Objectives Characterise inhalational exposures during deployment to Afghanistan and Southwest Asia and associations with postdeployment respiratory symptoms.
Methods Participants (n=1960) in this cross-sectional study of US Veterans (Veterans Affairs Cooperative Study ‘Service and Health Among Deployed Veterans’) completed an interviewer-administered questionnaire regarding 32 deployment exposures, grouped a priori into six categories: burn pit smoke; other combustion sources; engine exhaust; mechanical and desert dusts; toxicants; and military job-related vapours gas, dusts or fumes (VGDF). Responses were scored ordinally (0, 1, 2) according to exposure frequency. Factor analysis supported item reduction and category consolidation yielding 28 exposure items in 5 categories. Generalised linear models with a logit link tested associations with symptoms (by respiratory health questionnaire) adjusting for other covariates. OR were scaled per 20-point score increment (normalised maximum=100).
Results The cohort mean age was 40.7 years with a median deployment duration of 11.7 months. Heavy exposures to multiple inhalational exposures were commonly reported, including burn pit smoke (72.7%) and VGDF (72.0%). The prevalence of dyspnoea, chronic bronchitis and wheeze in the past 12 months was 7.3%, 8.2% and 15.6%, respectively. Burn pit smoke exposure was associated with dyspnoea (OR 1.22; 95% CI 1.06 to 1.47) and chronic bronchitis (OR 1.22; 95% CI 1.13 to 1.44). Exposure to VGDF was associated with dyspnoea (OR 1.29; 95% CI 1.14 to 1.58) and wheeze (OR 1.18; 95% CI 1.02 to 1.35).
Conclusion Exposures to burn pit smoke and military occupational VGDF during deployment were associated with an increased odds of chronic respiratory symptoms among US Veterans.
- occupational health
- air pollution
- respiratory system
Data availability statement
Data are available on reasonable request. Deidentified data are available for approved investigators with IRB and institutional approval.
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Contributors EG, PDB and SPP designed the data collection tools. AK, AKT, NLS and KN monitored data collection and implemented the study together with EG and PDB who are the guarantors. PDB and EG designed the analysis plan, and AK conducted the statistical analysis with the assistance of AKT. FK, VSF, OI, PRM, ESW, CHW and CW supervised study data collection. JEH, PK and MJ contributed to study design. CAR, CPB, PC, WK and JEH contributed to data analysis and interpretation. EG and PDB drafted the paper and revised the draft paper with the contribution of CAR and AK. All authors approved the final manuscript.
Funding US Department of Veterans Affairs; Veterans Affairs Cooperative Studies Program #595: Pulmonary Health and Deployment to Southwest Asia and Afghanistan, also known as SHADE (Service and Health Among Deployed Veterans) from the Office of Research and Development, Clinical Science Research and Development, Cooperative Studies Program. The contents do not represent the views of the US Department of Veterans Affairs or the US Government.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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