1 15 2 https://www.nal.usda.gov/exhibits/speccoll/files/original/50b676245a6738a4436186b0ffd32c23.pdf 4ab0135d5d39c9bc6d19b41aa922325c PDF Text Text Item ID Number 01770 Author Kan 9'Han Corporate Author Report/Article TltlO Soft Tissue Sarcoma and Military Service in Vietnam: a Case-Control Study JOUrnal/BOOk Title Year Journal of the National Cancer Institute 1987 Month/Day Color October n Number of limps ? Descripton Notes Monday, June 11, 2001 Page 1771 of 1793 �Soft Tissue Sarcoma and Military Service in Vietnam: A Case-Control Study1 Han Kang, Dr.P.H.,23 Franz Enziger, M.D.,4 Patricia Breslin, Sc.D.,2 Michael Fell, M.S.,z Yvonne Lee, M.S.,2 and Barclay Shepard, M.D.5-6 ABSTRACT—A case-control study was conducted in men who were of draftable age during the Vietnam conflict to examine the association of soft tissue sarcomas (STSs) with military service in Vietnam as well as other host and environmental risk factors. A total of 217 STS cases selected from the Armed Forces Institute of Pathology were compared to 599 controls for Vietnam service, occupational and nonoccupational exposure to various chemicals, occupational history, medical history, and life-style (smoking, alcohol, coffee, etc.)- Military service information was verified by a review of the patient's military personnel records. Other information was ascertained from a telephone interview with either sub-' jects or their next of kin. Cases and controls were stratified on the basis of the hospital type (civilian, Veterans Administration, and military); the Mantel-Haenszel estimate of the odds ratio (OR), adjusted for the effects of the stratification variable, was calculated. Vietnam veterans in general did not have an increased risk of STS when compared to those men who had never been in Vietnam (OR, 0.85; 95% confidence interval, 0.54-1.36). Subgroups of Vietnam veterans who had higher estimated opportunities for Agent Orange exposure seemed to be at greater risk of STSs when their counterparts in Vietnam were taken as a reference group. However, this risk was not statistically significant.—JNCI 1987; 79:693-699. without such exposure. A similar risk was reported by the" Swedish investigators for malignant lymphoma (7). Studies published subsequent to the Swedish studies have not demonstrated the association between STS and either exposure to phenoxyherbicides or military service in Vietnam (8-11). Several cases of STS have been reported, however, among workers involved in the manufacture or use of phenoxyherbicides (12-14). These industrial workers, in contrast to the herbicide applicators, are believed to have been exposed to relatively high levels of TCDD contaminant. STSs are a complex and diverse group of malignant neoplasms that originate in extraskeletal supporting structures of the body, excluding the hematopoietic system, the glia, and supporting tissues of specific organs and tissues (15). STSs account for about 1% of all malignant neoplasms and for about 2% of all cancer deaths. The average annual age-adjusted incidence rate for white males is 3.82 per 100,000, and it is estimated that about 8,000 patients are diagnosed with STS each year in the United States (16). Little is known about the etiology of STS. An excess ABBREVIATIONS USED: AFIP = Armed Forces Institute of Pathology; CI = confidence interval; MOSC = Military Occupation Specialty Code; OR = odds ratio; RR = relative risk; STS = soft tissue sarcoma; TCDD = 2,3,7,8-tetrachlorodibenzo-/>-dioxin. There is much concern in the United States that many health problems in Vietnam veterans may be the result of exposure to Agent Orange during their military service in Vietnam. Their complaints range from psychological disorders to cancer. Agent Orange was the herbicide most commonly applied in Vietnam by the United States Air Force during the Vietnam conflict. It was a mixture of two commercial herbicides, 2,4-dichlorophenoxyacetic acid (CAS: 94-75-7) and 2,4,5-trichlorophenoxyacetic acid (CAS: 93-76-5). The 2,4,5-trichlorophenoxyacetic acid contained minute amounts of an extremely toxic chemical, dioxin [TCDD (CAS: 1746-01-6)], which contaminated the herbicide during the manufacturing process. TCDD is teratogenic and carcinogenic in some experimental animals (1-3). During the 5-year period from 1965 to 1970, the United States Air Force sprayed more than 11 million gallons of Agent Orange in South Vietnam (4). Approximately 2 million military personnel served in Vietnam during the same period. The possibility that exposure to the herbicide may induce rare forms of cancer in humans such as STS has been suggested from studies in Sweden (5, 6). The Swedish studies have shown that persons reporting exposure to phenoxyherbicides have a fivefold to sixfold higher risk of developing STS as compared to persons 1 Received April 29, 1987; accepted May 28, 1987. Office of Environmental Epidemiology, Department of Medicine and Surgery, Veterans Administration, Washington, DC 20006-3868. 3 Address reprint requests to Dr. Kang, VA Office of Environmental Epidemiology, Riddell Building, 1730 K St., N.W., Room 401, Washington, DC 20006-3868. 4 Department of Soft Tissue Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000. 5 Agent Orange Projects Office, Veterans Administration, Washington, DC 20420. 6 We acknowledge the contribution of the Westat staff, especially Mr. John Ward and Ms. Susan Rogers, in tracing study subjects and conducting telephone interviews. We also thank Mr. Richard Christian, Major Leslie Halapy, Mr. James Cox, and others at the U.S. Army and Joint Services Environmental Support Group for reviewing military records and providing geographic location of military units to which Vietnam veteran study subjects were assigned in Vietnam. Eleanor Travers, Af.D., Director of the Veterans Administration Pathology Service, is appreciated for her strong support of the study from its inception and for writing to several hundred pathologists for their participation in the study. We are grateful to Marilyn Fingerhut, Ph.D., Carl Keller, Ph.D., Richard Monson, M.D., Paul Stolley, M.D., Alvin Young, Ph.D., and Shelia Hoar Zahm, Sc.D., for their review of the earlier version of the manuscript. 2 693 JNCI, VOL. 79, NO. 4, OCTOBER 1987 �694 Kang, Enziger, Breslin, et al. of STS has been reported in patients receiving immunosuppression therapy for renal transplantation and other conditions (17, 18). A small fraction of STS is induced by heavy external radiation therapy for various benign disorders and malignant tumors. Nearly all cell types of STS have been described following radiation (19, 20). Some radioactive materials used for diagnostic or therapeutic purposes may induce sarcomas at or near sites of deposition (21, 22). The well-known examples of associations between specific chemicals and sarcomas of specific cell types are angiosarcoma of the liver and exposure to vinyl chloride and mesothelioma and exposure to asbestos (23, 24). In view of the concern raised by many veterans that their contact with Agent Orange during Vietnam service may increase the risk of developing STS and conflicting research findings in the scientific literature regarding association between exposure to phenoxyherbicides or military service in Vietnam and STS, a case-control study of STSs among men of draftable ages during the Vietnam conflict was conducted. SUBJECTS AND METHODS Selection of cases and controls.—Cases were drawn from soft tissue tumor files of the AFIP. The AFIP offered a unique resource to contribute to this study. The AFIP routinely provides consultation services for civilian and military pathologists throughout the United States, especially for conditions such as STS that present special diagnostic problems. Almost one-quarter to onethird of the STSs occurring in the United States are being sent to the AFIP for review. Thus the AFIP is one of the largest single registries in the world for this group of tumors. The uniformity of diagnoses at the AFIP gives it an added advantage as a resource for epidemiologic studies. Selection of STS cases was restricted to men who were diagnosed at the AFIP as STS patients between January 1, 1975, and December 31, 1980, and who were born between 1940 and 1955. These eligibility criteria were established to restrict the study to individuals who were potentially at risk of exposure to Agent Orange and to reduce selection bias. These individuals would have been between 18 and 25 years of age during the Vietnam conflict, and their specimens would have been referred for diagnostic evaluation to the AFIP before the publicity appeared on Vietnam service, Agent Orange exposure, and the risk of STS. Controls were selected from the patient logs of referring pathologists or their pathology department. This was to duplicate the selective factors (e.g., socioeconomic status, area of residency, etc.) that bring people to these hospitals or clinics. Excluded from consideration as controls were patients with diagnoses of STS, nonHodgkin's lymphoma, and Hodgkin's disease. The latter two conditions have been associated with exposure to phenoxyacetic acid herbicides, chlorophenols, or their contaminants (7). For each STS case, a pathologist in JNCI, VOL. 79, NO. 4, OCTOBER 1987 each referring pathology unit was asked to select the 3 male patients who would have been born between 1940 and 1955. Controls were not matched to the STS case by race or vital status. A total of 440 STS cases was identified from the AFIP soft tissue tumor registry as potentially eligible cases. A letter was sent to each of the 368 hospitals representing the potential cases requesting their cooperation in the study. One hundred and nineteen hospitals (32%) did not respond positively because they were either unable or unwilling to retrieve and review the requisite medical records for selection of controls. These medical records could be as old as 10 years. Ultimately, 249 hospitals nationwide cooperated in the study and contributed 279 STS cases and 808 controls. Interviews,—A letter was then sent to attending physicians of the STS cases and controls indicating our intent to approach the study subjects or the next of kin for a telephone interview unless the physician believed that there was strong medical contraindication for their participation in the interview. When negative responses were not received from the physician, an introductory letter was sent to each study subject or the next of kin to solicit his participation in a telephone interview. In the letter the purpose of the study was described simply as a national health study of adult men who were treated in various hospitals throughout the United States. No specific mention was made of cancer, STS, Agent Orange, or service in Vietnam. The telephone interview averaged approximately 40 minutes and elicited information on occupational exposures, medical history, life-style including alcohol and tobacco consumption, and socio-demographic factors. Interviews were successfully conducted for 217 of 279 cases (78%) and 599 of 808 controls (74%). Reasons for unsuccessful interviews included inability to locate study subjects or their next of kin (17% of cases and 17% of controls) and refusal to be interviewed (5% of cases and 9% of controls). In an attempt to minimize interviewer bias, a two-interview approach was taken. The first interviewer asked questions on medical history, and the second interviewer administered the remaining questions on occupational exposure, life-style, and military history. The interviewers had no opportunity to know the case or control status of the respondent. Interviews were obtained directly from the study subjects for 120 of 217 cases (55%) and 527 of 599 controls (88%). Military and Vietnam service for all study subjects was documented by reviewing the existing military personnel records stored at various locations. Measure for herbicide exposure.