78). Adjusted for age, service branch, rank, and military status. Controls to compare the risk of birth defects with specific exposures were male veterans who never had a child with a birth defect but had at least one healthy child matched with veterans who fathered a child with a birth defect after deployment on age.
White et al. 2001 Cross-sectional study 193 GW veterans and 47 Germany deployed veterans. Deployment to the GW 1990-1991 and related self-reported exposures. Neuropsychological function. Chemical warfare agent and pesticide exposures were related to poorer neuropsychological tests performance (p<0.05), oil well fire smoke, pyridostigmine bromide were not. Exposure to oil well fire smoke significantly increased score on the POMS tension scale; GW veterans performed worse on several tests (only mood complaints remained significant after Bonferroni correction) than Germany-deployed veterans. Adjusted for age, education, gender, and sampling design. Controlled for post-traumatic stress disorder, major depression, and other known covariates. Adjustment for multiple comparisons.
Wolfe et al. 2002 Cross-sectional study 1,290 GW veterans at Ft Devens in 1997 (who previously were surveyed in 1991). Deployment to the GW 1990-1991 and related exposures. Prevalence of multisymptom illness (at least two categories of symptoms: fatigue, mood-cognition, musculoskeletal). 60% prevalence of multisymptom illness. Multivariate regression showed several factors to be related (female, OR 1.8, 95% CI 1.1-2.9; college education, OR 0.5, 95% CI 0.4-0.7; GSI clinical caseness, OR 9.8, 95% CI 7.3-13.1; oil fire smoke, OR 1.6, 95% CI 1.2-2.1; chemicals, OR 2.4, 95% CI 1.6-3.6; heater in tent, OR 1.4, 95% CI 1.0-1.8; seen in clinic, OR 1.5, 95% CI 1.2-2.0; anthrax vaccine, OR 1.5, 95% CI 1.1-2.0; medium or exposure to Anti-nerve gas, OR 1.4, 95% CI 1.0-1.9 and OR 2.1, 95% CI 1.4-3.1 respectively. Stratified for GSI caseness criteria.
Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
×

NOTE: AIDS = acquired immune deficiency syndrome; CDC = Centers for Disease Control and Prevention; CHD = coronary heart disease; CI = confidence interval; CNS = central nervous system; DoD = Department of Defense; EMS = emergency medical services; FEF25–75 = forced expiratory flow between 25% and 75%; FEF50 = forced expiratory flow at 50%; FEV1 = forced expiratory volume in one second; FVC = forced vital capacity; GW = Gulf War; IDR = incidence density ratio; IRR = incidence rate ratio; km = kilometers; L/sec = liters per second; MN = malignant; MOR = mortality odds ratio; NS = not significant; OR = odds ratio; PEFR = peak expiratory flow rate; PM = particulate matter; PMR = proportional mortality ratio; PVC = polyvinyl chloride; RR = relative risk; RV = residual volume; SIR = standardized incidence ratio; SMR = standardized mortality ratio; SMOR = standardized mortality odds ratio; SPMR = standardized proportional mortality ratio; TEQ = toxicity equivalent; TLC = total lung capacity; V25 = maximum expiratory flow rates at 25% of FVC; V50 = maximum expiratory flow rates at 50% of FVC; VA = Department of Veterans Affairs; VC = vital capacity.

Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
×

REFERENCES

Aronson, K. J., L. A. Dodds, L. Marrett, and C. Wall. 1996. Congenital anomalies among the offspring of fire fighters. American Journal of Industrial Medicine 30(1):83-86.

Aronson, K. J., G. A. Tomlinson, and L. Smith. 1994. Mortality among fire fighters in metropolitan Toronto. American Journal of Industrial Medicine 2(1):89-101.

Bandaranayke, D., D. Read, and Clare Salmond. 1993. Health consequences of a chemical fire. International Journal of Environmental Health Research (3):104-114.

Baris, D., T. J. Garrity, J. L. Telles, E. F. Heineman, A. Olshan, and S. H. Zahm. 2001. Cohort mortality study of Philadelphia firefighters. American Journal of Industrial Medicine 39(5):463-476.

Barth, Shannon K., Han K. Kang, Tim A. Bullman, and Mitchell T. Wallin. 2009. Neurological mortality among U.S. veterans of the Persian Gulf War: 13-year follow-up. American Journal of Industrial Medicine 52(9):663-670.

