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6 Analysis and Interpretation of Registry Health Outcome Data
Pages 129-156

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From page 129... ... The chapter begins with a description of the health outcomes data collected from the registry questionnaire and an assessment of the scientific validity of the collected information. Using that information and the results of previous reports and epidemiological studies on burn pit exposures and health effects, the committee addresses the conditions and diseases that are the most plausibly affected by exposures to burn pits and other airborne hazards that might have been experienced during deployment to the Southwest Asia theater of operations. Read the entire page →
From page 130... ... Second, the committee considers the time since exposure to have been too short and the mean age of both the respondents and eligible populations of Gulf War and post-9/11 veterans to be too young for the development of most cancers that could be due to airborne hazards or open burn pit–related pollutants. Read the entire page →
From page 131... ... Strategies for Assessing Self-Reported Health Information The committee applied multiple methods to both directly and indirectly examine the characteristics, attributes, and quality of the registry health data. Direct methods included analyses to check for internal consistency of the questionnaire; indirect methods included reviewing published comparisons of analyses using registry data and the Department of Veterans Affairs (VA) Read the entire page →
From page 132... ... In both the self-report and VA medical record analyses, no dose–response associations were found between cumulative days of deployment near a documented burn pit and the incidence of asthma, hypertension, or cardiovascular disease. When the number of self-reported hours per day of burn pit smoke was used as the exposure measure in place of days deployed near a burn pit, the associations with self-reported hypertension and the combined respiratory outcome of emphysema, chronic bronchitis, or COPD were strong and larger. Read the entire page →
From page 133... ... . There were too few nonsmokers who reported no exposures to burn pits or other airborne hazards to use that group as a comparison to isolate the effect of airborne exposures on respiratory or cardiovascular outcomes. Read the entire page →
From page 134... ... This likewise suggests reasonable internal consistency of the questionnaire. HEALTH CONDITIONS USED IN ANALYSES The committee focused on the following health outcomes for its analysis: • Asthma • Functional limitation due to lung or breathing problem • Emphysema/chronic bronchitis/COPD • Any respiratory symptom • Hypertension • Coronary artery disease (CAD) Read the entire page →
From page 135... ... 1,609 (3.5%) angina, or MI NOTE: CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; MI = myocardial infarction. Read the entire page →
From page 136... ... 11,297 (89.9%) Any cardiovascular conditions (N = 17,168) Read the entire page →
From page 137... ... Table 6-7 shows the number and percentage of respondents by demographic and other attributes who did and did not report a diagnosis of each health outcome category. Table 6-8 shows the odds ratios, upper and lower confidence limits, and p-values for each demographic category by health outcome. Read the entire page →
From page 138... ... TABLE 6-7 Number and Percent of Health Outcomes Reported During or After Deployment by Demographic Categories 138 Asthma Emphysema, Chronic Bronchitis, or COPD Any Respiratory Symptoms Functional Limitation Due to Lung Problem Yes No Missing Yes No Missing Yes No Yes No Missing N % N % N % N % N % N % N % N % N % N % N % Total 5,861 13.0 37,189 82.4 2,088 4.6 6,470 14.3 35,286 78.2 3,382 7.5 34,533 74.4 11,871 25.6 11,899 25.6 34,194 73.7 311 0.7 Sex Male 4,873 12.1 33,487 83.2 1,871 4.7 5,435 13.5 31,749 78.9 3,047 7.6 30,723 74.3 10,622 25.7 10,487 25.4 30,582 74.0 276 0.7 Female 912 20.1 3,425 75.6 192 4.2 939 20.7 3,292 72.7 298 6.6 3,498 74.8 1,180 25.2 1,295 27.7 3,351 71.6 32 0.7 Missing 76 20.1 277 73.3 25 6.6 96 25.4 245 64.8 37 9.8 312 81.9 69 18.1 117 30.7 261 68.5 3 0.8 Age at questionnaire completion (years) <30 914 11.9 6,364 83.2 373 4.9 985 12.9 6,117 80.0 549 7.2 5,838 73.8 2,068 26.2 2,006 25.4 5,842 73.9 58 0.7 30–39 2,159 12.4 14,505 83.0 816 4.7 2,162 12.4 14,045 80.3 1,273 7.3 13,254 73.7 4,729 26.3 4,460 24.8 13,392 74.5 131 0.7 40–49 1,922 13.7 11,478 81.9 619 4.4 2,202 15.7 10,693 76.3 1,124 8.0 10,685 74.4 3,682 25.6 3,724 25.9 10,551 73.4 92 0.6 50–59 749 14.4 4,210 80.9 246 4.7 979 18.8 3,861 74.2 365 72.0 4,134 77.3 1,212 22.7 1,474 27.6 3,847 72.0 25 0.5 ≥60 117 14.9 632 80.7 34 4.3 142 18.1 570 72.8 71 9.1 622 77.6 