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Oral Session 7 – Veterans’ health

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O7.1 EPIDEMIOLOGICAL STUDIES TO EXPLORE THE HEALTH OF PORTON DOWN VETERANS: STUDY DESIGN AND RESULTS FROM THE PILOT PHASE

K. M. Venables, L. M. Carpenter, T. Keegan, S. Allender, C. Brooks, V. Beral, M. J. Nieuwenhuijsen1, P. Doyle2, N. Maconochie2, T. Fletcher2.Department of Public Health, University of Oxford, Oxford, UK; Imperial College1, London, UK; London School of Tropical Medicine & Hygiene2, UK

Introduction: The UK has carried out trials relating to chemical warfare (CW) defence (the “human volunteer programme”) since the First World War at a facility at Porton Down. A wide variety of CW agents was used, including nerve agents and vesicants. Most participants were servicemen, and recently veterans have raised concerns about potential longterm health effects. Two studies have been commissioned by the UK Medical Research Council: (a) a cohort study of mortality and cancer incidence and (b) a symptoms survey of a group of veterans. We report their design, and also results from an initial 12 month pilot phase. The approach to detailed exposure assessment is reported separately.

Methods and Results: (a) The Porton Down cohort consists of all those participating in the “human volunteer programme” during 1939–89 and is believed to total 19 492. Of these, 35% were exposed in the 1940s, 33% in the 1950s, 12% in the 1960s, 12% in the 1970s, and 8% in the 1980s. Personal identifiers, such as date of birth and military service number, are currently being assembled from military personnel files. The pilot phase assessed the feasibility of assembling a control cohort using the neighbouring service number to the Porton Down cohort members. This gave comparability in age, sex, branch of the military, and military rank. Both cohorts are being submitted to the UK Office for National Statistics. The pilot phase suggests that a trace rate of at least 80% will be achieved. Progress to date will be presented. (b) In the survey, the 436 members of the Porton Down Veterans Support Group were mailed a questionnaire on current health and past illnesses. Up to three mailings were sent in 2003. Of the 436 questionnaires, 280 (64%) were returned.

Conclusions: A cohort study of veterans potentially exposed to CW agents during trials at Porton Down is feasible and has now started, and a survey of a group of living veterans has been completed.

O7.2 MORTALITY AND CANCER INCIDENCE IN AUSTRALIAN KOREAN WAR VETERANS

W. Harrex1, P. Trickett2, K. W. A. Horsley1, E. J. Wilson1, R. van der Hoek2, I. Pieris-Caldwell2.1Australian Government Department of Veterans’ Affairs, Canberra, ACT, Australia; 2Australian Institute of Health and Welfare, Canberra, ACT, Australia

Introduction: Over 17 000 Australian Defence Force personnel served in the Korean War between June 1950 and April 1956. Conditions during the war were harsh, with extremes in climate and exposure to endemic infectious agents and high levels of chemicals. This study describes the mortality and cancer incidence experience for Australian male Korean War veterans.

Methods: A nominal roll of male Korean War veterans was matched against national databases to determine vital status, mortality cause and cancer incidence. Mortality was determined from 1950 to 2000. Cancer incidence was determined from 1982 to 1999. Standardised mortality and cancer incidence rates were calculated using the person year method.

Results: Of the 17 464 veterans included in the study, 7514 deaths were identified and 5.1% were lost to follow up. Korean War veterans experienced a 21% higher mortality rate than an equivalent Australian male population (standardised mortality ratio (SMR) 1.21; 95% confidence interval (CI) 1.18 to 1.24). Death rates from external causes (SMR 1.37; 1.27 to 1.46), digestive (SMR 1.35; 1.20 to 1.50) respiratory (SMR 1.32; 1.21 to 1.42), neoplasms (SMR 1.31; 1.26 to 1.36), and circulatory system diseases (SMR 1.13; 1.09 to 1.17) were higher than controls. Mortality from cancers of the head and neck, larynx, oesophagus, unknown primary, lung, prostate, and colorectum was also higher. Among the service branches, Army veterans had the highest overall mortality (31% higher), followed by the Navy (11% higher); in contrast, the Air Force had an 11% lower mortality. Between 1982 and 1999, 3543 cancers were identified. For this period, the incidence of cancer among Korean War veterans was higher than the Australian male population (standardised incidence ratio (SIR) 1.23; 1.19 to 1.27). Cancer incidence was higher for cancers of the lung, head and neck, larynx, oesophagus, colorectum, and prostate, and for melanoma. Army and Navy veterans both had a 25% rise in cancer incidence. In addition, Army veterans experienced a significant rise in liver cancer (SIR 1.78; 1.12 to 2.43). Air Force veterans did not show a rise in cancer incidence.

Conclusions: This study has shown that Australian male Korean War veterans experienced elevated mortality and cancer incidence. Army and Navy personnel were most affected.

O7.3 CANCER INCIDENCE IN AUSTRALIAN VIETNAM VETERANS

E. J. Wilson1, R. van der Hoek2, K. W. A. Horsley1.1Australian Government Department of Veterans’ Affairs, Canberra, ACT, Australia; 2Australian Institute of Health and Welfare, Canberra, ACT, Australia

Introduction: Nearly 60 000 personnel of the Australian defence forces participated in the Vietnam Conflict from 1962 to 1973. More than 76 million litres of dioxin contaminated herbicide were sprayed in Vietnam during this time. This paper reviews cancer incidence and mortality in Vietnam veterans from previous studies, and describes the methods used for a cancer incidence study currently in progress and the first cancer incidence study of Vietnam veterans from all three service branches.