Bates, J. T. 1987. Coronary artery disease deaths in the Toronto Fire Department. Journal of Occupational Medicine 29(2):132-135.

Bates, M. N. 2007. Registry-based case-control study of cancer in California firefighters. American Journal of Industrial Medicine 50(5):339-344.

Bates, M. N., J. Fawcett, N. Garrett, R. Arnold, N. Pearce, and A. Woodward. 2001. Is testicular cancer an occupational disease of fire fighters? American Journal of Industrial Medicine 40(3):263-270.

Beaumont, J. J., G. S. Chu, J. R. Jones, M. B. Schenker, J. A. Singleton, L. G. Piantanida, and M. Reiterman. 1991. An epidemiologic study of cancer and other causes of mortality in San Francisco firefighters. American Journal of Industrial Medicine 19(3):357-372.

Betchley, C., J. Q. Koenig, G. van Belle, H. Checkoway, and T. Reinhardt. 1997. Pulmonary function and respiratory symptoms in forest firefighters. American Journal of Industrial Medicine 31(5):503-509.

Biggeri, A., F. Barbone, C. Lagazio, M. Bovenzi, and G. Stanta. 1996. Air pollution and lung cancer in Trieste, Italy: Spatial analysis of risk as a function of distance from sources. Environmental Health Perspectives 104(7):750-754.

Bresnitz, E. A., J. Roseman, D. Becker, and E. Gracely. 1992. Morbidity among municipal waste incinerator workers. American Journal of Industrial Medicine 2(3):363-378.

Bullman, T. A., C. M. Mahan, H. K. Kang, and W. F. Page. 2005. Mortality in US Army Gulf War veterans exposed to 1991 Khamisiyah chemical munitions destruction. American Journal of Public Health 95(8):1382-1388.

Burnett, C. A., W. E. Halperin, N. R. Lalich, and J. P. Sestito. 1994. Mortality among fire fighters: a 27 state survey. American Journal of Industrial Medicine 26(6):831-833.

Calvert, G. M., J. W. Merling, and C. A. Burnett. 1999. Ischemic heart disease mortality and occupation among 16- to 60-year-old males. Journal of Occupational Medicine 41(11):960-966.

Carozza, S. E., M. Wrensch, R. Miike, B. Newman, A. F. Olshan, D. A. Savitz, M. Yost, and M. Lee. 2000. Occupation and adult gliomas. Am J Epidemiol 152(9):838-846.

Charbotel, B., M. Hours, A. Perdrix, L. Anzivino-Viricel, and A. Bergeret. 2005. Respiratory function among waste incinerator workers. International Archives of Occupational and Environmental Health 78(1):65-70.

Comba, P., V. Ascoli, S. Belli, M. Benedetti, L. Gatti, P. Ricci, and A. Tieghi. 2003. Risk of soft tissue sarcomas and residence in the neighbourhood of an incinerator of industrial wastes. Occupational and Environmental Medicine 60(9):680-683.

Cordier, S., C. Chevrier, E. Robert-Gnansia, C. Lorente, P. Brula, and M. Hours. 2004. Risk of congenital anomalies in the vicinity of municipal solid waste incinerators. Occupational and Environmental Medicine 61(1):8-15.

Cowan, DN, Lange JL, Heller J, Kirkpatrick J, DeBakey S. 2002. A case-control study of asthma among U.S. Army Gulf War veterans and modeled exposure to oil well fire smoke. Military Medicine 167(9):777-782.

Cresswell, P. A., J. E. Scott, S. Pattenden, and M. Vrijheid. 2003. Risk of congenital anomalies near the Byker waste combustion plant. Journal of Public Health Medicine 2 (3):237-242.

Demers, P. A., H. Checkoway, T. L. Vaughan, N. S. Weiss, N. J. Heyer, and L. Rosenstock. 1994. Cancer incidence among firefighters in Seattle and Tacoma, Washington (United States). Cancer Causes Control 5(2):129-135.

Demers, P. A., N. J. Heyer, and L. Rosenstock. 1992a. Mortality among firefighters from three northwestern United States cities. British Journal of Industrial Medicine 49(9):664-670.

Demers, P. A., T. L. Vaughan, H. Checkoway, N. S. Weiss, N. J. Heyer, and L. Rosenstock. 1992b. Cancer identification using a tumor registry versus death certificates in occupational cohort studies in the United States. American Journal of Epidemiology 136(10):1232-1240.