—Although desirable, a valid and precise estimate of the exposure of each Vietnam veteran to Agent Orange is not considered feasible based on either military records or self-reported exposure. In this study the probability of opportunity for exposure was determined in several different ways with varying degrees of likelihood of exposure: service in the Army or Marine Corps, military occupation, broad geographical location of the individual's unit in �A Case-Control Study—Soft Tissue Sarcoma Vietnam at the time of his service, or a combination of the above. It has been suggested that ground troops (Army or Marines) in Vietnam, by the nature of their military operations through defoliated zones and the practice of base perimeter spraying, might have a higher probability of direct or indirect contact with Agent Orange than other Vietnam veterans. Furthermore, it has been suggested that, among ground troops, those engaged in combat were more likely to be placed in herbicidesprayed areas than individuals who were not in combat. In the military personnel records, there was no single data element applicable to all veterans that would indicate whether they actually had been in combat. As an alternative measure, the proportion of individuals with combat-related MOSCs was determined for both STS cases and controls. Combat-related MOSCs were those occupations where primary duties involved direct offensive and defensive action against an armed hostile force. Examples of combat MOSCs include rifleman, field artillery man, and tank crew member. As another surrogate measure for herbicide exposure, the broad geographic location of the individual's military unit in reference to recorded herbicide spray missions was also determined. Initially, an elaborate computer matching of troop location to recorded aerial spray missions (Ranch Hand HERB and Service HERB tapes) was planned. However, an expert government panel (25) has subsequently determined that military records alone could not be used to locate troops with enough precision to allow a scientifically valid estimate of the likelihood of exposure to herbicides. For example, it cannot be determined in many instances whether a man was within 2 km of a spray tract on the day of a Ranch Hand spray mission. According to maps developed by the National Research Council of the National Academy of Sciences from recorded spray missions, areas of defoliation and crop destruction were most extensive in military region III (26). There were 3,487 spray missions carried out in military region III for the purposes of crop destruction, defoliation, and clearance of base perimeters and supply lines from 1964 to 1971 (25). During the same period the number of spray missions recorded within military regions I, II, and IV were 2,015, 2,406, and 825, respectively. Army units were classified as located in regions I, II, III, or IV. Almost all Marine units were located in military region I. Statistical analysis.—The measure of association between the risk of STS and the various exposure factors that included military service in Vietnam was the RR, as approximated by the OR. Tests of significance were derived by the Mantel-Haens/el chi-square statistic, and 95% CIs were calculated using Cornfield's method (27, 28). The confounding variable of hospital type (civilian, Veterans Administration, and military) was evaluated by stratified techniques. The Mantel-Haenszel procedure was used to estimate the OR and calculate the 95% CI (27). Since matching was employed in the study design and cases and controls were not replaced when the interview was not completed because of inability to locate them or refusal to participate, analysis was also conducted using a logistic approach for matched data with unequal number of controls per case (29). The results were similar to those derived from the unmatched stratified analysis. For this reason, the results from the unmatched stratified analysis were chosen for presentation. RESULTS The distribution of cases and controls by age, accession year, and type of hospital for controls is shown in table 1. Demographic characteristics for cases and controls were almost identical with respect to marital status, religion, race, and level of education (table 2). There were 45 of 217 STS cases and 145 of 599 controls who had a record of military service in Vietnam. No statistically significant positive association was found between STS and military service in Vietnam on a crude and adjusted basis. The crude OR was 0.82, with a 95% CI of 0.55-1.21. The Mantel-Haenszel OR adjusted for the effect of hospital type was 0.85, with a 95% CI of 0.54-1.36 (table 3). Distribution of histologic type of STS reported among Vietnam veterans was similar to that reported among non-Vietnam veterans. No particular anatomic site or histologic type was predominant in either group. Notwithstanding the assumption that ground troops were more likely to be exposed to Agent Orange than non-ground troops, table 4 indicates that ground troops in Vietnam as a group showed a lower RR of STS when compared to men who had never been in Vietnam or Vietnam veterans in general. However, it appears that subgroups of ground troops who had higher estimated opportunities for Agent Orange exposure experienced greater risk of STS. For example, the OR was 0.61 (95% CI, 0.32-1.13) for Army Vietnam veterans, whereas the OR increased to 1.06 (95% CI, 0.42-2.59) for a subgroup of Army Vietnam veterans who were likely to TABLE 1.—Distribution of STS cases and control patients by age, accession year, and hospital type Cases Characteristic Age at accession, yr <26 26-35 >35 or more Accession year 1975 or earlier 1976-77 1978-79 1980 or later Type of hospital Civilian Veterans Administration Military Controls (n = 217) No. Percent (»i = 599) No. Percent 30 165 22 14 76 10 77 476 46 13 79 8 37 64 73 43 17 29 34 20 98 159 205 137 16 27 34 23 163 26 28 75 12 13 431 86 82 72 14 14 JNCI, VOL. 79, NO. 4, OCTOBER 1987 695 �696 Kang, Enziger, Breslin, et al. TABLE 2.—Distribution of selected demographic characteristics for STS cases and control patients Cases (n = 217) Characteristic" Exposure group" Percent No. Controls OR 95% CI Never in Vietnam Ever in Vietnam Army, all Combat MOSCs MR I MR I and combat MOSCs MR III MR III and combat MOSCs Marine, all Combat MOSCs Percent 154 18 45 0 71 8 21 0 409 62 125 3 68 10 21 <1 7 52 146 12 3 24 67 6 26 176 361 36 4 29 60 6 178 31 6 2 82 14 3 1 511 62 17 9 85 10 3 2 22 62 11 60 34 28 0 10 29 5 28 16 13 0 63 175 22 148 81 108 2 11 29. 4 25 14 18 <1 DK STS cases 172 45 15 8 7 3 454 145 65 20 15 6 1.00 0.82 0.61 1.06 1.23 1.32 0.55-1.21 0.32-1.13 0.42-2.59 0.45-3.29 <0.01-6.00 6 5 30 11 0.53 1.20 0.19-1.36 0.36-3.80 5 3 24 13 0.54 0.61 0.18-1.55 0.08-2.32 Controls (« = 599) No. Marital status Married Divorced Never married Other-DK Religion None Catholic Protestant Others Race White Black Hispanic Other Education <llth grade High school Vocational school Some college 4-yr college Post college TABLE 4.—0#s/or STSs in relation to various categories of estimated Agent Orange exposure likelihood for all study subjects 0 Combat MOSCs include the following career groups: infantry, combat engineering, field artillery, special operations, and armor. MR refers to military region. South Vietnam was divided into four regions. The regions were denoted by I, II, III, and IV. They went from north to south. 65% chance of detecting a 1.5 times increase in the risk of STS and a 98% chance of detecting a twofold increase in the risk of STS for Vietnam veterans in general. It must be noted, however, that the study had a very low power to detect greater increased risks for subgroups of Vietnam veterans who had higher estimated opportunities for Agent Orange exposure. There was a 10% chance of detecting a 1.5 times increase in the risk of STS, a 23% chance of detecting a twofold increase, and an approximately 80% chance of detecting a fivefold increase in the risk of STS for Army combat veterans when non-combat Army Vietnam veterans were taken as a reference group. No statistically significant association was found between STS and other study variables, including histories of viral infections, tropical diseases, skin problems, use of certain medications, organ transplantation, artificial joints, trauma, cancer other than STS, immune deficiency, chronic edema, radiation therapy, blood transfusion, and cancer in the family; smoking, alcohol drinking, and coffee drinking; work in certain occupations or industries that might involve herbicide, pesticide, and other toxic chemical exposure; exposure to specific chemicals such as asbestos, arsenic, herbicides, °DK = Donotknow. have been involved in combat. For this reason, the ORs were calculated for Army and Marine veterans with combat-related MOSCs by military region where their units were stationed, taking their non-combat counterparts in each military region as reference groups (table 5). Army Vietnam veterans who had a combatrelated MOSC showed a 2.6 times elevated risk of STS as compared to their non-combat counterparts in Vietnam (OR, 2.57; 95% CI, 0.72-9.36). The risk of STS was even greater (OR, 8.64; 95% CI, 0.77-111.84) when the location of their units was within military region III, the area where Agent Orange spray was reported to be extensive. In both instances, however, these increased risks were not statistically significant. In this study the power to detect moderate increases in RR of STS among the entire group with Vietnam service is fairly good. The study had an estimated TABLE 3.—Distribution of STS cases and control patients by Vietnam service status" Hospital type Vietnam service Veterans Administration Civilian Total Military Cases Yes No Total OR 95% CI Controls Cases Controls Cases Controls Cases Controls 20 143 163 66 365 431 11 15 26 43 43 86 14 14 28 36 46 82 45 172 217 145 454 599 0.77 0.43-1.36 0.73 0.27-1.94 1.27 0.50-3.29 0.82 0.55-1.21 °The Mantel-Haenszel estimate of the OR adjusted for the effects of the stratification variable = 0.85; 95% CI = 0.54-1.36. JNCI, VOL. 79, NO. 4. OCTOBER 1987 �A Case-Control Study— Soft Tissue Sarcoma 697 TABLE b.—ORsfor STSs in relation to combat and military region among Vietnam veterans" Military region6 Combat MOSC II I Cases Controls Cases 7 9 15 0 2 2 Total III Controls Cases Controls Cases Controls 5 1 6 11 19 30 8 7 15 20 45 65 Army Vietnam veterans Yes No Total OR 3 4 7 1.13 0.13-9.85 95% CI 3 17 20 0 8.64 0.77-111.84 2.57 0.72-9.36 Marine Vietnam veterans Yes No Total OR 95% CI 13 11 24 3 2 5 13 11 24 3 2 5 1.27 0.13-7.90 1.27 0.13-7.90 0 The b Mantel-Haenszel estimate of the OR adjusted for the effects of the military region for Army personnel = 2.32; 95% CI = 0.47-11.41. South Vietnam was divided into four military regions. No Army Vietnam veterans in the study served in military region IV. Almost all Marine units were located in military region I. degreasing chemicals, insecticides or pesticides, and vinyl chloride or polyvinyl chloride; and occupational exposure to radiation (table 6). The STS cases were also compared to control patients with cancer (n = 132) for study variables. No statistically significant association was found for any variable. This was also true when taking only the study subjects who responded directly (120 cases and 527 controls), with one exception. Men who had a history of topical tar ointment application had an OR of 2.72, with a 95% CI of 1.25-5.85. This finding is of interest in that crude coal tar contains chemical substances that can cause benign and malignant neoplasms in animals and a case-control study reported that patients with high exposure to tar and UV radiation had a 2.4 times increase in the risk of skin cancer as compared with those patients lacking the high exposure (30). DISCUSSION The results of the present study do not support a strong positive association between Vietnam service and the occurrence of STS. These findings are consistent with the results of several other case-control studies of STSs. Greenwald and co-workers in 1984 (8) reported no significant association between STS and military service in Vietnam or Agent Orange-2,4,5-trichlorophenoxyacetic acid exposure. Of 281 STS cases, 10 men had mili- TABLE 6.