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Veterans and Agent Orange: Update 2014 (2016)

Chapter: 5 Epidemiologic Studies: Compendium of New Publications

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Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

5

Epidemiologic Studies:
Compendium of New Publications

The continuing effort to evaluate and integrate epidemiologic studies pertinent to the possible health effects of the chemicals of interest (COIs)—2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) and its contaminant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), 4-amino-3,5,6-trichloropicolinic acid (picloram), and dimethyl arsenic acid (DMA or cacodylic acid)—has involved the review of thousands of publications over successive reports (the original retrospective report, nine updates prior to the current report, and three short reports on single issues, as delineated in Chapter 1). The search strategy used to identify these publications is described in Chapter 2, along with explanations of the various refinements that have been employed since the initial volume in this series was prepared.

This chapter tabulates publications of primary epidemiologic research that appeared in the period from October 1, 2012 (the closing date for inclusion in Update 2012 [IOM, 2014]), through September 30, 2014, as a compendium of the new information on human health outcomes considered by the present committee. In this chapter and later chapters, epidemiologic studies are organized into categories according to the populations being studied (Vietnam veterans, occupational populations other than Vietnam veterans, and nonoccupational populations affected by environmental exposures) or by study design (case-control). The various study designs (the most relevant being cohort, case-control, and cross-sectional) have strengths and weaknesses that influence their potential to contribute evidence considered in the health-outcomes chapters.

Design information on populations that are the subject of multiple references in this and earlier Veterans and Agent Orange (VAO) reviews—including new studies of populations that have been studied previously and studies of new

Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

populations that had multiple health outcomes—is provided in the next chapter “Epidemiology Studies: Background on Multiply Referenced Populations,” along with committee commentary. This integrative approach has been taken to avoid repeating design information in multiple health-outcomes chapters and to make evident to the reader the extensive degree of interrelationship among many of the published analyses that have been reviewed in the course of the VAO series. (Design information on the studies of new populations that involve single health outcomes is provided in the various health-outcomes chapters.)

In addition to reviewing studies involving exposures to the specific COIs listed previously, this and earlier VAO committees have considered studies that examined compounds chemically related to the herbicides used in Vietnam, such as 2-(2-methyl-4-chlorophenoxy) propionic acid, hexachlorophene, and chlorophenols, particularly 2,4,5-trichlorophenol. Some publications did not indicate the specific herbicides or polychlorinated biphenyls (PCBs) with dioxin-like toxic actions to which study participants were exposed or the magnitude of exposure; those limitations were considered when the committee weighed the relevance of each publication, as detailed in Chapter 2. The committee considers studies of exposure to PCBs and other dioxin-like compounds (DLCs) informative if their results were reported in terms of TCDD toxic equivalents (TEQs) or concentrations of specific congeners of DLCs. The available details of the exposure assessment and the use of the resulting data in analyses are discussed in Chapter 3, which follows the same sequence to categorize the study populations.

NEW EPIDEMIOLOGIC PUBLICATIONS

The new epidemiologic publications reviewed by the committee for this update are listed in Tables 5-1, 5-2, and 5-3. The conditions listed in the “Health Outcomes Reported” columns are indicative of the chapters in which the new publications are considered. Note, however, that studies assessing the occurrence of various cancers after exposure scenarios that are temporally comparable with exposure during military service are discussed in Chapter 8, which addresses cancer outcomes as applicable to the veterans themselves. Studies of childhood cancers in relation to parental exposure to the COIs are discussed in Chapter 10, which addresses possible adverse effects in veterans’ offspring. Cancer studies that consider only childhood exposure are not considered relevant to the committee’s charge.

Publications Reporting a Single Health Outcome in New Populations

The new publications reporting a single health outcome in populations not studied previously are listed in Table 5-1 with an indication of the outcomes. Descriptions and critiques of the designs of the studies are provided in the sections of the report that discuss the results related to particular health outcomes. The

Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

TABLE 5-1 Publications Reporting a Single Health Outcome in New Populations

Author Study Design Exposure Measure(s) Having Results Health Outcome(s) Reported Study Population
Studies of Vietnam Veterans
Ansbaugh et al., 2013 Cohort “Agent Orange” as per US Department of Veterans Affairs designation Prostate cancer 2,720 veterans referred to the Portland Veterans Affairs Medical Center
Li Q et al., 2013 Cohort Dioxin-TEQ levels measured in abdominal subcutaneous fat Prostate cancer, biochemical recurrence after radical prostatectomy 93 Vietnam veterans who underwent radical prostatectomy, median of 5.3 yrs of post-operative follow-up
Environmental Studies
Delvaux et al., 2014 Cohort EDCs, including dioxin (TEQs) and non-dl PCBs in cord blood Prenatal exposure to EDCs and body composition at 7–9 years of age Flemish children; part of the Flemish Environment and Health Study
Ferguson et al., 2012 Cohort POPs in serum (including dl-PCBs 77, 105, 118, 156, 170, 180) Reproductive hormones Male partners (aged 18–51), in subfertile couples seeking infertility evaluation and treatment at Massachusetts General Hospital (01/2000–05/2003)
Gauthier et al., 2014 Cross-sectional OCDD and dl-PCBs (including PCBs 105, 118, 156, 157, 189) Fasting plasma levels (pg/ml) from nondiabetic, obese, post-menopausal women “Metabolically healthy” vs 40 “metabolically abnormal” women from Montreal, categorized on the basis of insulin sensitivity
Hansen et al., 2014 Cohort PCB congeners (including dl-PCBs 118, 156, 170, 180) Asthma in offspring to mothers exposed to POPs 965 women; 20-year follow-up to the Danish Fetal Origins 1988–1989 Cohort in Aarhus, Denmark
Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Author Study Design Exposure Measure(s) Having Results Health Outcome(s) Reported Study Population
Kim et al., 2013 Cross-sectional PCB congeners Free t3, total T3, free T4, total T4, TSH 138 pregnant women from 5 Korean hospitals
Medehouenou et al., 2014 Cohort OC pesticides and PCBs measured in plasma, including dl-PCBs 105, 118, and 156 Dementia Canadian Study of Health and Aging, a national cohort study of Canadians 65+ years of age
Nakamoto et al., 2013 Cross-sectional PCDD/Fs, dl-PCBs, and total dioxins in blood History of disease, including asthma, atopic dermatitis, allergic rhinitis, hypertension, hyperlipidemia, diabetes, gout, thyroid and kidney disease, gastric ulcer Japanese men (1,063) and women (1,021), aged 15–76 yrs, from general population
Sioen et al., 2013 Cohort dl-compounds (including total of PCDD/Fs and dl-PCBs Prenatal exposure and behavior problems at 7–8 years of age Flemish Mother–New-Born Cohort)
Spector et al., 2014 Cross-sectional and longitudinal associations PCBs (dl-PCBs 105, 118, 156 combined) Immune function in postmenopausal women 109 postmenopausal overweight women enrolled in the Physical Activity for Total Health study, 1998–2000
Tai et al., 2013 Cohort Dioxin in breast milk Neurodevelopment in infants birth to 4 months old 216 mother-infant pairs living near the Da Nang airport in Vietnam
Valera et al., 2013a,b Cohort dl-PCB 105 Hypertensive status Inuit adults from Quebec and Greenland
Wohlfahrt-Veje et al., 2014 Cohort PCDDs, furans, and biphenyls in breast milk Exposures to dl chemicals in breast milk and early growth and serum IGF1 Copenhagen Mother Child Cohort of Growth and Reproduction; Danish children (born 1997–2001)
Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Author Study Design Exposure Measure(s) Having Results Health Outcome(s) Reported Study Population
Winneke et al., 2014 Cohort TEQs from maternal blood during gestation and milk within 3 weeks of birth Behavioural sexual dimorphism in school-age children Duisburg Cohort; 232 pregnant women 09/2000–10/2002 in Duisburg, Germany
Case-Control Studies
Cocco et al., 2012 Case-control Pesticides (including 2,4-D, phenoxys, chlorophenols, organochlorines) Lymphoma Participants in the EPILYMPH case-control study in six European countries (1998–2003)
Glass et al., 2012 Case-control Phenoxy herbicides ALL Parental occupational exposures and ALL in Australia
Metayer et al., 2013 Case-control Pesticides, including 2,4-D ALL Northern California Childhood Leukemia Study

NOTE: 2,4-D, 2,4-dichlorophenoxyacetic acid; ALL, acute lymphoblastic lymphoma; dl, dioxin-like; EDC, endocrine-disrupting chemical; OC, organochloride; OCDD, octachlorodibenzo-p-dioxin; PCB, polychlorinated biphenyl; PCDD, polychlorinated dibenzo-p-dioxin; PCDF, polychlorinated dibenzofuran; POP, persistent organic pollutant; TEQ, (total) toxic equivalent; TSH, thyroid-stimulating hormone.

publications in this table include a mix of study designs and focus principally on individual types of cancer as the primary health outcome of interest.