Deschamps, S., I. Momas, and B. Festy. 1995. Mortality amongst Paris fire-fighters. European Journal of Epidemiology 11(6):643-646.

Dibbs, E., H. E. Thomas, S. T. Weiss, and D. Sparrow. 1982. Fire fighting and coronary heart disease. Circulation 65 (5):943-946.

Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Douglas, D. B., R. B. Douglas, D. Oakes, and G. Scott. 1985. Pulmonary function of London firemen. British Journal of Industrial Medicine 42(1):55-58.

Elci, O. C., M. Akpinar-Elci, M. Alavanja, and M. Dosemeci. 2003. Occupation and the risk of lung cancer by histologic types and morphologic distribution: a case control study in Turkey. Monaldi Archives of Chest Disease 59(3):183-188.

Eliopulos, E., B. K. Armstrong, J. T. Spickett, and F. Heyworth. 1984. Mortality of fire fighters in Western Australia. British Journal of Industrial Medicine 41(2):183-187.

Elliott, P., G. Shaddick, I. Kleinschmidt, D. Jolley, P. Walls, J. Beresford, and C. Grundy. 1996. Cancer incidence near municipal solid waste incinerators in Great Britain. British Journal of Cancer 73(5):702-710.

Feuer, E., and K. Rosenman. 1986. Mortality in police and firefighters in New Jersey. American Journal of Industrial Medicine 9(6):517-27.

Firth, H. M., K. R. Cooke, and G. P. Herbison. 1996. Male cancer incidence by occupation: New Zealand, 1972-1984. International Journal of Epidemiology 25(1):14-21.

Floret, N., F. Mauny, B. Challier, P. Arveux, J. Y. Cahn, and J. F. Viel. 2003. Dioxin emissions from a solid waste incinerator and risk of non-Hodgkin lymphoma. Epidemiology 14(4):392-398.

Glueck, CJ, et al. 1996. Risk Factors for Coronary Heart Disease Among Firefighters in Cincinnati. American Journal of Industrial Medicine 30:331-340.

Grimes, G., D. Hirsch, and D. Borgeson. 1991. Risk of death among Honolulu fire fighters. Hawaii Medical Journal 50(3):82-85.

Guidotti, T. L. 1993. Mortality of urban firefighters in Alberta, 1927-1987. American Journal of Industrial Medicine 23(6):921-940.

Gustavsson, P. 1989. Mortality among workers at a municipal waste incinerator. American Journal of Industrial Medicine 15(3):245-253.

Gustavsson, P., B. Evanoff, and C. Hogstedt. 1993. Increased risk of esophageal cancer among workers exposed to combustion products. Archives of Environmental Health 48(4):243-245.

Hansen, E. S. 1990. A cohort study on the mortality of firefighters. British Journal of Industrial Medicine 47(12):805-809.

Hazucha, M. J., V. Rhodes, B. A. Boehlecke, K. Southwick, D. Degnan, and C. M. Shy. 2002. Characterization of spirometric function in residents of three comparison communities and of three communities located near waste incinerators in North Carolina. Archives of Environmental Health 5(2):103-112.

Heyer, N., N. S. Weiss, P. Demers, and L. Rosenstock. 1990. Cohort mortality study of Seattle fire fighters: 1945-1983. American Journal of Industrial Medicine 17(4):493-504.

Horsfield, K., F. M. Cooper, M. P. Buckman, A. R. Guyatt, and G. Cumming. 1988a. Respiratory symptoms in West Sussex firemen. British Journal of Industrial Medicine 45(4):251-255.

Horsfield, K., A. R. Guyatt, F. M. Cooper, M. P. Buckman, and G. Cumming. 1988b. Lung function in West Sussex firemen: a four year study. British Journal of Industrial Medicine 45(2):116-121.

Hours, M., L. Anzivino-Viricel, A. Maitre, A. Perdrix, Y. Perrodin, B. Charbotel, and A. Bergeret. 2003. Morbidity among municipal waste incinerator workers: A cross-sectional study. International Archives of Occupational and Environmental Health 76(6):467-472.

Hu, S. W., M. Hazucha, and C. M. Shy. 2001. Waste incineration and pulmonary function: an epidemiologic study of six communities. Journal of the Air & Waste Management Association 51(8):1185-1194.

Iowa Persian Gulf Study Group. 1997. Self-reported illness and health status among Gulf War veterans: A population-based study. Journal of the American Medical Association 27(3):238-245.