—ORsfor STSs for various host and environmental factors'1 Factors Cases («=217) Controls (n=599) OR 95% CI Manufacture or repair of electrical transformers Work with asbestos Work with arsenic Work with herbicides Work with vinyl chloride-polyvinyl chloride Work with x-ray Apply herbicides on farm or ranch Work at incinerator for waste materials Work in lumbering, logging, or forestry Use herbicides in yard work Cigarette smoking Coffee drinking Drinking alcoholic beverages Angioma Psoriasis Neurofibromatosis Radiotherapy Tar ointment Close relative with cancer 11 53 6 17 14 22 12 3 13 60 126 131 193 13 5 4 9 15 70 20 151 21 77 35 61 61 12 45 157 401 371 559 19 10 2 28 23 159 1.52 0.97 0.81 0.62 1.13 0.99 0.51 0.69 0.79 1.08 0.71 0.92 0.66 1.95 1.43 6.00 0.99 1.85 1.31 0.60-3.82 0.44-2.11 0.13-4.87 0.32-1.21 0.36-3.57 0.86-1.14 0.19-1.37 0.05-10.24 0.35-1.76 0.68-1.70 0.51-0.99 0.63-1.35 0.36-1.20 0.87-4.36 0.19-10.81 0.89-40.39 0.83-1.18 0.89-3.86 0.92-1.87 °ORs were calculated using the Mantel-Haenszel procedure controlling for the effect of hospital type. JNCI, VOL. 79, NO. 4, OCTOBER 1987 �698 Kang, Enzlger, Breslin, et al. tary service in Vietnam; in contrast, of 281 live controls, 18 had served in Vietnam. The OR was 0.5, with a 95% CI of 0.21-1.31. The OR associated with Agent Orange exposure as reported by the subjects was 0.70, with a 95% CI of 0.17-2.92. Smith and co-workers (9), in studying 82 STS cases and 92 controls for their potential exposure to phenoxyherbicides, did not observe a statistically significant positive association. The estimate of RR was 1.3, with a 90% CI of 0.6-2.5. In a recent paper, Hoar and co-workers (10) confirmed the non-positive association between STS and herbicide exposure. They reported that neither STS nor Hodgkin's disease was associated. with herbicide exposure. Of the 133 STS cases, 95 men reported having worked or lived on farmland as compared with 662 of 948 controls, yielding an OR of 1.00, with a 95% CI of 0.7-1.6. Twenty-two of the STS cases reported farm herbicide use as compared to 192 of the controls. The OR was 0.9, with a 95% CI of 0.5-1.6. However, Hoar et al. reported a strong association between non-Hodgkin's lymphoma and farm herbicide use. The absence of an increased risk of STS in Vietnam veterans as a group when compared to those men who had never been in Vietnam cannot be explained by possible differential referral patterns to the AFIP with respect to the presence of study factors such as Vietnam service or Agent Orange exposure. The hospital pathologist referring STS cases to the AFIP seldom has that information. Furthermore, selection of STS cases was restricted to the cases referred to the AFIP in 1980 or earlier, before the publicity appeared on Vietnam service, Agent Orange exposure, and the risk of STS. Preferential referral of Vietnam veteran STS cases to the AFIP, however, would have introduced a bias toward overestimating the risk of STS for Vietnam veterans. Selection of controls from the hospital that referred the STS case to the AFIP does not appear to have introduced either an overrepresentation or an underrepresentation of men who were unlikely to have been in the military because of their chronic illness. The whole spectrum of diagnoses reflecting acute and chronic conditions was recorded for the control patients in the hospital records. However, it is unknown what the recorded health status of the STS cases as well as the controls was as far back as 15 years ago, during their draftable age. Interview data show that the proportions of cases and controls reporting as having had any physical conditions that might have prevented them from serving in the military during their draftable age were similar: 24% of the STS cases and 23% of the controls. Had bias been introduced, it would have created a spurious positive association by underrepresenting veterans in controls. Several mortality studies of Vietnam veterans found no statistically significant excess deaths from STS, with the exception of the Massachusetts Stale study (31-34). The Massachusetts study found 9 deaths from STS among Vietnam veterans as compared to only 1 expected death from STS. The results of the mortality studies reported to date are difficult to interpret since there are some limitations, which include the small number of JNCI, VOL. 79, NO. 4, OCTOBER 1987 deaths available for analysis (lack of adequate statistical power), the varying quality and accuracy of the death certificate coding, possible misdiagnosis of this malignancy, and lack of verification of Vietnam service. The absence of a possible positive association between STS and Vietnam service might be the result of insufficient observation time since Agent Orange exposure in Vietnam. In general, it takes more than a decade for cancer to manifest itself if it is induced by a chemical carcinogen. Over 80% of the STS cases in this study were observed less than 10 years after the last troops were exposed to Agent Orange in Vietnam. Another possibility is that, although Agent Orange or dioxin can induce STS, Vietnam veterans as a group were exposed to such small doses or only a very small fraction of Vietnam veterans might have been exposed to Agent Orange that the present study does not have an adequate statistical power to detect, the excess risk. In summary, Vietnam veterans as a group as well as subgroups of those veterans who were categorized as having had higher opportunities for Agent Orange exposure by virtue of their military occupation or location of their units in Vietnam did not have a statistically significant increased risk of STS when compared to men who had never been in Vietnam. However, within Vietnam veterans, those who had higher opportunities for Agent Orange exposure appear to have greater risk of STS. The conclusion for subgroups of Vietnam veterans is based on considerably weaker study power than the conclusion about Vietnam veterans in general. Therefore, the possibility of a modestly increased risk of STS associated with Agent Orange exposure in Vietnam among select groups of Vietnam veterans can be neither confirmed nor ruled out in this study. Additional studies using better characterization of exposure are needed to answer this question. REFERENCES (1) KOCIBA RJ, KF.YES DG, BEYES JE, et al. Results of a two-year chronic toxicily and oncogenicity study of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in rats. Toxicol Appl Pharmacol 1978; 46:279-303. (2) National Toxicology Program. Carcinogencsis bioassay of 2,3,7,8-tetrachlorodibenzo-p-dioxin (CAS No. 1746-01-6) in Osborne-Mendel rats and B6C3Fi mice (gavage study). Washington, DC: U.S. Govt Print Off, 1982 [DHHS publication No. (NIH)82-1765]. (3) POLAND A, KNUTSON J. 2,3,7,8-Tetrachlorodibcnzo-p-dioxin and related halogenated hydrocarbons. Examination of the mechanism of toxicity. Am Rev Pharmacol Toxicol 1981; 22:517-554. (4) BUCKINGHAM WA JR. Operation Ranch Hand. Washington, DC: Office of Air Force History, United States Air Force, 1982. (5) HARDELL L, SANDSTROM A. Case-control study: Soft tissue sarcoma and exposure to phenoxyacelic acids or chlorophenols. B r J Cancer 1979:39:711-717. (6) HARDELL L. Relation of soft-tissue sarcoma, malignant lymphoma and colon cancer to phenoxy acids, chlorophenols and other agents. Scand J Work Environ Health 1981; 7:119-130. (7) HARDELL L, ERIKSSON M, LENNER P, etal. Malignant lymphoma and exposure to chemicals, especially organic solvents, chlorophenols and phenoxy acids: A case-control study. Br J Cancer 1981; 43:169-176. (8) GREENWALD P, KOVASZNAY B, COLLINS DN, et al. Sarcomas of soft tissues after Vietnam service. JNCI 1984; 73:1107-1109. �A Case-Control Study—Soft Tissue Sarcoma 699 (9) SMITH AH, PEARCE NE, FISHER DO, ei al. Soft tissue sarcoma and exposure to phenoxyherbicides and chlorophenols in New Zealand. JNCI 1984; 73:1111-1117. (10) HOAR S, BLAIR A, HOLMES FF, et al. Agricultural herbicide use and risk of lymphoma and soft-tissue sarcoma. JAMA 1986; 256:1141-1147. (//) RANG HK, WEATHERBEE L, BRESLIN PP, et al. Soft tissue sarcomas and military service in Vietnam: A case comparison group analysis of hospital patients. J Occup Med 1986; 28:1215-1218. (72) COOK RR. Dioxin, chloracne, and soft tissue sarcoma [letter]. Lancet 1981; 1:618-619. (13) HONCHAR PA, HALPERIN WE. 2,4,5-T, trichlorophenol, and soft tissue sarcoma [letter]. Lancet 1981; 1:268-269. (14) MOSES M, SELIKOFF IJ. Soft tissue sarcomas, phenoxy herbicides and chlorinated phenols [letter]. Lancet 1981; 1:1370. (15) ENZINGER FM, LATTES R, TORLINI H. Histological typing of soft tissue tumors. In: International histological classification of tumors. No. 3. Geneva: WHO, 1969. (16) CUTLER SJ, YOUNG JL JR, eds. Third National Cancer Survey: Incidence data. Natl Cancer Inst Monogr 1975; 41:1-454. (17) HOOVER R, FRAUMENI JF JR. Risk of cancer in renal transplant recipients. Lancet 1973; 2:55-57. (18) KINLEN LJ, SHEIL AG, PETO J. Collaborative United Kingdom-Australasian study of cancer in patients treated with immunosuppressive drugs. Br Med J 1979; 2:1461-1466. (19) CZESNIN K, WRONKOWSKI Z. Second malignancies of the irradiated area in patients treated for uterine cervix cancer. Gynecol Oncol 1978; 6:309-315. (20) KIM JH, CHU FC, WOODWARD HO, et al. Radiation-induced soft tissue and bone sarcoma. Radiology 1978; 129:501-508. (21) McKiLLOP JH, DOIG JA, KENNEDY JS, et al. Laryngeal malignancy following iodine-125 therapy for thyrotoxicosis. Lancet 1978; 2:1177-1179. (22) FALK H, TELLES NC, ISHAK KG, et al. Epidemiology of thorotrastinduced hepatic angiosarcoma in the United States. Environ Res 1979; 18:65-73. (23) FALK H, THOMAS LB, POPPER H, et al. Hepatic angiosarcoma associated with androgenic-anabolic steroids. Lancet 1979; 2:1120-1123. (24) SELIKOFF IJ, HAMMOND EC, SEIDMAN H. Mortality experience of insulation workers in the United States and Canada, 1943-1976. Ann NY Acad Sci 1979; 330:96-116. (25) AOWG Science Panel. Report of the Agent Orange Working Group Science Subpanel on exposure assessment. Washington, DC: Department of Health and Human Services, June 3, 1986. (26) National Research Council. The effects of herbicides in South Vietnam: Part A. Summary and conclusion. Washington, DC: National Academy of Sciences, 1974. (27) MANTEL N, HAENSZEL W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959; 22:719-748. (28) KLEINBAUM DG, KUPPER LL, MORGENSTERN H. Epidemiologic research: Principles and quantitative methods. Belmont, CA: Lifetime Learning Publications, 1982. (29) LUBIN JH. A computer program for the analysis of matched casecontrol studies. Comput Biomed Res 1981; 14:138-143. (30) STERN RS, ZIERLER S, PARRISH JA. Skin carcinoma in patients with psoriasis treated with topical tar and artificial ultraviolet radiation. Lancet 1980; 1:732-735. (31) United States Air Force School of Aerospace Medicine. An epidemiologic investigation of health effects in Air Force personnel following exposure to herbicide. Mortality update. Brooks Air Force Base, TX: Epidemiology Division, United States Air Force School of Aerospace Medicine, December 1984. (32) KOGAN MD, CLAPP RW. Mortality among Vietnam veterans in Massachusetts, 1972-1983. Boston, MA: Massachusetts Department of Public Health, January 25, 1985. (33) HOMES AP, BAILEY C, BARON RC, et al. West Virginia Vietnamera veterans mortality study. Charleston, WV: West Virginia Health Department, January 1986. (34) ANDERSON HA, HANRAHAN LP, JENSEN M, et al. Wisconsin Vietnam veteran mortality study. Madison, WI: Wisconsin Department of Health and Social Services, March 1986. JNCI, VOL. 79, NO. 4, OCTOBER 1987 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 066 Folder The folder containing the original item. 1770 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Kang, Han Franz Enziger Patricia Breslin Michael Fell Yvonne Lee Barclay Shepard Source A related resource from which the described resource is derived Journal of the National Cancer Institute Date A point or period of time associated with an event in the lifecycle of the resource 1987-10-01 Title A name given to the resource Soft Tissue Sarcoma and Military Service in Vietnam: a Case-Control Study Subject The topic of the resource case referent study cancer risk assessment ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/5fe0008ae62b2a9f36880208141d9b06.pdf 1f5fb5c0167e5b0bed2ddb443362fd91 PDF Text Text Item ID Number 01775 Author Breslin, Patricia Corporate Author Report/ArtlGlO TltlO Typescript: A Preliminary Report: The Vietnam Veterans Mortality Study, October 1986 Journal/Book Title 000 Year ° Month/Day Color n Number of Images 10 ° Dascplpton Notes Monday, June 11, 2001 Page 1777 of 1793 �A PRELIMINARY REPORT THE VIETNAM VETERANS MORTALITY STUDY Patricia Breslin, Sc.D Yvonne Lee, M.Sc. Han Rang, DrPH Vicki Burt, M.Sc. Barclay Shepard, MD Office of Environmental Epidemiology Veterans Administration Washington DC 20420 October 1986 �SUMMARY The patterns of mortality among 24,235 veterans of the Army and Marine Corps who served in Vietnam and 26,685 Vietnam era veterans who served in the Army and Marine Corps other than in Southeast Asia were investigated using standardized proportional mortality ratios (SPMRs). The study subjects were a random sample of Vietnam era veteran deaths taken from the Veterans Administration's Beneficiary Indentification and Record Locator Subsystem (BIRLS). Data on the type of military service, place and dates of military service, military occupational speciality code, principal duties, and other demographic information were obtained from the military record. Cause of death information came from death certificates (97%), Department of Defense Reports of Casuality, or VA records. All cause of death information was coded by experienced nosologists using ICDA-8. The veterans who had served in Vietnam were seen to have died from accidents, violence and trauma significantly more frequently than those who did not serve in Vietnam. The excesses seem to be among deaths from motor vehicle accidents and accidental drug poisonings. A closer investigation revealed that the accidental drug poisonings were predominantly heroin overdoses. Deaths coded as suicides were not in excess among those who served in