180 22.4 235 29.3 562 70.1 5 0.6 Race White 3,447 11.7 24,666 83.9 1,269 4.3 3,865 13.2 23,567 80.2 1,950 6.6 22,248 73.6 7,966 26.4 7,762 25.7 22,231 73.6 221 0.7 Black 640 17.5 2,818 77.2 190 5.2 710 19.5 2,590 71.0 348 9.5 2,858 75.7 915 24.3 980 26.0 2,774 73.5 19 0.5 Hispanic 490 14.9 2,599 79.0 200 6.1 443 13.5 2,491 75.7 355 10.8 2,632 78.1 740 21.9 801 23.8 2,548 75.6 23 0.7 Other 173 12.1 1,161 81.3 94 6.6 183 12.8 1,105 77.4 140 9.8 1,064 71.9 416 28.1 329 22.2 1,138 76.9 13 0.9 Missing 1,111 15.0 5,945 80.4 335 4.5 1,269 17.2 5,533 74.9 589 8.0 5,731 75.8 1,834 24.2 2,027 26.8 5,503 72.7 35 0.5 Smoking Nonsmoker 3,449 13.5 20,848 81.6 1,242 4.9 3,218 12.6 20,357 79.7 1,964 7.7 18,823 71.8 7,389 28.2 6,535 24.9 19,485 74.3 192 0.7 Former smoker 1,297 12.8 8,510 83.8 352 3.5 1,588 15.6 7,944 78.2 627 6.2 7,904 75.4 2,575 24.6 2,794 26.7 7,663 73.1 22 0.2 Current smoker 567 10.8 4,493 85.7 182 3.5 1,005 19.2 3,931 75.0 306 5.8 4,501 83.0 919 17.0 1,463 27.0 3,948 72.8 9 0.2 Missing 548 13.1 3,338 79.5 312 7.4 659 15.7 3,054 72.7 485 11.6 3,305 77.0 988 23.0 1,107 25.8 3,098 72.2 88 2.0 Body mass index Underweight/ 784 10.4 6,407 85.3 316 4.2 859 11.4 6,135 81.7 513 6.8 5,268 68.1 2,467 31.9 1,669 21.6 6,003 77.6 63 0.8 Normal Overweight 2,478 11.4 18,300 84.3 943 4.3 2,746 12.6 17,425 80.2 1,550 7.1 16,035 71.9 6,272 28.1 5,351 24.0 16,818 75.4 138 0.6 Obese 2,455 16.5 11,758 78.9 686 4.6 2,688 18.0 11,081 74.4 1,130 7.6 12,470 81.3 2,863 18.7 4,618 30.1 10,666 69.6 49 0.3 Missing 144 14.2 724 71.6 143 14.1 177 17.5 645 63.8 189 18.7 760 73.9 269 26.1 261 25.4 707 68.7 61 5.9 Read the entire page →
From page 139... ... CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; MI = myocardial infarction. Read the entire page →
From page 140... ... Former smoker 1.0 0.9 1.0 0.26 1.3 1.2 1.4 * Read the entire page →
From page 141... ... 2.0 1.4 3.0 * NOTE: LCL = lower confidence level; OR = odds ratio; ref = reference group; UCL = upper confidence level. Read the entire page →
From page 142... ... Sample sizes differed across models and ranged from 32,178 for construction exposure and emphysema, chronic bronchitis, or COPD to 39,271 for each of the three burn pit metrics (cumulative days near a burn pit, cumulative days of burn pit duties, and cumulative hours of exposure to smoke from burn pits) and any respiratory symptoms. Read the entire page →
From page 143... ... 2.5 2.0 1.5 Odds Ratio 1.0 0.5 0.0 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Asthma Emphysema, Any respiratory Functional Hypertension CAD, MI, or chronic symptoms limitation angina pectoris bronchitis, or due to lung COPD problem Cumulative Days Near a Burn Pit FIGURE 6-1a Adjusted odds ratios for health cutcomes by quartile levels of exposure for cumulative days near a burn pit. NOTE: CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; MI = myocardial infarction. Read the entire page →
From page 144... ... 2.5 2.0 1.5 Odds Ratio 1.0 0.5 0.0 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Asthma Emphysema, Any respiratory Functional Hypertension CAD, MI, or chronic symptoms limitation angina pectoris bronchitis, or due to lung COPD problem Cumulative Hours of Burn Pit Smoke Exposure FIGURE 6-1c Adjusted odds ratios for health outcomes by quartile levels of exposure for cumulative hours exposed to smoke from burn pits. NOTE: CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; MI = myocardial infarction. Read the entire page →
From page 145... ... 1.6 1.4 1.2 1.0 Odds Ratio 0.8 0.6 0.4 0.2 0.0 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Asthma Emphysema, Any respiratory Functional Hypertension CAD, MI, or chronic symptoms limitation angina pectoris bronchitis, or due to lung COPD problem Implausible Cumulative Days Near a Burn Pit FIGURE 6-2b Adjusted odds ratios for health outcomes by quartile levels of exposure for implausible cumulative days near a burn pit. NOTE: CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; MI = myocardial infarction. Read the entire page →
From page 146... ... 1.8 1.6 1.4 1.2 Odds Ratio 1.0 0.8 0.6 0.4 0.2 0.0 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Asthma Emphysema, Any respiratory Functional Hypertension CAD, MI, or chronic symptoms limitation angina pectoris bronchitis, or due to lung COPD problem Implausible Cumulative Days with Burn Pit Duty FIGURE 6-2d Adjusted odds ratios for health outcomes by quartile levels of exposure for implausible cumulative days of burn pit duty. NOTE: CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; MI = myocardial infarction. Read the entire page →
From page 147... ... Plausible smoke hours showed showed positive, strong associations with all the respiratory and cardiovascular conditions categories, and the tests for trend were all also statistically significant. Associations between the five exposure category variables (burn pits, diesel/exhaust/fuel, construction, dust, and combat) Read the entire page →