Jansson, B., and L. Voog. 1989. Dioxin from Swedish municipal incinerators and the occurrence of cleft lip and palate malformations. International Journal of Environmental Studies (34):99-104.

Kang, D., L. K. Davis, P. Hunt, and D. Kriebel. 2008. Cancer incidence among male Massachusetts firefighters, 1987-2003. American Journal of Industrial Medicine 51(5):329-335.

Kang, H. K., C. M. Mahan, K. Y. Lee, C. A. Magee, and F. M. Murphy. 2000. Illnesses among United States veterans of the Gulf War: a population-based survey of 30,000 veterans. Journal of Occupational and Environmental Medicine 42(5):491-501.

Kilburn, K. H., R. H. Warsaw, and M. G. Shields. 1989. Neurobehavioral dysfunction in firemen exposed to polycholorinated biphenyls (PCBs): possible improvement after detoxification. Archives of Environmental Health 44(6):345-350.

Krishnan, G., M. Felini, S. E. Carozza, R. Miike, T. Chew, and M. Wrensch. 2003. Occupation and adult gliomas in the San Francisco Bay Area. Journal of Occupational and Environmental Medicine 45(6):639-647.

Lange, J.L., D. A. Schwartz, B. N. Doebbeling, J. M. Heller, and P. S. Thorne. 2002. Exposures to the Kuwait oil fires and their association with asthma and bronchitis among gulf war veterans. Environmental Health Perspectives 110(11):1141-1146.

Lee, J. T., and C. M. Shy. 1999. Respiratory function as measured by peak expiratory flow rate and PM10: six communities study. Journal of Exposure Analysis and Environmental Epidemiology 9(4):293-299.

Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Liu, D., I. B. Tager, J. R. Balmes, and R. J. Harrison. 1992. The effect of smoke inhalation on lung function and airway responsiveness in wildland fire fighters. American Review of Respiratory Disease 146(6):1469-1473.

Lloyd, O. L., M. M. Lloyd, F. L. Williams, and A. Lawson. 1988. Twinning in human populations and in cattle exposed to air pollution from incinerators. British Journal of Industrial Medicine 4(8):556-560.

Ma, F., L. E. Fleming, D. J. Lee, E. Trapido, and T. A. Gerace. 2006. Cancer incidence in Florida professional firefighters, 1981 to 1999. Journal of Occupational and Environmental Medicine 48(9):883-888.

Ma, F., L. E. Fleming, D. J. Lee, E. Trapido, T. A. Gerace, H. Lai, and S. Lai. 2005. Mortality in Florida professional firefighters, 1972 to 1999. American Journal of Industrial Medicine 47(6):509-517.

Ma, F., D. J. Lee, et al. 1998. Race-specific cancer mortality in US firefighters: 1984-1993. Journal of Occupational and Environmental Medicine 40(12):1134-1138.

Markowitz, J. S. 1989. Self-reported short- and long-term respiratory effects among PVC-exposed firefighters. Archives of Environmental Health 44(1):30-33.

Michelozzi, P., F. Forastiere, D. Fusco, C. A. Perucci, B. Ostro, C. Ancona, and G. Pallotti. 1998. Air pollution and daily mortality in Rome, Italy. Occupational and Environmental Medicine 55(9):605-610.

Miedinger, D., P. N. Chhajed, D. Stolz, C. Gysin, A. B. Wanzenried, C. Schindler, C. Surber, H. C. Bucher, M. Tamm, and J. D. Leuppi. 2007. Respiratory symptoms, atopy and bronchial hyperreactivity in professional firefighters. European Respiratory Journal 30(3):538-544.

Milham, S., and E. Ossiander. 2011. Occupational mortality database. Washington State Department of Health. https://www.doh.wa.gov/data/multi-topic.htm (accessed January 19, 2011).

Mohan, A., D. Degnan, C.E. Feigley, C. M. Shy, C.A. Hornung, T. Mustafa, and C.A. Macera. 2000. Comparison of respiratory symptoms among community residents near waste disposal incinerators. International Journal of Environmental Health Research 10:63-75.

Musk, A. W., J. M. Peters, L. Bernstein, C. Rubin, and C. B. Monroe. 1982. Pulmonary function in firefighters: a six-year follow-up in the Boston Fire Department. American Journal of Industrial Medicine 3(1):3-9.