Vietnam. The Marines who served in Vietnam appear to have an excess of mortality from malignancies. Part of this excess seems to be lung cancer and non-Hodgkins lymphomas (NHL). Marines with combat related MOSCs have a greater risk for NHL than those with either direct combat support or indirect combat support MOSCs. The excess for NHL among Marines is also seen if general population mortality data or if U.S. cancer mortality data are used as comparisons. Standardized mortality odds ratios were also calculated for the NHL deaths among Marines using all cardiovascular deaths among Marines who did not serve in Southeast Asia as a comparison population. SMOR's were elevated for Marines with combat related MOSCs and for Marines whose first tour of duty was 1967-1969. Additional data are being collected. Analyses are planned that will investigate the relationship between the place the Veteran served in Vietnam and the herbicide spray patterns in Air Force records. �INTRODUCTION In response to growing concerns about the potential adverse health effects of military service in Vietnam, studies have been undertaken by governments, veterans organizations and others in the United States and Australia. To address some of these concerns, the Veterans Administration undertook a mortality study of Vietnam veterans based on deaths known to it. The study was designed and and the original contracts for data collection were let by the Veterans Administration's Office of Reports and Statistics and subsequently transferred to the Agent Orange Projects Office to be completed. This is a preliminary report on some of the data from the study. The purpose of the study was to compare the mortality patterns of men who served in Vietnam with those of men who served in the military during the same era but who did not serve in Southeast Asia. SOURCES OF DATA Ideally one would like to be able to do a cohort study in which one could assess the relative risks of death from all causes or from specific causes for military personnel who served in Vietnam compared to military personnel who did not serve in Vietnam. Unfortunately, there is no complete roster of persons who served in the military during that era. Another approach had to be taken. The Veterans Administration maintains an automated information system used to identify and to locate records of veterans who have received or are receiving veterans benefits such as compensation, pensions, loan guarantees, or education as well as records for veterans whose beneficiaries have received a death benefit. This system is known as the Beneficiary Identification and Record Locator Subsystem (BIRLS) and contains more than 38 million names. Until October 1981, the Veterans Administration was authorized to pay a lump sum benefit for all eligible veteran deaths. The number of eligible veterans was large and included those who served during the Vietnam era. Although this system does not provide a complete list of all veterans, it is believed to be a reasonably complete source for veteran deaths. Beebe and Simon (1) assessed the completeness of the file for World War II veterans and found that 98% of independently ascertained deaths were known to the VA and BIRLS has been used as a source of data in other mortality studies of veterans. (2,3,4) This study was undertaken with the assumption that the BIRLS file would be able to provide a similarly complete list of Vietnam era veterans' deaths. The National Academy of Sciences(5), under contract to the Veterans Administration, has assessed the completeness of this file for Vietnam era veterans. Its findings and their implications for this study are discussed in Appendix A-l. �If a reasonably complete roster of Vietnam era veterans' deaths could be assembled and they could be classified as to whether or not they served in Vietnam, they could form the data base for a proportional mortality study (PMR analysis). Although the data in the BIRLS record do not consistently indicate whether or not the veteran has served in Vietnam, they do provide several advantages toward obtaining this information. The basic BIRLS record format may contain information such as social security number, service number, branch of service, dates of enlistment and discharge etc. These are data items needed to identify the veteran in the military record system. As the name indicates, BJERLS is a file used to locate the VA claim folder for the veteran. It is the paper record of veterans' claims for benefits or claims made in his or her behalf. For deceased veterans, the file contains some kind of notification of death. In many cases this is the death certificate issued by the state or country where the veteran died or a DD1300, a Department of Defense form, Report of Casualty, issued in the event of death to an active member of the armed forces or reserve. The cause of death should be available for most veterans in these files. Given the type of data readily available, a proportional mortality analysis was planned using a sample of the Vietnam era veterans' deaths found in BIRLS. The purpose of the study was to describe the proportional mortality patterns of men who served in the Army or Marine Corps during a portion (1965-1973) of the Vietnam era (1965-1975). The study will compare the mortality patterns of servicemen who served in Vietnam with those of servicemen who did not serve in Southeast Asia. SELECTING THE TARGET POPULATION Proceeding under the assumption that the BIRLS system had the potential for yielding a reasonably complete roster of Vietnam Era veterans' deaths, it was necessary to devise strategies to select these deaths from among all deaths recorded in BIRLS. The objectives of the selection process were to obtain as complete a list as possible. This list would include all the Vietnam era veterans and would exclude veterans who had not served in the military during the Vietnam era. In the first stage, the attempt was made to provide as complete a list as possible. To do this, all veterans whose service dates included the period 1964-1975 were selected. For those records where the service dates were missing, persons whose birth dates were given as falling between 1935 and 1957 inclusive were selected. This yielded about 815,000 records. Recalling the purpose of the study, to compare the mortality patterns of men who served in Vietnam with those who did not serve in Vietnam, additional criteria were introduced based on time of service and branch of service. �The Vietnam era, as defined by the Veterans Administration, was Aug. 5, 1964 to May 7, 1975. Prior to July 1965 and after January 1973 there were relatively few troops in Vietnam. If one sampled deaths among those who served before 1965 or after Jan. 1, 1973 there would be relatively few decedents who had served in Vietnam. Therefore, the study population was limited to military personnel who were in the armed forces on or after July 4, 1965 but before March 1, 1973. Data published by the Department of Defense(6) indicate that 81% of those who served in Vietnam were in the Army or Marine Corps. For these branches of service duty in Vietnam meant, in most cases, service "in country". For those in the Air Force or Navy, Vietnam service is not so clear cut. It may be difficult to determine whether Navy personnel who were considered to have service in the Vietnam theatre of operations were ever actually "in country" or if Air Force personnel who flew missions over Vietnam or to Vietnam were ever "in country". Hence the study population was further limited to persons serving in the Army or Marine Corps between July 4, 1965 and March 1, 1973. Since this was to be a proportional mortality study and deaths related to combat could only occur among those with service in Southeast Asia and not among those who did not serve in Southeast Asia, deaths in service before the end of 1973 were excluded. The study population as defined by these criteria consisted of 186,000 names of military personnel who served in the Army or Marine Corps or unknown branch any time between July 4, 1965 and March 1, 1973 or whose year of birth was between 1934 and 1957 inclusive. SAMPLE SELECTION Power calculations done by the Office of Reports and Statistics of the Veterans Administration(7) suggested that at least 50,000 eligible cases would be needed for the study. It was assumed that some of the cases selected from the target population of 186,000 would be ineligible for the study based on branch or time of service, (these would be cases included in the target population because these data items were not recorded in the BIRLS) therefore, 60,000 names were selected from the target population by simple random sampling. It was assumed that the extra 10,000 names would allow for the ineligible and the final sample for analysis would be at least 50,000 names. A small sample of the records classified a priori as ineligible for the study by the selection criteria was taken in order to evaluate these criteria. The analysis of this "quality control" sample indicated that about 1% of the deaths of eligible males may have been excluded from the target population file because of incomplete or erroneous data in BIRLS. In order to spread the work load over time, the 60,000 records were randomly divided into 4 batches to be processed at intervals of three months. The returns for the first batch suggested that the proportion of ineligible cases among those sampled was larger than the 16% allowed for in the 60,000, and if 50,000 eligible cases were to be obtained, the later batches would have to be increased in size. While the first two batches were in process, a committee of experts �(Appendix A-2) was convened. Because of the relative youth of the deaths in the study, the committee suggested that deaths occurring later in the study time frame i.e. after 1975 should be more heavily sampled in the later batches in order to enhance the possibility of seeing a broader spectrum of chronic diseases. Given the need to increase the sample size, and the recommendations of the expert committee, it was decided to select only deaths after 1975 and increase the sample size of the last two batches. Ultimately, 75617 records were selected. Using the results of the quality control sample and the outcome of the military records searches done on the cases selected, it was estimated that there should have been about 144,450 deaths of men meeting the study criteria in BIRLS and that this study included about" 36% of them. MILITARY RECORDS Military records for discharged veterans are kept in the National Personnel Record Center (NPRC) in St. Louis, MO. Although the military records are not automated, there is a computerized "register" that can be used to locate a veteran's record. To use this register, one needs the veteran's name, branch of service, social security number, birth date, and if available, service number. For most subjects this information was available in BIRLS. A computer tape containing the requisite information was sent to the contractor responsible for the military records searching and abstracting. The tape was matched to the register and the file locations for the required cases were obtained. Attempts were made to locate records for persons not found by computer match by manually searching other unautomated files. Records for which a location was determined were requested from the NPRC and abstracted by the contractor. The types of data obtained from these records are given in appendix B-l. For some persons whose military record could not be located or obtained at NPRC, VA records were searched for evidence of eligibility, such as branch, time, and place of service. Abstracted records were returned to the VA project staff on computer tape. The staff of the study project then 'edited* the tape as far as possible looking for inconsistencies among military occupational specialty codes (MOSC), branch and grade codes. For veterans who had served in Southeast Asia, more data elements were abstracted from the military record. Any apparent inconsistencies such as disagreement between unit address and branch of service were resolved. CAUSE OF DEATH INFORMATION It had been assumed at the inception of the study that for most cases a death certificate had been filed with the VA by the next of kin in order to obtain some veteran's benefit or that there would be some other form such as DD1300, Report of Casualty that would indicate the cause of death in the veteran's VA file. To obtain this death �information, the records selected were sorted by the location of the record given in the BIRLS file. Lists of names with requisite identifying information were sent to the locations of record. The instructions issued to these offices were to locate the record, search for a death certificate