Publications Reporting Multiple Health Outcomes in New Populations

The new publications reporting multiple health outcomes in populations not studied previously are listed in Table 5-2 with a list of outcomes that were investigated. Comprehensive discussions of the designs of the studies are presented in Chapter 6, organized according to the type of study population. For Update 2014, six publications were identified from a new, exceptionally large epidemiological study of more than 114,000 Korean Vietnam War veterans. This study cohort is much larger in scope than all of the other published epidemiological studies conducted among Vietnam veterans. It provides results for a very large set of health outcomes, including rare conditions, as well as information on both non-fatal outcomes and cause-specific mortality. The results for new publications reporting multiple health outcomes in populations not studied previously, with

Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

TABLE 5-2 Publications on Multiple Health Outcomes in New Study Populations

Author Study Design Exposure Measures(s) Having Results Health Outcome(s) Reported Study Population
Studies of Vietnam Veterans
McBride et al., 2013 Cohort Service in Vietnam during Vietnam War Mortality and cancer experience (1988–2008) New Zealand Vietnam war veterans
Yi, 2013 Cohort Service in Vietnam during the Vietnam War Cancer incidence 1992–2003; all cancers and full spectrum individually KVHS–Korean Vietnam veterans identified using the Korea National Cancer Incidence Database
Yi and Ohrr, 2014 Cohort AO exposure using GIS-based model Cancer incidence 1992–2003; all cancers and full spectrum individually KVHS–Korean Vietnam veterans identified using the Korea National Cancer Incidence Database
Yi et al., 2014a Cohort AO exposure using GIS-based model Disease prevelance, full spectrum individually KVHS–Korean Vietnam veterans identified using Korean National Health Insurance Health claim data, January 2000–September 2005
Yi et al., 2014b Cohort AO exposure using GIS-based model Morbidity and mortality from individual cancers and various diseases KVHS–Korean Vietnam veterans with cause of death reported 1992–2005
Occupational Studies
Wang et al., 2013 Cohort PCDDs/PCDFs Lung, liver, and stomach cancer, individually Workers from an automobile foundry factory in Hubei province in China
Environmental Studies
Papadopoulou et al., 2013a Cohort Dietary intake of dioxins and dl-compounds Maternal diet and birth size Mothers enrolled in Norwegian Mother and Child Cohort Study
Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Author Study Design Exposure Measures(s) Having Results Health Outcome(s) Reported Study Population
Papadopoulou et al., 2013b Cohort dl activity in maternal blood samples at time of delivery and anogenital distance in newborns and infants Anogenital distance in newborns and children Mothers and newborns enrolled in European NewGeneris Cohort
Papadopoulou et al., 2014 Cohort dl activity in maternal blood samples at time of delivery Association between maternal diet and birth outcome Mothers enrolled in European NewGeneris Cohort
Vafeiadi et al., 2013 Cohort In utero exposure to dioxin and dl-compounds In utero exposure to dioxin and dl-compounds and anogenital distance Subset of mother–Child cohorts from NewGeneris Cohort
Vafeiadi et al., 2014 Cohort dl activity in cord blood and maternal blood samples at time of delivery dl activity in blood and birth weight, gestational age, and head circumference, Mothers and newborns enrolled in European NewGeneris Cohort

NOTE: AO, Agent Orange; dl, dioxin-like; GIS, geographic information system; KVHS, Korean Veterans Health Study; PCDD, polychlorinated dibenzo-p-dioxin; PCDF, polychlorinated dibenzofuran.

comments related to their reliability or limitations, appear in the appropriate outcome-specific sections of Chapters 713.

New Publications on Previously Studied Populations

The new publications on previously studied populations are listed in Table 5-3. The new publications are reviewed in the context of the history of publications on the same populations to take into account the fact that they are not presenting entirely new evidence, but rather enhancing a picture that has been emerging for many years.

A number of long-term studies of populations exposed to the COIs are of particular importance to the VAO project. The disease experiences of those populations are updated with the passage of time. Placing each new publication into its historical context helps the committee combine the evidence from various publications appropriately and take into consideration the interdependence of related publications. Such clusters of studies are useful in describing the course of a population’s response to an exposure, and joint consideration of an entire body

Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

TABLE 5-3 Publications on Previously Studied Populations

Author Study Design Exposure Measure(s) Having Results Health Outcome(s) Reported Study Population
Studies of Vietnam Veterans
Kang et al., 2014 Retrospective cohort US military service in Vietnam or near Vietnam Mortality 1965–2010; all cancers and specific (brain, breast, cervical, ovarian, pancreatic, respiratory, uterine), diabetes mellitus, heart disease, circulatory disease, respiratory disease, and nervous system disease US women who served in Vietnam or near-Vietnam vs non-Vietnam veteran peers in the US
ADVA, 2014a,b Cohort Vietnam veteran families Study overview, pregnancy and birth defect outcomes Vietnam veteran sons and daughters
ADVA, 2014c Cohort Vietnam veteran families Mortality patterns Vietnam veteran families
Occupational Studies
Goldner et al., 2013 Cohort 50 specific herbicides, including 2,4-D, 2,4,5-T, and 2,4,5-TP Association between thyroid disease and use of insecticides, herbicides, and fumigants/fungicides AHS (male private pesticide applicators)
Rinsky et al., 2013 Cohort Specific pesticides, inluding 2,4-D Stroke mortality AHS (male private pesticide applicators)
Saberi Hosnijeh et al., 2013a (same group as Saberi Hosnijeh et al., 2012a) Cohort TCDD Serum metabolomics pertubations Subcohort of IARC (Dutch phenoxy herbicide workers)
Saberi Hosnijeh et al., 2012b Cohort TCDD Changes in lymphocyte subsets Subcohort of IARC (Dutch phenoxy herbicide workers)
Starling et al., 2014 Cohort Pesticides (including 2,4,5-T) Diabetes AHS (wives of farmers)
Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Author Study Design Exposure Measure(s) Having Results Health Outcome(s) Reported Study Population
Environmental Studies
Bouchard et al., 2014 Chevrier et al., 2014 Cross-sectional Cohort PCB congeners Serum TCDD concentrations Cognitive function Thyroid hormone levels NHANES (1999–2002) SWHS (Seveso women 0–40 yrs old at time of accident; follow-up April 2008–December 2009)
Eskenazi et al., 2014 Cohort Serum TCDD concentrations Bone density and structure SWHS (Seveso women 0–40 yrs old at time of accident; follow-up 2008)
Everett and Thompson, 2014 Cross-sectional Dioxins and dl-PCBs (including dl-PCBs 81, 105, 118, 126, 156, 157, 167) in blood samples Diabetes nephropathy NHANES (1999–2004)
Gallagher et al., 2013 Cross-sectional dl-PCBs Serum antinuclear antibodies NHANES (2003–2004)
Krieg, 2013 Cross-sectional Pesticide metabolites in urine after 2,4-D exposure Cognitive function NHANES III
Lin et al., 2012 Cross-sectional PCDDs, PCDFs, dl-PCBs (dl-PCBs 81, 105, 118, 126, 156, 157, 167, 169, 189) in serum Cause-specific mortality through 2006 for all-causes, all cancers, and CVD NHANES (1999–2004)
Lind et al., 2013 Cross-sectional POPs (including dl-PCBs 105, 118, 126, 156, 157, 169, 189) Life-time weight change PIVUS seniors (2001–2004)
Pahwa P et al., 2012a Cohort Herbicides Chronic bronchitus Saskatchewan Rural Health Study
Peters et al., 2014 Cross-sectional dl-PCBs (dl-PCBs 81, 118, 126, 189) Blood pressure NHANES (1999–2008)
Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Author Study Design Exposure Measure(s) Having Results Health Outcome(s) Reported Study Population
ten Tusscher et al., 2014 (same cohort as Patandin et al., 1998) Cohort Pre-, peri-, and postnatal exposure to dioxin Neurodevelopmental retardation Amsterdam–Zaandam cohort; children born 1987–1991
Turunen et al., 2012 Warner et al., 2013 Cohort Cohort PCDDs, PCDFs, PCBs Serum TCDD concentrations C-reactive protein (an indicator of inflammation) Diabetes, metabolic syndrome, obesity Finnish fisherman and their wives SWHS (Seveso women 0–40 yrs old at time of accident; follow-up April 2008–December 2009)
Wesselink et al., 2014 Cohort Serum TCDD concentrations Pregnancy outcomes SWHS (Seveso women 0–40 yrs old at time of accident; follow-up 2008–2009)
Case-Control Studies
Carmichael et al., 2013 Case-control Pesticides (including 2,4-D, MCPA, Hypospadias NBDPS
Carmichael et al., 2014 Case-control cacodylic acid) Pesticides (including 2,4-D) Selected congenital birth defects NBDPS
Kachuri et al., 2013 Case-control Pesticides (including 2,4-D) Multiple myeloma CCSPH
Navaranjan et al., 2013 Case-control Herbicides, phenoxy herbicides Hodgkin lymphoma CCSPH
Pahwa P et al., 2012b Case-control Pesticides (including phenoxys, 2,4-D, MCPA) Multiple myeloma CCSPH
Shaw et al., 2014 Case-control 2,4-D Early pregnancy and risk of gastroschisis NBDPS
Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Author Study Design Exposure Measure(s) Having Results Health Outcome(s) Reported Study Population
Yang et al., 2014 Case-control 2,4-D Neural tube defects and orofacial clefts NBDPS