From page 148... ... 4.0 3.5 3.0 2.5 Odds Ratio 2.0 1.5 1.0 0.5 0.0 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 Asthma Emphysema, Any respiratory Functional Hypertension CAD, MI, or chronic symptoms limitation angina pectoris bronchitis, or due to lung COPD problem Diesel/Exhaust/Fuel Exposure FIGURE 6-3b Adjusted odds ratios for health outcomes by levels of diesel/exhaust/fuel exposure. NOTE: CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; MI = myocardial infarction. Read the entire page →
From page 149... ... 4.0 3.5 3.0 2.5 Odds Ratio 2.0 1.5 1.0 0.5 0.0 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 Asthma Emphysema, Any Functional Hypertension CAD, MI, or chronic respiratory limitation angina bronchitis, or symptoms due to lung pectoris COPD problem Dust Exposure FIGURE 6-3d Adjusted odds ratios for health outcomes by levels of dust exposure. NOTE: CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; MI = myocardial infarction. Read the entire page →
From page 150... ... 3.0 2.5 2.0 Odds Ratio 1.5 1.0 0.5 0.0 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q4 Asthma Emphysema, Any Functional Hypertension CAD, MI, or chronic respiratory limitation angina bronchitis, or symptoms due to lung pectoris COPD problem Composite Exposure FIGURE 6-4 Adjusted odds ratios for health outcomes by levels of composite exposure potential measure. NOTE: CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; MI = myocardial infarction. Read the entire page →
From page 151... ... The relationship was relatively monotonic. These findings suggest that the statistical relationships between self-reported exposure to airborne hazards and the prevalence of self-reported health outcomes in the registry responses are biased toward TABLE 6-9 Associations Between Asbestos and Selected Health Outcomes Neurological Conditions Immune Problems Liver Conditions N = 36,399 N = 30,759 N = 36,883 Asbestos Years (5.5.A and [Median 5.5.C) Read the entire page →
From page 152... ... population and are not unexpected, based on the respondents' age range and other demographic factors. Empirically, among registry respondents, the overall and stratified prevalence of self-reported respiratory and cardiovascular conditions differed by health outcome, but all were statistically significantly associated with exposure to burn pits and other potentially harmful deployment exposures. Read the entire page →
From page 153... ... Third, limitations in the registry data constrain the analyses to suggest, at most, where epidemiologic studies are needed to quantify, confirm, or refute the associations between exposures and health outcomes. It is clear from the registry responses and comments from veterans service organizations that some service members and veterans with burn pit and other airborne exposures from deployment to Southwest Asia are experiencing serious health effects. Read the entire page →
From page 154... ... Analyses of plausible and implausible exposure to burn pits based on the country of deployment were conducted using three burn pit exposure metrics. For cumulative days deployed near a burn pit, many of the point estimates for quartiles of plausible exposure were lower than the point estimates for the same disease category for implausible exposure. Read the entire page →
From page 155... ... Thus, the committee recommends that other means for evaluating the potential health effects associated with airborne hazards and open burn pit exposures be developed, such as a well-designed epidemiologic study. The 2011 Institute of Medicine report Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan contains advice and recommendations on how such a study might be conducted. Read the entire page →
From page 156... ... 2016. Burn pit emissions exposure and respiratory and cardiovascular conditions among Airborne Hazards and Open Burn Pit Registry participants. Read the entire page →

From page 129...

... The chapter begins with a description of the health outcomes data collected from the registry questionnaire and an assessment of the scientific validity of the collected information. Using that information and the results of previous reports and epidemiological studies on burn pit exposures and health effects, the committee addresses the conditions and diseases that are the most plausibly affected by exposures to burn pits and other airborne hazards that might have been experienced during deployment to the Southwest Asia theater of operations.

6 Analysis and Interpretation of Registry Health Outcome Data Pages 129-156

6 Analysis and Interpretation of Registry Health Outcome Data
Pages 129-156