or cause of death information, and send a copy of the death certificate or other document to the contractor responsible for coding the cause of death information. For about 30% of the names selected the request was returned with no codeable cause of death information. These were cases where the file was not found; the file had been transferred elsewhere; the file contained no death certificate or other document showing cause of death; the death certificate in the file did not show a cause of death; or an incorrect certificate was returned (sometimes certificates for other family members, marriage certificates, baptismal certificates etc. were sent). Every conceivable approach was taken to obtain cause of death information for these cases. Death certificates were the preferred source of information but Reports of Casualty issued by the military in the event of death active duty personnel or reservists were accepted if the death occurred out of the country and no death certificate could be obtained. It should be noted that most of these cases were accidents and probably little additional information would have been obtained from the death certificate if it were available. For cases where files had been transferred, the request was re-submitted to the new location. If the file was missing, VA records were researched to look for duplicate files in other locations. If BIRLS indicated that the veteran carried insurance, death certificates were requested from the insurance carrier. Arrangements were made with state vital statistics registrars to obtain death certificates from state records. For cases where a death certificate was returned without a cause of death (cases marked "pending" further investigation or certificates from New York City that did not include the portion of the certificate that contained the cause of death information) a request was made of the jurisdiction issuing the certificate to send an amended certificate. BIRLS files were searched for evidence of last known state of residence and requests were directed to that state. If the year of death was 1979 or later the name, birth date and social security number were submitted for a National Death Index search. If the records indicated that the veteran died while on active duty, a request was made to the contractor abstracting military records to look for a death certificate or DD1300 in the military record. The predominant source of information on the cause of death for all cases was the death certificate or an abstract of the death certificate. This was true for both those who served in Vietnam and those who did not. �SOURCE OF CAUSE OF DEATH INFORMATION Death certificates or abstracts DD 1300 VA Forms/records 96.95% 2.13% .92% DEATH CERTIFICATE CODING All information contained on the death certificate was coded for inclusion in the data base. Demographic information, geographic information and information on occupation and industry were coded using standard codes. « All cause of death information was coded by trained nosologists using the International Classification of Diseases, 8th Revision (ICDA-8)(8) for entry into the Automated Classification of Medical Entities (ACME)(9) system. All certificates for selected causes of death were reviewed by a senior staff member on the study. It was found that the cause of death information was consistently and accurately coded. A few questionable codes were re-submitted to the nosologist for review. Because the version of ACME used in this study was the earliest attempt to automate the assignment of the underlying cause of death on death certificates, occasionally there were re-submitted to the nosologist for review. Because the version of ACME used in this study was the earliest attempt to automate the assignment of the underlying cause of death on death certificates, occasionally there were codes erroneously assigned by the computer. Many of the cases questioned by the project staff member fell into this category. Consequently, an experienced nosologist, knowledgeable about the ACME system and its inadequacies, re-reviewed the cause of death coding on all certificates. DATA MERGING The data tapes containing the information abstracted by the contractors were matched to the original BIRLS data to confirm that the cases abstracted were the cases selected. Non-matches were culled from the tapes to be reviewed and if necessary, re-abstracted. This merge was straight forward for the military information. The military record abstract contained an identification number based on the alphabetical sequence of the names in each batch and this was known to the study staff. In the case of the death certificate abstracts, there was no such common number available on the tape and matches had to be attempted by social security number, name or VA claim number. This was not as straight forward as it may seem. Nearly 18,000 cases could not be matched by these means and had to be matched by someone looking at the data in both files and manually entering the matching file numbers. (For 15% of the eligible cases, there were no matching social security numbers between BIRLS and the death certificate data.) Once it was determined that all death certificate abstracts that could be matched to BIRLS had been identified, the military record file and the death certificate files �were matched. Again, checks were run looking for differences in names,social security numbers, and birth dates. Dates of death recorded on the death certificate abstracts were matched with dates of death given in BIRLS. Alldiscrepancies were investigated. Most mismatches were found in time to be researched and included in the study; some were not and are now classified among the missing certificates. Where demographic data from the military abstract data did not match the BIRLS data for the case, there was no time to have these re-abstracted. These cases are counted among the search completed and not found cases. CHARACTERISTICS OF THE SAMPLE The final sample consisted of 75617 names; of these 69.1% (52253) were found to be eligible for inclusion in the study by virtue of branch of service or time of service. DISTRIBUTION OF SAMPLE BY ELIGIBILITY STATUS Names Selected Found Eligible Found Ineligible Not found 75617 52253 22332 1032 100.0% 69.1% 29.5% 1.4% The ineligible count includes duplicate names; men who did not serve in the military during the Vietnam Era; men who served in the Navy, Coast Guard or Air Force; men who were killed in action or reported missing in action and subsequently were declared dead; men who died in service before 1974; men who died of war related injuries; and all women. It should be noted that there were only 340 women identified. No women in this had served in Southeast Asia and not all had served during the Vietnam era. Of the 52253 men determined to be eligible for the study, cause of death was ascertained for 51421 or 98.4%. The remaining 832 names (1.6%) were cases where the cause of death was pending; the veteran died overseas and the certificate available had no cause of death; the veteran was probably still alive; and cases where the place of death had not been identified. STATUS OF ELIGIBLE CASES Eligible by branch and time of service Cause of death known Cause of death not found 52253 51421 832 100.0% 98.4% 1.6% �Of the 51421 men for whom military service data and cause ofdeath information was available, 24736 were known to have served in Southeast Asia: 24235; were identified as having served in Vietnam; 450 were known to have served in Thailand, and for 51 the unit with which they served is known but the place of service (i.e. Vietnam or elsewhere in Southeast Asia) has yet to be resolved. PLACE OF MILITARY SERVICE No service in Southeast Asia 26685 Served in Vietnam 24235 Served in Thailand only 450 Place of service in Southeast Asia unk. 51 51.9% 47.1% 0.9% 0.1% This report will be based on 50920 deaths, 24235 men who served in Vietnam and 26685 men who did not serve in Southeast Asia. METHODOLOGY Jablon and Seltzer(2) concluded from their studies of veteran populations that it was hazardous to compare "selected cohorts" to the general population since these screened populations may vary systematically or confound the interpretation of an exposure hence there is a need to compare veterans to veterans. In this report we have heeded this advice and will use the Vietnam Era veterans who did not serve in Southeast Asia as a comparison group for those who served in Vietnam. Of the 50920 men in this report, 83.6% had served in the Army; 47.6% had served in Vietnam (another 1% had served elsewhere in Southeast Asia). The Marines were more apt to have served in Vietnam (54.5% of the Marines and 46.2% of the Army had served in Vietnam). These proportions are close to what those that can be estimated from published data. According to Department of Defense figures(6), 8,844,000 men had served in the military between 4 Aug. 1964 and 27 Jan. 1973, Of these, 5,162,000 were in the Army or Marine Corps. Veterans Administration (9) figures indicate that 3,169,000 Vietnam era veterans served in Vietnam. If 81% of these were in the Army or Marine Corps(6) then 2,535,000 Army or Marine Corps veterans were in Vietnam. Therefore 2535/5162 or 49.1% of Army or Marine Corps personnel during that period served in Southeast Asia. PLACE OF SERVICE BY BRANCH SERVED IN VIETNAM YES NO Army Marine Corps 19708 4527 TOTALS 24235 22904 3781 26685 TOTAL 42612 8308 50920 �Of the 50920 deaths used in this report, 79.6% were white, 17.7% were black and 2.7% were of other racial groups. Proportional mortality ratios,standardized for age, race, and branch of service (SPMRs) were calculated for all major causes of death among all men who served in Vietnam. To calculate a proportional mortality ratio for a particular cause of death, the deaths were first divided into two groups which were those who served in Vietnam and those who did not. Within each of these groups the deaths were then divided by branch of service and within branch of service, they were divided by race. Within each racial group they were divided into 10 age groups (20-24, 25-29, . . . 60-64, 65+). The the proportion of deaths from the cause of interest was calculated for each age group in the comparison group (veterans who did not go to Vietnam). These proportions were then multiplied by the total number of deaths in the corresponding age-race group in the Vietnam service group to obtain the number of deaths that would be expected to be seen among the veterans with Vietnam service if they had the same proportional distribution of deaths by age,race,branch and cause as those veterans who did not go to Vietnam. These expected numbers for a specific cause are then added to give the total number of deaths that would be expected if the veterans who had served in Vietnam had the same age,race,branch,specific proportional mortality as those veterans who did not serve in Vietnam. Mathematically this process can be expressed as : d(i,j,k,+) X D(i,j,k,l) Expected(+,+,+,!)