NOTE: 2,4-D, 2,4-dichlorophenoxyacetic acid; 2,4,5-T, 2,4,5-trichlorophenoxyacetic acid; 2,4,5-TP, 2-(2,4,5-trichlorophenoxy) propionic acid; AHS, Agricultural Health Study; CCSPH, Cross-Canada Study of Pesticides and Health; CVD, cardiovascular disease; dl, dioxin-like; IARC, International Agency for Research on Cancer; MCPA, 2-methyl-4-chlorophenoxyacetic acid; NBDPS, National Birth Defects Prevention Study; NHANES, National Health and Nutrition Examination Survey; PCB, polychlorinated biphenyl; PCDD, polychlorinated dibenzo-p-dioxin; PCDF, polychlorinated dibenzofuran; PIVUS, Prospective Study of the Vasculature in Uppsala Seniors; POP, persistent organic pollutant; SWHS, Seveso Women’s Health Study; TCDD, 2,3,7,8-tetrachlorodibenzo-p-dioxin.

of research on a population may yield insights into relationships with potential confounding factors.

Many groups potentially exposed to the COIs have been monitored periodically, including the cohorts of the International Agency for Research on Cancer (IARC) and the National Institute for Occupational Safety and Health (NIOSH); residents of Seveso; and Ranch Hand and Army Chemical Corps personnel. For the sake of completeness, the discussions of specific health outcomes and the associated cumulative-results tables in Chapters 713 include references to publications discussed in previous VAO reports and to new publications. In drawing its conclusions, the committee combined the evidence in new publications and the evidence synthesized in the most recent update (Update 2012), taking into account the interdependence of related publications. For the present update, several relevant studies of dioxin-like compounds and a range of health outcomes were identified from serum samples collected from the federally funded National Health and Nutrition Examination Survey (NHANES).

Individual researchers who belong to research consortia that are evaluating cohorts in large multicenter studies (such as the IARC and NIOSH cohort studies) sometimes publish reports based on the subsets of study participants that they themselves are monitoring. The VAO committees consider all reports that have been published, including those based on entire cohorts and those based on subcohorts. In drawing its conclusions, the committee factored in both types of studies, taking into consideration the interdependence among related studies. In particular, some subcohort studies have access to information not available for the entire cohort, such as data on individual serum TCDD concentrations and personal information that can be used to adjust for confounders of concern. Furthermore, even when the analyses based on an entire cohort would include data on a subcohort as a subset, the reports on the subcohort might provide additional information on the consistency of the relationships among subcohorts, such as

Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

whether there are important subcohort-by-exposure interaction effects, when these issues were not considered in the full-cohort studies. As long as the structures of the study populations are recognized, VAO committees have been less concerned about over-weighting unstable positive findings on small subgroups or giving “repeated consideration” to duplicative results than would be the case if a quantitative meta-analysis were being undertaken.

Many of the cohorts that have contributed to the cumulative findings of the VAO committees are no longer being followed; however, the cohorts’ histories are briefly recapitulated in the body of this report. Additional background information can be found in earlier reports in this series. The subjects of the new epidemiological studies identified include female US Vietnam veterans as well as Australian, Korean, and New Zealand veterans who served in Vietnam. These studies are augmented with a wealth of new data from civilian populations exposed to the COIs along with herbicides and pesticides with mechanistic and toxic properties similar to the COIs.

Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
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Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
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Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
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Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
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Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
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Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
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Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
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Suggested Citation:"5 Epidemiologic Studies: Compendium of New Publications." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
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From 1962 to 1971, the US military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and cacodylic acid made up the bulk of the herbicides sprayed. The main chemical mixture sprayed was Agent Orange, a 50:50 mixture of 2,4-D and 2,4,5-T. At the time of the spraying, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic form of dioxin, was an unintended contaminant generated during the production of 2,4,5-T and so was present in Agent Orange and some other formulations sprayed in Vietnam.

Because of complaints from returning Vietnam veterans about their own health and that of their children combined with emerging toxicologic evidence of adverse effects of phenoxy herbicides and TCDD, the National Academy of Sciences was asked to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange, other herbicides used in Vietnam, and the various components of those herbicides, including TCDD. Updated evaluations were conducted every two years to review newly available literature and draw conclusions from the overall evidence. Veterans and Agent Orange: Update 2014 is a cumulative report of the series thus far.

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