Methods: The literature was reviewed to assess the cancer mortality and incidence in Vietnam veterans in preparation for the cancer incidence study of Australian Vietnam veterans. An existing nominal roll of Vietnam veterans was augmented through evaluation of historical documents. The nominal roll was matched against several national databases to determine vital status and cancer incidence. The databases from the following agencies or sources were used: National Death Index for 1980–2003, Australian Electoral Commission, DVA, Health Insurance Commission, Cancer Registry, and Department of Immigration and Multicultural Affairs data, and hand searching of state Births, Deaths, and Marriages registries for pre-1980 deaths. All notifiable cases of cancer between 1982 and 2000 were identified for the cohort.

Results: A previous study of cancer incidence in Australian Vietnam veterans completed in 1992 showed elevation in relative risk for pancreatic, lung, and brain cancer for the National Service subset of Army veterans. A mortality study published in 1997 showed overall mortality from neoplasms was higher (standardised mortality rate 1.21; 95% confidence interval (CI) 1.11 to 1.31) among military veterans. For the present cancer incidence study, over 1000 newly identified veterans have been added to the nominal roll. The military cohort of Vietnam veterans is 59 179; by service branch: Army 41 084, Navy 13 538 and Air Force 4570. Vital status was obtained for over 97% of the cohort, and 4623 cancers were identified among the cohort for the study period of 1980–2000.

Conclusions: Previous studies show cancer incidence and mortality is higher among Vietnam veterans and the current study will test this trend. New veterans continue to be identified through historical research.

O7.4 RESPIRATORY HEALTH STATUS OF AUSTRALIAN GULF WAR VETERANS AND THE EFFECTS OF OIL WELL FIRE SMOKE AND DUST STORM EXPOSURE

H. L. Kelsall, M. R. Sim, A. B. Forbes, D. P. McKenzie, D. C. Glass, J. F. Ikin, P. Ittak, M. J. Abramson.Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

Introduction: Since the 1991 Gulf War, concerns have been raised about the effects on Gulf War veterans’ health of exposure to smoke from Kuwaiti oil well fires and to dust storms.

Methods: Our cross sectional study compared 1456 Australian Gulf War veterans and a randomly sampled military comparison group (n = 1588) who were in operational units at the time of the 1991 Gulf War but were not deployed. A postal questionnaire asked about respiratory conditions, exposures, medications, tobacco use, demographics, and military service details. Spirometry and physical examination were performed and a respiratory questionnaire administered during medical assessment.

Results: The response rate for the Gulf War veteran group was 80.5% and for the comparison group 56.8%. We found that Australian Gulf War veterans have a higher than expected prevalence of respiratory symptoms, respiratory conditions suggesting asthma (odds ratio (OR) 1.4; 95% confidence interval (CI) 1.1 to 1.9), and bronchitis first diagnosed since the Gulf War (OR 1.9; 95% CI 1.2 to 3.1). However, veterans do not have poorer lung function or more ventilatory abnormalities than the comparison group. Veterans exposed to smoke from oil well fires have slightly poorer forced vital capacity (difference between means −0.10 litres; 95% CI −0.18 to −0.03) and those exposed to dust storms have slightly better PEFR (difference between means 12.0 l/min; 95% CI 0.6 to 23.4) than veterans who were not exposed. Veterans who were in the Gulf at or after the start of the oil well fires have an increase in respiratory conditions suggesting asthma (OR 1.7; 95% CI 1.0 to 2.9) compared with veterans who completed their deployment prior to this time.

Conclusions: Increased selfreporting of respiratory symptoms, asthma, and bronchitis by Gulf War veterans was not reflected in poorer lung function, and our findings do not suggest major long term sequelae of oil well fire smoke or dust storm exposure in this setting.

O7.5 THE SHOAMP (STUDY OF HEALTH OUTCOMES IN AIRCRAFT MAINTENANCE PERSONNEL) CANCER INCIDENCE AND MORTALITY STUDY

M. Guest1, J. Attia1, C. D’Este1, T. Brown2, J. Byles3.1Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, NSW, Australia; 2Population Health, Macquarie Area Health Service, Dubbo, NSW, Australia; 3Centre for Research and Education in Ageing, University of Newcastle, Callaghan, NSW, Australia

Introduction: A cancer incidence study was undertaken to determine if there was evidence to support the anecdotal reports of adverse health problems, including cancer, in aircraft maintenance personnel who undertook deseal/reseal activities on the Australian Air Force’s F-111 aircraft at Amberley Air Base. The deseal/reseal process required the personnel to enter the fuel tanks where there was excessive exposure to formulations containing solvents such as methyl ethyl ketone, toluene (aromatic naptha), thiophenol, and propolylene glycol (monomethyl ether acetate). This would also apply to primers and sealants containing chromates, unreacted isocyanates, and curing agents.

Methods: A study population of 873 exposed personnel and 16 985 comparison personnel were matched to Australian National Cancer Statistics Clearing House database to ascertain if a person had been diagnosed with a registrable cancer. The status was determined from 1983 to 2000. Relative risks were calculated for specific cancers on the basis of the comparison populations. Hazard ratios were calculated using survival analysis to account for time to first cancer. Standardised mortality ratios were calculated for specific cancers on the basis of the national reference rates.

Results: The analysis is ongoing at this time and results will be presented in the oral presentation.

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