Mustacchi, P. 1991. Neurobehavioral dysfunction in firemen exposed to polychlorinated biphenyls (PCBs): possible improvement after detoxification. Archives of Environmental Health 46(4):254-255.

Mustajbegovic, J., E. Zuskin, E. N. Schachter, J. Kern, M. Vrcic-Keglevic, S. Heimer, K. Vitale, and T. Nada. 2001. Respiratory function in active firefighters. American Journal of Industrial Medicine 40(1):55-62.

Olshan, A. F., K. Teschke, and P. A. Baird. 1990. Birth defects among offspring of firemen. Am J Epidemiol 131 (2):312-21.

Peters, J. M., G. P. Theriault, L. J. Fine, and D. H. Wegman. 1974. Chronic effect of fire fighting on pulmonary function. New England Journal of Medicine 291(25):1320-1322.

Prezant, D. J., A. Dhala, A. Goldstein, D. Janus, F. Ortiz, T. K. Aldrich, and K. J. Kelly. 1999. The incidence, prevalence, and severity of sarcoidosis in New York City firefighters. Chest 116(5):1183-1193.

Proctor S.P., T. Heeren, R. F. White, J. Wolfe, M. S. Borgos, J. D. Davis, L. Pepper, R. Clapp, P. B. Sutker, J. J. Vasterling, and D. Ozonoff. 1998. Health status of Persian Gulf War veterans: Self-reported symptoms, environmental exposures and the effect of stress. International Journal of Epidemiology 27(6):1000-1010.

Rosenstock, L., P. Demers, N. J. Heyer, and S. Barnhart. 1990. Respiratory mortality among firefighters. British Journal of Industrial Medicine 47(7):462-465.

Rydhstroem, H. 1998. No obvious spatial clustering of twin births in Sweden between 1973 and 1990. Environmental Research 76(1):27-31.

Sama, S. R., T. R. Martin, L. K. Davis, and D. Kriebel. 1990. Cancer incidence among Massachusetts firefighters, 1982-1986. American Journal of Industrial Medicine 18(1):47-54.

Sardinas, A., J. W. Miller, and H. Hansen. 1986. Ischemic heart disease mortality of firemen and policemen. American Journal of Public Health 76(9):1140-1141.

Schnitzer, P. G., A. F. Olshan, and J. D. Erickson. 1995. Paternal occupation and risk of birth defects in offspring. Epidemiology 6(6):577-583.

Serra, A., F. Mocci, and F. S. Randaccio. 1996. Pulmonary function in Sardinian fire fighters. American Journal of Industrial Medicine 30(1):78-82.

Shy, C. M., D. Degnan, D. I. Fox, S. Mukerjee, M. J. Hazucha, B. A. Boehlecke, D. Rothenbacher, P. M. Briggs, R. B. Devlin, D. D. Wallace, R. K. Stevens, and P. A. Bromberg. 1995. Do waste incinerators induce adverse respiratory effects? An air quality and epidemiological study of six communities. Environmental Health Perspectives 103(7-8):714-724.

Smith, T. C., J. M. Heller, T. I. Hooper, G. D. Gackstetter, and G. C. Gray. 2002. Are Gulf War veterans experiencing illness due to exposure to smoke from Kuwaiti oil well fires? Examination of Department of Defense hospitalization data. American Journal of Epidemiology 155(10):908-917.

Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Sparrow, D., R. Bosse, et al. 1982. The effect of occupational exposure on pulmonary function: a longitudinal evaluation of fire fighters and nonfire fighters. American Review of Respiratory Disease 125(3):319-322.

Spencer, P. S., L. A. McCauley, J. A. Lapidus, M. Lasarev, S. K. Joos, and D. Storzbach. 2001. Self-reported exposures and their association with unexplained illness in a population-based case-control study of Gulf War veterans. Journal of Occupational and Environmental Medicine 43(12):1041-1056.

Tango, Toshiro, Toshiharu Fujita, Takeo Tanihata, Masumi Minowa, Yuriko Doi, Noriko Kato, Shoichi Kunikane, Iwao Uchiyama, Masaru Tanaka, and Tetsunojo Uehata. 2004. Risk of adverse reproductive outcomes associated with proximity to municipal solid waste incinerators with high dioxin emission levels in Japan. Journal of Epidemiology 14(3):83-93.

Tepper, A., G. W. Comstock, and M. Levine. 1991. A longitudinal study of pulmonary function in fire fighters. American Journal of Industrial Medicine 20(3):307-316.