= where d(i,j,k,+) = the number of deaths from all causes in the ith branch, jth race and kth age group among veterans who served in Vietnam. D(i,j,k,l) = the number of deaths from the 1th cause in the ith branch, jth race, and kth age group among veterans who did not serve in Vietnam. D(i,j,k,+) = the number of deaths from all causes in the ith branch, jth race, and kth age group among The SPMR (standardized proportional mortality ratio) is obtained for each cause by dividing the observed number of deaths from that cause in veterans with Vietnam service by the expected number (O/E). The O/E (observed to expected ratio) indicates whether the group of interest has relatively more deaths (greater than 1) or relatively fewer deaths (O/E less than 1) than expected from a specific cause. In the tables presented here the expected numbers were rounded in printing the table. The Mantel-Haenszel chi-square statistic (11) was calculated for each category to indicate whether the deviation from unity is "statistically significant", that is, whether or not such �10 differences are likely to be seen by chance. (The 0/E ratio and SPMR have been used interchangeably in this report.) The disadvantages of proportionate mortality analysis are well known. If the overall mortality in the exposed population is different from that of the non-exposed population the SPMR will not approximate the standardized mortality ratio (SMR). That is, if the overall mortality rate is less among those who did not serve in Southeast Asia the the SPMRs will under estimate the cause specific risks for those who did go to Vietnam. A cause specific SMPR is also dependent on the relative distribution of other causes of death. For example, if men who served in Vietnam had a higher mortality rate for accidents than the referent population, then the SPMR for some other cause might be depressed. , All major causes of death were looked at separately among all men with service in Vietnam and in subgroups of that population. SPMRs were calculated separately for the men who served in the Army and for those who served in the Marine Corps because the branches might have had different types of "exposures" in Vietnam either by virtue of the location of their units or the types of duties they were assigned. For example, it is known that virtually all of the Marines in Vietnam were stationed in I Corps (the northern provinces of Vietnam). It is well known that mortality patterns tend to differ by race. For this reason, SPMR's were calculated separately for whites and non-whites. Most of the non-whites were blacks. There were too few persons of other races to consider them separately. Rather than excluding them from consideration, they were grouped with the blacks for the purpose of these preliminary analyses. Conceivably, enlisted men might have different experiences or exposures than officers. Thus, these two groups were considered separately. Certainly one might expect that men who were in combat might differ from those who were not. There was no data element that would indicate whether the man had been in combat. As a surrogate measure for combat, those with "combat" related MOSCs were compared with those who served in Vietnam with non-combat related MOSCs in each branch. Combat related MOSCs were those occupations where the primary duty would involve direct offensive and defensive action against an armed hostile force, for example: rifleman, field artilleryman, tank crew member etc. The MOSC groupings used here are those used in the Wisconsin study(12). They can be found in Appendix B-2. Data from all these analyses are presented in this report. Certainly many other subgroups might be identified as the analyses of this data set continue. RESULTS AND DISCUSSION If one looks at the deaths by major disease groups, there would seem to be no remarkable differences between the men who served in Vietnam and their counterparts who did not serve in Vietnam except for "accidents, violence, and trauma (E800-E989) which is"significantly" in excess among those who served in Vietnam. Deaths from "musculoskeletal and connective tissue diseases (710-730)" also �11 can be seen to be consistently elevated across the several subgroups but the differences are not seen to be "statistically" significant. The only other major disease category seen in significant excess is that of diseases of the nervous system and sense organs (380-389) in the marines with combat related MOSCs where the SPUR is 2.28 based on 17 cases observed. ACCIDENTS, VIOLENCE AND TRAUMA Since over half of all the deaths in the study population are due to accidents, violence, or trauma and because they are seen to be in excess, they bear investigation. Within this broad category, motor vehicle accidents account for most of the deaths and they are significantly in excess among all the sub populations except the Marines. A cursory investigation was carried out to see if the men who were in Vietnam were more likely to have civilian jobs that would put them at higher risk of having a motor vehicle accident. The proportion of men with jobs that might require driving a motor vehicle was the same in the two groups. "Other transport accidents" are seen to be in excess primarily among Army personnel who are not enlisted men. Investigation revealed that these were occurring with greatest relative frequency among warrant officers who had MOSCs that indicated they were helicopter pilots and that helicopter crashes were a leading cause of death in this cause category. It was found that many of these men were killed while at work as helicopter pilots. These accident would not seem to be related to their "Vietnam experience" except for the correlation of MOSC, Vietnam service and civilian occupation. Most of the men with an MOSC that indicated that they were helicopter pilots had served in Vietnam. The category of "accidental poisonings" was elevated among all groups. They seem to be a particular problem among white, Army enlisted personnel. A sample from all of these deaths was drawn and the death certificates were reviewed for more information. It was found that on 98 of 100 certificates the death was due to narcotic overdose, mostly heroin. The accidents coded as "other accidents and injury" suggest they might be related to occupation but these have not been looked at in detail. Death by suicides is relatively less frequent in all of the sub groups presented here except for nonwhite servicemen where the observed number exceeds the expected number by less than 1%. Deaths by homicide are in excess among officers and those with combat experience. A preliminary investigation revealed that men who had service in Vietnam were more likely to have had a civilian job such as guard, policemen, etc., that would put them at risk of violent death. �12 MALIGNANCIES The possibility of excess malignancies occurring among the men who served in Vietnam and who may have been exposed to herbicides has long been a concern to veterans. When all malignancies are grouped together, Marines, non-whites, and officers who served in Vietnam exhibit an excess of cancer when compared to their counterparts who did not serve in Southeast Asia. The excesses are not statistically significant but they suggest that there could be a problem in a subgroups of these men. SPMRs FOR ALL MALIGNANCIES GROUP All All All All All All All OBS. cases Army Marines white servicemen non-white servicemen enlisted officers 0/E 2973 2452 1.00 .97 1.20 .99 1.06 .99 1.04 521 2480 492 2566 318 The men with combat related MOSCs were not seen to have more malignancies than those who served with non-combat related MOSCs. SPMRs FOR ALL MALIGNANCIES AMONG COMBAT RELATED MOSCs BRANCH Army Marines OBS. 0/E 550 158 .76 .98 This might suggest that if there is an "environmental" factor associated with military service in Vietnam that is related to the slight excesses seen in overall malignancies, it is not confined only to men who had a high probability of being in combat. Differences between the services are seen for specific cancer sites among those who served in Vietnam . The most outstanding differences are the significant excess of deaths from lung cancer and non-Hodgkins lymphoma seen in the Marines. The SPMRs for these malignancies are also elevated among Army personnel although the excess are not seen as statistically significant. �13 SPMRs FOR SELECTED MALIGNANCIES BY BRANCH ARMY SITE All sites Lung Non-Hodgkins Lymphoma OBS 2452 632 92 MARINES 0/E .97 1.03 1.16 OBS 521 130 35 O/E 1.20 1.58* 2 .10* Soft tissue sarcomas have been of particular interest to those studying the health or mortality of Vietnam veterans since they are a type of tumor that has been reported to be associated with exposure to phenoxy-herbicides by Swedish investigators(13). They are not elevated in this population. In each group the O/E ratio is 1.00 or less. Some marked differences in the ratios of observed numbers of deaths to expected numbers of deaths have been noted between the men who served in the Army and those who served in the Marine Corps among both those who served in Vietnam and those who did not. Cause specific standardized proportional mortality ratios are dependent upon the relative distribution of other causes of death. The SPMR for the group of external causes of death (accidents, etc..) is higher among those who went to Vietnam relative to those who did not go to Vietnam in both those who served in the Army and those who served in the Marine Corps. This can occur either because those who went to Vietnam had higher relative risks of dying from external causes of death or because they have lower overall mortality rates than their counterparts who did not serve in Vietnam. It might be expected that in comparison to the general population there would be relatively fewer deaths from circulatory diseases and certain other diseases in the military population because among these causes of death are conditions that would make one ineligible for military service. On the other hand the selection process for military service can not screen out persons likely to have an accident or to suffer from a malignancy in the future. It would be expected that any comparison with the general population there would be lower death rates for some diseases among those who served in the military. Consequently, the proportional mortality ratios will be less than 1 for these causes. Conversely, the proportional mortality ratios for diseases occurring at approximately the same rate or higher than in the general population will be elevated. Standardized proportional mortality ratios were calculated for white male veteran deaths occurring in the years 1978 to 1981 using the 1978 U.S. white male mortality data (14) for four broad groups of causes of death: all malignancies, circulatory diseases, external causes, and all other. As expected, the groups of causes that are unlikely to be screened out at entry into the military service have relatively larger observed to expected ratios than those for �14 categories that include conditions that would lessen the likelihood of military service. SPMRs FOR SELECTED CAUSES OF DEATH WHITE VETERANS No Vietnam Service Army Malignancies Circulatory dis. External causes All other Marines .99 .87 .88 .78 1.10 . .1.16 .88 .66 1978-1981 Vietnam Service Army .98 .96 1.14 .69 Marines 1.04 .87 1.17 .60 U.S. white male mortality for 1978 were uses as a comparison. No significance tests were done. When compared to the U.S. white male mortality for 1978, the proportion of deaths from external causes tends to be the same for the Marines who went to Vietnam as for those who didn't go. There still appears to be an excess of malignancies among Marines who went to Vietnam when compared to the general population. The deaths among the Marine veterans are distributed differently than those among the Army veterans when compared to deaths among the U.S. white male population. One explanation might be the difference in the ages of the two populations. The mean age of death for the Army veterans was the same for those who went to Vietnam (36.3 years) as for those who did not go (36.2 years). The mean age of death for the Marine Corps veterans was less than that of the Army veterans. The mean age of death for Marines who did not serve in Vietnam was younger (30.9 years) than that of the marines who had served in Vietnam (34.4 years). Mortality rates for most causes of death are related to age. Younger populations will die relatively more frequently from accidents, etc. than older populations. The SPMRs were recalculated for this same group of deaths excluding all external causes of death. When all external causes of death were removed, there is less difference between the distribution of the Army deaths and the Marine deaths among both those who went to Vietnam and those who did not. OBSERVED TO EXPECTED RATIOS FOR SELECTED CAUSES OF DEATH WHITE VETERANS 1978-1981 EXCLUDING EXTERNAL CAUSES OF DEATH No Vietnam Service Army All malignancies Circulatory dis. External causes All other Marines Vietnam Service Army Marines 1.09 .93 1.15 .95 1.09 1.06 1.35 1.01 1.01 .93 .82 .76 U.S. white male mortality for 1978 used as a comparison. No significance tests were done. �15 One might question whether the excess mortality from non-Hodgkins lymphoma or lung cancer might be artifacts of the apparent excess deaths from external causes among Marine veterans who did not go to Vietnam thereby yielding a relatively smaller proportion of expected deaths from malignancies among these men thus increasing the 0/E ratios in the internal comparisons presented in this report. The expected numbers of malignancies were calculated using U.S. mortality data and using only the distribution of specific malignancies(15) within all malignancies. OBSERVED AND EXPECTED NUMBERS OF DEATHS FOR SELECTED MALIGNANCIES, WHITE MALES, 1973-1981, ARMY No Vietnam Service OBS. EX1 EX2 All malignancies Ca-colon Ca-lung , bronchus Hodgkins Lymphoma Non-Hodgkins Lymphoma Leukemia 2061 133 488 72 122 192 1964 142 446 94 113 188 154 495 91 115 184 Vietnam Service OBS. EX1 EX2 1773 107 443 65 84 152 1753 125 410 83 101 163 128 433 79 100 157 EX1 = Expected numbers based on 1973-81 total white male mortality EX2 = Expected numbers based on 1973-81 white male cancer mortality OBSERVED AND EXPECTED NUMBERS OF DEATHS FOR SELECTED MALIGNANCIES, WHITE MALES, 1973-1981 MARINES No Vietnam Service OBS. EX1 EX2 All malignancies Ca-colon Ca-lung , bronchus Hodgkins Lymphoma Non-Hodgkins Lymphoma Leukemia 226 10 40 11 8 21 264 17 41 18 17 35 15 46 11 13 24 Vietnam Service OBS. EX1 EX2 409 18 103 17 29 36 392 27 79 22 24 42 29 91 20 25 36 EX1 = Expected numbers based on 1973-81 total white male mortality EX2 = Expected numbers based on 1973-81 white male cancer mortality �16 When the influence of the external causes death is removed from the standardized proportional mortality ratios by calculating the expected numbers using only the proportional distribution within all malignancies as a comparison, the apparent increase in lung cancer and in NHL still exists. Since the SPMSs using the internal comparisons were elevated for a subset of Marines, those with combat related MOSCs, expected numbers for this population were calculated using the U.S. mortality as in the tables above. OBSERVED AND EXPECTED NUMBERS OF DEATHS FOR SELECTED MALIGNANCIES, WHITE MALES, 1973-1981 MARINES WITH COMBAT MOSCs No Vietnam Service OBS. EX1 EX2 All malignancies Ca-colon Ca-lung , bronchus Hodgkins lymphoma Non-Hodgkins lymphoma Leukemia 35 3 4 0 1 5 51 3 6 4 4 7 2 4 2 2 4 Vietnam Service OBS. EX1 EX2 136 5 20 6 14 17 133 9 19 10 9 18 9 24 8 9 17 EX1 = Expected numbers based on 1973-81 total white male mortality EX2 = Expected numbers based on 1973-81 white male cancer mortality The observed numbers of NHL are not as different from the expected numbers in those who did not serve in Vietnam as they are among those who served in Vietnam. The results are similar for black males who served in the Army. Therefore, the excess mortality from NHL seen using the internal comparisons is probably not an artifact. OBSERVED AND EXPECTED NUMBERS OF DEATHS FOR SELECTED MALIGNANCIES, BLACK MALES, 1973-1981 ARMY WITH COMBAT MOSC'S No Vietnam Service OBS. EX1 EX2 All malignancies Ca-colon Ca-lung , bronchus Hodgkins Lymphoma Non-Hodgkins Lymphoma Leukemia 290 37 76 5 8 21 253 18 71 9 9 21 21 60 10 10 24 Vietnam Service OBS. EX1 EX2 344 30 48 10 18 21 281 20 86 8 9 29 24 106 9 11 23 EX1 = Expected numbers based on 1973-81 total black male mortality EX2 = Expected numbers based on 1973-81 black male cancer mortality �17 ADDITIONAL ANALYSIS FOR NON-HODGKIN'S LYMPHOMA The SPMR for non-Hodgkin's lymphoma in Marines who went to Vietnam when compared to those who didn't go to Vietnam was 2.10 based on 35 observed cases. This is significantly greater than 1 using the Mantel Haenszel(ll) chi-square statistic. Case control analyses (16) were carried out to examine the relationship between mortality from non-Hodgkin's lymphoma (NHL) to service in Vietnam. The controls for these analyses were all cardiovascular deaths (ICDA-8 codes: 390.0-458.9) among Marines who did not go to Southeast Asia. These were chosen because in this mortality study and several others (12,18,19,20 ) no association was found between Vietnam service and cardiovascular mortality. Also, no biologic hypothesis exists suggesting a relationship between service in Vietnam and cardiovascular mortality. In case control analysis, if the exposure of interest is not a risk factor for the selected control group the standardized mortality odds ratio (SMOR) is equivalent to the SMR. All SMOR analyses were standardized by age. AGE SPECIFIC MORTALITY ODDS RATIOS FOR NON-HODGKIN'S LYMPHOMA MARINES Age Group OBS MOR (LCI,UCI) 20-29 30-39 40-49 50-59 60+ Overall 7 23 2 2 1 35 2.28 5.11 0.28 0.95 1.58 2.08 (0.64,8.18) (1.51,17.3)* (0.04,2.03) (0.08,10.7) (0.05,48.8) (1.21,3.60) * p-value for Mantel-Haenszel chi square < .01. (Cardiovascular deaths among Marines who did not go to Southeast Asia are the control population.) Marines age 30 through 39 at death had a mortality odds ratio of 5.11 with a lower 95% level of 1.51. The overall SMOR for Marines was 2.08 with a lower 95 percent confidence level of 1.21. The data collected from the military records included information on military occupational speciality and dates of service in Vietnam. The most usual tour of duty in Vietnam was 13 months for the Marines. If the difference between the date the veteran first went to Vietnam and the date he last left Vietnam was greater than 13 months for a Marine there is a strong possibility that the veteran served more that one tour of duty in Vietnam. Marines thus classified as having one tour had a significantly elevated SMOR of 2.44 for NHL. �18 STANDARDIZED MORTALITY ODDS RATIOS FOR NON-HODGKIN'S LYMPHOMA AMONG MARINES BY LENGTH OF SERVICE IN VIETNAM OBS 1 tour 1+ tours 20 15 SMOR (LCI,UCI) 2.44 (1.33,4.47) 1.74 (0.93,3.27) (Cardiovascular deaths among Marines who did not go to Southeast Asia are the control population) Herbicides were used in Vietnam in greatest volume in 1967 through 1969. The standardized mortality odds ratios are highest in both groups among those who first went to Vietnam during that time interval. The elevation is significant in the Marines but not in the Army personnel. STANDARDIZED MORTALITY ODDS RATIOS FOR NON-HODGKIN'S LYMPHOMA AMONG MARINES BY FIRST YEAR IN VIETNAM OBS 1965-66 1967-69 1970+ 16 17 2 SMOR(LCI,UCI) 1.76 (1 .02, 4. 95) 2.54 (1 .22, 5. 25) 1.88 (0 .42, 8. 36) (Cardiovascular deaths among Marines who did not go to Southeast Asia are the control population) Military Occupation Specialty Codes (MOSCs) were categorized as combat troops, direct support of combat troops, and indirect support of combat troops. A description of the categories of MOSC appear in the Appendix B-2. Combat related MOSCs had the highest SMOR for military occupations at 3.25. The SMOR by MOSC decreases from combat to indirect support assignments. STANDARDIZED MORTALITY ODDS RATIOS FOR NON-HODGKIN'S LYMPHOMA AMONG MARINES BY MOSC GROUPS OBS Combat Direct Support Indirect Support SMOR(LCI,UCI) 17 11 7 3.25 (1.45,7.32) 1.70 (0.89,3.23) 1.37 (0.94,2.25) (Cardiovascular deaths among Marines who did not go to Southeast Asia are the control population) �19 Several studies have revealed an association between herbicide use and non-Hodgkin's lymphoma. A report of a recent population based case control study done by the National Cancer Institute (21) presents an odds ratio of 2.2 ( Confidence interval:1.2-4.1) for farmers ever using phenoxyacetic acids. A matched case control study done in Sweden (xx) of malignant lymphomas (Hodgkin's and NHL ) found a relative risk of 4.8 for those exposed to phenoxy acids. Because agent orange and other herbicides used in Vietnam contained phenoxyacetic acids, an attempt will be made to try to relate the location of the units in which these men served to the known herbicide spray patterns. STATE VIETNAM VETERANS MORTALITY STUDIES Wisconsin, West Virginia, New York and Massachusetts (12,18,20,17) have done mortality studies of Vietnam Era veteran. The Air Force "Ranch Hand Study" (19) includes a cohort mortality analysis. Although the results of these studies are suggestive of possible excess mortality for some causes of death, they are not strictly comparable to the data given in this report. They differ from this study in several ways. They included all Vietnam era veterans from all branches of services, some used only men with service "in country" Vietnam; other chose all who served in Southeast Asia as service in Vietnam. Wisconsin, New York and West Virginia used other Vietnam era veterans, all other state veteran and non veterans as comparison populations for SPMR analyses. Massachusetts used all other state veterans who applied for veteran bonuses and served between 1958 and 1973 as their comparison group. In the Ranch Hand Study, a standardized mortality ratio (SMR) analysis was done comparing "Ranch Banders" (i.e. men who were involved with herbicide spraying) with cargo flight crews who did not handle herbicides. The findings reported by the state studies are somewhat inconsistent with each other and with what was found here. For example, Wisconsin and Massachusetts both seen to have an excess of soft tissue sarcoma among those who went to Vietnam when compared to all other veterans. Since each state used somewhat different methods and populations, a series of tables comparable to those done for the total study population was done for each of these states using all U.S. veterans who did not serve in Southeast Asia as a comparison group for veterans from each state who had served in Vietnam. Only tables for white servicemen were done to illustrate the differences one might see when comparing more homogeneous groups and holding the comparison group constant. �20 SPMRs FOR SELECTED EXTERNAL CAUSES OF DEATH BY STATE WHITE SERVICEMEN WI NY OBS All ext causes Motor veh ace. Ace. poison Suicide All malignancies Ca-intestines Ca-soft tissue Ca-testes Cirrhosis-alcholic Cirrhosis-other 412 137 31 70 79 10 1 1 26 20 O/E 0.83 .73* 1 .65* .64* 1 .01 1.87* 0.70 0.23 3 .17 1.95* OBS O/'E 214 1.04 105 1. 34* 4 0. 45 49 1. 08* 34 1.03 3 1. 31 3 5. 11* 5 2. 86* 4 1. 01 1 0.23 M[A OBS 0/E 172 48 27 38 26 1 2 2 2 9 0.99 0.74* 3 .67* 0.98 0.82 0.44 3 .81* 1.40 0.56 2.10* Vi'V OBS 0/E 11 0.96 7 0.92 5 0.92 0 0.60* 30 0.92 2 0.85 1 1.95 2 1.69* 7 1.89 3 0.64 * P<0.05 for chi-square with 1 degree of freedom All U.S. veterans who did not go to Vietnam were the comparison group Cause of death groups consistent with grouping used in other tables In the largest category of deaths, that for accidents, suicide and trauma, great variation is seen among the states. When some states seem to have significant excess deaths for a particular subgroup another may show significant deficits for the same subgroup. Similar results can be found among other causes of death. These data are shown for selected causes where at least one state's data indicate a significant excess. Whether these variations among the states are the result of sampling error or whether they suggest an underlying difference in the mortality experience among states is not obvious. There were sufficient deaths from California in the study population to permit a comparison of SPMRs one could observe using different comparison populations. Using deaths from external causes as an example, it can be seen that white California veterans as a group have a different mortality experience then than of all white U.S. servicemen in the study population. When using all U.S. white veterans from the study population with no service in Southeast Asia as a comparison group, the white California veterans with no Vietnam service have significantly more deaths from accidental poisoning (drug overdose) and relatively more suicides than other veterans. When the California veterans with Vietnam service are compared to Vietnam era veterans from California who did not serve in Vietnam, these excesses diminish. Suicides are fewer than expected and the deaths from drug overdose are only slightly more than expected. �21 COMPARISONS OF SPMR'S FOR SELECTED CAUSES OF DEATH IN CALIFORNIA DBS All ext. causes 1232 Motor veh. ace. 446 Ace. poisoning 97 Suicides 280 All malignancies 245 Ca-intestines 11 Ca-soft tissue 18 Ca-testes 17 Cirrhosis-alcoholic 48 Cirrhosis-other 45 O/E1 1.05* 1.00 2.17* 1.07 .93 .56 .97 1.77* . «9.14* 1.48 0/E2 1.02 0.99 1.06 0.92 .94 .42 .56 2.87* 1.14 1.06 * p<0.05 for chi-square with 1 degree of freedom 0/E1 = All U.S. veteran who did not serve in Vietnam used as a comparison group. 0/E2 = California veterans who did not serve in Vietnam used as a comparison group. CONCLUSIONS The results of the preliminary analysis of some of the data from the Vietnam Veterans Mortality Study indicate that veterans who served in Vietnam were more likely to die from accidents, violence, or trauma than their counterparts who did not serve in Southeast Asia. In particular, they were more likely to die from motor vehicle accidents or from drug overdoses. There was no evidence that there are excess numbers of suicides among those who served in Vietnam. The SMPRs suggest that there might be some causes of death that should be investigated further. One of these causes, non-Hodgkins lymphoma, was submitted to further analysis. The excess of NHL-among Marines are seen using the U.S. mortality data as a comparison. Standardized mortality odds ratios using cardiovascular deaths among all Marines who did not serve in Vietnam as a control, indicate elevated risks for Marines with combat related military occupational speciality codes and for Marines who served in Vietnam for the first time between 1967 and 1969. The data collection for this study has been extended to include veteran deaths from 1982-1984. When these data are available for analysis they will be added to the data presented here and re-analyzed. One such analysis will look at the location of the unit in which a man served in Vietnam relative to the herbicide spray patterns recorded by the Air Force. �REFERENCES 1. Beebe, G.W. and Simon, A.H. Ascertainemnt of mortality in U.S. veteran population. Amer. Jour, of Epid.:89:636-643. 