Tornling, G., P. Gustavsson, and C. Hogstedt. 1994. Mortality and cancer incidence in Stockholm fire fighters. American Journal of Industrial Medicine 25(2):219-228.

Unger, K. M., R. M. Snow, J. M. Mestas, and W. C. Miller. 1980. Smoke inhalation in firemen. Thorax 35(11):838-842.

Unwin, C., N. Blatchley, W. Coker, S. Ferry, M. Hotopf, L. Hull, K. Ismail, I. Palmer, A. David, and S. Wessely. 1999. Health of UK servicemen who served in Persian Gulf War. Lancet 353(9148):169-178.

Vena, J. E., and R. C. Fiedler. 1987. Mortality of a municipal-worker cohort: IV. Fire fighters. American Journal of Industrial Medicine 11(6):671-84.

Verret, C., M. A. Jutand, C. De Vigan, M. Begassat, L. Bensefa-Colas, P. Brochard, and R. Salamon. 2008. Reproductive health and pregnancy outcomes among French gulf war veterans. Biomed Central Public Health 8:141.

Viel, J. F., P. Arveux, J. Baverel, and J. Y. Cahn. 2000. Soft-tissue sarcoma and non-Hodgkin’s lymphoma clusters around a municipal solid waste incinerator with high dioxin emission levels. American Journal of Epidemiology 152(1):13-19.

Viel, Jean-Francois, Come Daniau, Sarah Goria, Pascal Fabre, Perrine de Crouy-Chanel, Erik-Andre Sauleau, and Pascal Empereur-Bissonnet. 2008a. Risk for non Hodgkin’s lymphoma in the vicinity of French municipal solid waste incinerators. Environmental Health: A Global Access Science Source 7:51.

Vinceti, M., C. Malagoli, S. Teggi, S. Fabbi, C. Goldoni, G. De Girolamo, P. Ferrari, G. Astolfi, F. Rivieri, and M. Bergomi. 2008. Adverse pregnancy outcomes in a population exposed to the emissions of a municipal waste incinerator. Science of the Total Environment 407(1):116-121.

White, R. F., S. P. Proctor, T. Heeren, J. Wolfe, M. Krengel, J. Vasterling, K. Lindem, K. J. Heaton, P. Sutker, and D. M. Ozonoff. 2001. Neuropsychological function in Gulf War veterans: relationships to self-reported toxicant exposures. American Journal of Industrial Medicine 40(1):42-54.

Williams, F. L., A. B. Lawson, and O. L. Lloyd. 1992. Low sex ratios of births in areas at risk from air pollution from incinerators, as shown by geographical analysis and 3-dimensional mapping. International Journal of Epidemiology 21(2):311-319.

Wolfe, J., S. P. Proctor, D. J. Erickson, and H. Hu. 2002. Risk factors for multisymptom illness in U.S. Army veterans of the Gulf War. Journal of Occupational and Environmental Medicine 44(3):271-81.

Young, I., J. Jackson, and S. West. 1980. Chronic respiratory disease and respiratory function in a group of fire fighters. Medical Journal of Australia 1(13):654-658.

Zambon, P., P. Ricci, E. Bovo, A. Casula, M. Gattolin, A. R. Fiore, F. Chiosi, and S. Guzzinati. 2007. Sarcoma risk and dioxin emissions from incinerators and industrial plants: a population-based case-control study (Italy). Environmental Health: A Global Access Science Source 6:19.

Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Suggested Citation:"Appendix C: Epidemiologic Studies Cited in Chapter 6: Health Outcomes." Institute of Medicine. 2011. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Washington, DC: The National Academies Press. doi: 10.17226/13209.
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Many veterans returning from the conflicts in Iraq and Afghanistan have health problems they believe are related to their exposure to the smoke from the burning of waste in open-air "burn pits" on military bases. Particular controversy surrounds the burn pit used to dispose of solid waste at Joint Base Balad in Iraq, which burned up to 200 tons of waste per day in 2007. The Department of Veterans Affairs asked the IOM to form a committee to determine the long-term health effects from exposure to these burn pits. Insufficient evidence prevented the IOM committee from developing firm conclusions. This report, therefore, recommends that, along with more efficient data-gathering methods, a study be conducted that would evaluate the health status of service members from their time of deployment over many years to determine their incidence of chronic diseases.

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