2. Seltzer, C. C. and Jablon, S. Effects of selection on mortality. Amer. Jour. Bpid.:100:367-370. 3. Seltzer, C. C. and Jablon, S.H. Army rank and subsequent mortality by cause: 23 year follow-up. Amer. Jour. Epid.: 105:559-566 4. Robinette, C. D. and Fraumini, J.F. Asthma and subsequent mortality in World War II veterans. J. Chron. Dis. :31:619-624 5. Ascertainment of Mortality in the U.S. Vietnam Veteran Population. Report of contract V101 (93) P-937, National Academy of Sciences Commission on the Life Sciences Medical Follow-up Agency, Washington, DC., 1985. 6. Selected Manpower Statistics, Fiscal Year 1981, Directorate for Information, Operations, and Reports, Department of Defense. 7. Protocol for the Vietnam Veterans Mortality Study. Office of Reports and Statistics, Statistical Policy and Research Service, Veterans Administration, Washington,DC., 1983. 8. Eighth Revision International Classification of Disease, Adapted for Use in the United States. Public Health Service Washington, DC. 9. Instructions for Medical Classification of Death Records for Automated Classification of Medical Entities, 1976-1978 U.S.Dept. of Health .Education and Welfare, Public Health Service, Washington DC, 1977 10. 1979 National Survey of Veterans. Reports and Statisics Service, Office of the Controller, Veterans Admnistration, Washington, DC, 1980. 11. Mantel, N. and Haenszel, W. "Statistical aspects of the analysis of data from retrospective studies of disease," Journal of the National Cancer Institute:28:947 (1962) 12. Wisconsin Vietnam Veteran Mortality Study, Final Report. State of Wisconsin Department of Health and Social Services, Division of Health, 1986. �13. Kardell, L., et al. "Malignant Lyntphoma and exposure to Chemicals Especially Organic Solvents, Chlorophenols and Phenoxy Acids: A Case-Control Study". British Journal of Cancer:43, 169-76. 1981. 14. Vital Statistics of the United States, 1978, Mortality. U.S. Dept. Health and Human Services, Public Health Service, National Center for Health Statistics, Rockville, MD 15. SEER Program Report, Cancer Incidence and Mortality in the United States 1973-1981. NIH Publication 85-1837, U.S. Dept. Health and Human Services, Public Health Service ,National Cancer Institute, Bethesda, MD, 1984 16. Miettinen, 0. £• and Wang, J. "An Alternative to the Proportionate Mortality Ratio". Amer.Jour. of Epid.:114 : 144-48, 1981. 17. Mortality Patterns Among Vietnam Veterans in Massachusetts 1972-83. Massachusetts Office of Commissioner of Veterans Services, Agent Orange Program, Massachusetts Department of of Public Health, Division of Health Statistics, 1985. 18. West Virginia Vietnam Bra Veterans Mortality Study. West Virginia Residents 1968-1983, Preliminary Report. West Virginia Health Department, 1986. 19. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides, Baseline Mortality Study.The Surgeon General, United States Air Force. June 30, 1983. 20. Mortality Patterns Among Vietnam and Vietnam Era Veterans, New Yor State Department of Health, draft report submitted to the Veterans Administration for review, 1983. 21. Hoar, 8. K., et al. "Agricultural Herbicide Use and Risk of Lymphoma and Soft-Tissue Sarcoma". Journal of the American Medical Association : 1986. �APPENDIX A �APPENDIX A-l The National Research Council (NRC) tested the completeness of BIRLS as a source of Vietnam era veterans deaths by selecting a sample of men who died in 1980 from the vital statistics records of 8 states. The names and social security numbers of the men were matched against the military records files at NPRC to ascertain military service; 3583 Vietnam era veterans were identified. Of these 3583, 88.8% were found to be recorded in BIRLS as dead; 5.3% were found in BIRLS with no death recorded and 5.9% were not found in BIRLS. The researcher used the social security number and name given on the death certificate to search the BIRLS file. It was the experience of the investigators in the VA's Vietnam Veterans Mortality Study that some veterans had more than one social security number or the name found on the death certificate was not the name in the BIRLS file. It was also found that some men* particularly those who served in the Vietnam era, may have h«d more than one BIRLS file. About the time the military switched from assigning service number to using social security numbers as the service number, the VA changed from assigning claims file numbers to using social security numbers as a claim file number. As a result of change in the VA's method of assigning claims file numbers, some veterans were found to have a BIRLS file under a claim number and another under a social security number. If the record filed under a claim number did not contain the social security number the second file might not be found by the method used by the National Research Council. This would be a particular problem for men with common names. Both of these two records may or may not have recorded the death. Frequently when these cases were encountered in this mortality study, one BIRLS record would have a death date and the other would not. Unfortunately no record was kept of the relative frequency of this problem. An attempt was made to evaluate the findings of the NRC report using materials that were available in the mortality study. All cases for whom a death certificate was available and for whom the military service history was known were searched for cases where: the social security number on the death certificate did not match the social security number in BIRLS; the name in BIRLS did not match the name on the death certificate; the birth date on BIRLS did not match the birth date (or age) on the death certificate. For 9.5% of all certificates the social security number of the death certificate did not match the social security number in BIRLS; for 51% of those with unmatched social security numbers, the names and/or birth dates did not match. These data suggest that 4.8% to 9.5% of the deaths BIRLS might not be found using the methods used by substract these number from the 11.2% not found by 1.7% to 6.6% of Vietnam era veterans may not be in known to be in NRC. If we NRC then perhaps BIRLS. �APPENDIX A-2 CONSULTANTS: Gilbert W. Beebe, PH.D., Clinical Epidemiology Branch, National Cancer Institute, NIH, Bethesda, MD. Chin Long Chaing, PH.D., Professor of Biostatistics, School of Public Health, University of California, Berkeley, CA. Joseph L. Fleiss, PH.D., Professor of Biostatistics, School of Public Health, Columbia University, New York, NY. Bernard G. Greenberg,PH.D., Professor of Biostatistiow, School of Public Health, University of Noeth Carolina, NC. Abraham M. Lilienfeld, M.D. Professor of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD. Richard Monson, M.D., School of Public Health, Harvard University, Boston, MA. �The 9.5% of deaths that night have been lost were arrayed by cause of death and Vietnam service. No differences were seen before these two groups. Therefore we feel that the BIRLS did provide a fairly complete roster of Vietnam era veteran deaths for this study. �APPENDIX B �APPENDIX B-l M . HlUtwy (Ueort) Soref> (W10> > ~14"*3 WLITMT HCCOIC M5TIUCT Ott*i tU ... _ " 1. Stwtfr ID »' (1) t*»e. 01] [U**l (11) (U) I. *«tr. ft I..J_J (U) J. taurai (II) S » .. * . U 0 4. S*i A N (If) 6 (X0> fc 7. •*" LJ-J-.LJ_LJ_LJ_ Award l«c*tlani LJ-J I..'-.'—'—'—'-.'—'—'—1 L.LJ LJ_J_LJ_J_LJ..LJ L-L.1 LLLLLLLLL . . . . . . . . (31) («0) (M) (91) («0) UX) I—'—l_l«.'—i—'—U-J_L. i—l—1—'—'—i—'—i—'—i-.i-.'-.i-.'^i-.1..'-.'-.i—.' (71) U»t. Suffix I—'-.'—LJ_'—LJ_J.J_L-'—C'—'—1 I-.'—'—'—I—LA.'—'—'—'_'-.i—i—LJ (101) firtt (1U) ». on i L. LJ_J_j_ii_J_J.J N (111) D «- »«" T MMlt «t N.X. » r « (1J») n. AMI v i s• (MO) • 0 U »» Duty IX. Oatti !_!_ l_l_l_l_ I (U1) N O T tJ. fe**i (U7) U. >Ml*nM> l ^ . ^ ^ ! . . ! . l . . ^ . . ! .l— l—l—I.J ^ l . ^ ^ . ! . . .!. !.^ . (1M) City L.LJ (170) St. UtMt tt^ntitn 19. C«t«i l_l_l_l_l_l_l (in) M O T U. Uuci 1 < ty • 19-19y M. 6r«d«i (171) l_l__l_l If. NBK 17. OiKhi (W1) 1 X 9 • tton 01«l UNC ITM JO. Trttl tatl«* Ogtyt i_u uu WS KB 9 • 7 f I we KD OWN UW L.I—1— '— ' 21. toe. X*t LJLJ I (TfX) tU S.C. MU fcrvle* (Sti*r IB •] (1) t**e. OX] (Ne. •] (•!•*] MMI (11) (13) (19) (U) CO Tr » f f*» T« l_l_l_l—I NBC i. i_i i_i I i_i_ i_«_i I LJ_LJ_L.LJ i_i_i^.i-.' (XO) (XI) (Z2) (») (J») (3») I i L.i_L.L_LJ.J.J.J_i.J I..I «wti i..^i_i—i_Ui_i—i—i_i_i—1—I i i i LJ_J .I. .!. (M) L.i_i_L.U_L-'—'_'—'_'_ U1—LJ_J_I—1—i—'—'—'-.'-.I—'—<-J—'—'—i (113) CO Tr « T. fi— 1 MOK »• I ' '— i LJ '—' i i I I— — —'— '-.'—I LJ-J—L.'-.• "*"• °«t>1 I— i '«»i_i_i_i—l_l_'_l (ID) (XI) (XX) (») 1 (J») Of) I LJ i I i ' I LJ 1—LJ w1"1 LLLLLLLLLLL1 i l l ' L.'—1—1—' . . . . . . . . . . . " "* (*») "" L-L.i_i^i_'_ i—L L L i_i . . . (113) �APPENDIX B-l (continued) CO Tr • >. I I I ftm I I 1 I I To I I I I L.L.L-1 I I I I I LJ_J *i«. Duty. LJ_L.LJ_LJ_I I I I can czri ccrr" "~"*~'~~~ ran — OD on ——— LJ—LJ—'—LJ—LJ—LJ—'—LJ—LJ »"« LJ—'—'—i—L.'—'—'—'—'—'—i—'—LJ—'—LJ—LJ i i i i i i i i i i i LJ_j i i i i i i i i i i i i i t i i i — — — — — — __ —_ —— Till; CD Tr » To ftw NBC I I 4. (an i_i i LJ—LJ—LJ i '—'—'—L_'—' ' '—'—'—'—' ftin- **»' ' '—'—'—L-1—'—'—'—'_' L.I I— '— LJ_'— '_ LJ—'—'—'— LJ— '—'— ' «*"' I '— '— '— '— '—LJ—L_ '— '—LJ—1_'—'— '—.LJ—LJ i i i i i i i i i i i i i i i i i LJ— '— LJ— LJ—LJ—'—LJ — CO —— — — — — —— — Tr • rra* To NBC ». i i i i i I i i i I I I i I i I I t L J I .i LJ **»• &*v !_i LJ-J.J_LJ-J.J_J ran cm OD ----can r (in — —*~ on I I I I I I I I I I I I Unitt LJ—'—1—t-1—'—1—1-.1—1— '-.'—'—l—'—1-.1—'-.'_' LJ_J_I — — ————————— (jj) — i_ _ i i i — — — ' i ' LJ_— — _ _ — — — — t—1—'_i^'—— _. ' ' i — __-. i ' ' ---— .'— '-.' i '-.'_' '— - — •—.'_' . CO Tr » i. I I I I I I otn cm cm""" I_ I I ---- I I To ftm I I I—I—I—I I I --- I ---I II I I nr I I I —II CJDl _ l I I I Ptln. Duty. LJ-.L.L.L-L-1-.'— L L I . . I-_ I— I—I—I Unlti (B)— I~I—I—•I—I—I I I (w> I I-.I—I—I-.I I I l_l I I I i"•~~"~~~"~~"~"~"~ i—1— L_L_ L_ L-1-.'— '_'_'—L.LJ_J_J.J i i i ' i i i i i CO Tr » rm !• 7. I I I I I I I I I I I I I I I I ND5C I I !_J_I_I I I '«»»• Outyi LI L.L. UI—1—1 ----cso on i i i i i i _ _ i i _ -i_ i i i i ut«u i iLJ^i i i_i i i_L-L_'—LJ_'_J— LJ_J_L ___i i —_ i _ —— tan can cm rzn----- '__ i i ' i '_.'_i LJ.J— LJ_J_L_ '-J.J i — .__ — — _ ~iTT) CO Tr * frtm T« I I I. I I I I I I I I I I I I I I I I I I I I Ll_l I ^ri«. *rty« LJ— '— '— '— ' nnr~ -" "" ~ -* can --- "~"~ OD on cnn _ _ _ i _ _ i _ « i _ _ i i _ _ _i_i_ i i uniti i i i i i i_i i_J_J_J.. L.1— '—L-1—'_'-.L_'_i _ i _ i _ i _ _i i _ flao"" ~~ i i i i i CO T r » iLJ_tJ T* ft* 1.1 1 1 flD1 rani i*~"~"i 1 1 i i LJ_J_J oo i LJ_L.LJ_J ***"• **»• can 1 i can i— i i i i ' i i i i i i—i—'—LJ """« jjpj LJ—'—'—'—'—'_'—'—'—<—i—i—i—'—i—i—L ——————————— '—'—'—L.i—'—•—'—L.L.'—L_'—'—i—L.L, CO Tr # rim To K). I I I I I I I I I I I I I_I_UI_I—I «J—I_J—LJ tl". Duty. ll_l_l_l_l_l_l_l_l_l ran 3T) <xtr"~"~"~" 1 1 1 (an OD 1 on 1 1 L. —'—'—'—I—'— — —L.i— —'—'—I—' """' LJ—l— —l—l—l—l—l— —l—l—l—!_'—l—i—l—l—'_l I—I I l_l_I I l_l_l_l_l_l—I—I—I—I CO Tr t ftm 1 T* "• <mi C?Di fZD""i i i i i LJ— —1—1—'—' o») '—'—'—' '»*"• **»' LJ—'—'—'_'_•_'_<—i—i i i i i "~ ~" "~ ~" (an LJ_ on 1 '— '_' '— i i— i i—i—i— LJ— '— L.L-' 'w* LJ—L.'—'—'—i—L-'—'—L-1—' ' '—»— '— »— L.L.' '_'_' '—'—'—'~"'— i—'— '_'— '— '—LJ—«— i I— >—i— '—'— I—I—i—'—i L ~™ ' �APPENDIX B-2 Explanation of MOS Codes The Military Occcupational Speciality code at time of discharge was obtained from the military record for all persons in the study. If a man had served in Southeast Asia his MOS and principle duty for each assignment in Vietnam was abstracted. The MOS coding scheme for the Army personnel had changed during the period of service covered by the study. Translation tables were built using materials supplied by the U.S. Army and Joint Service Environmental Support Group. Some codes could not be translated from the materials supplied. Some codes were missing. The codes are more complete for those'"who served in Vietnam because the description of the principal duties or title made it possible to assign a MOSC at least the 2-digit level. It was noticed during the review of these codes that for the men who had served in Vietnam the MOS at their first assignment in Vietnam was more descriptive of the type of duties assigned to him during his tour of duty in Vietnam than his MOS at discharge. After consultation with staff at the Environmental Support Group it was decided to use the MOS of the first assignment in Vietnam to characterize the man's duties in Vietnam. The MOSC for the men with service in Vietnam grouped into three categories, combat, direct support, and indirect, support based on probability of combat. (These are the same groupings used in the Wisconsin Vietnam veterans mortality study.) The definitions of these groups are: Combat: Occupations such as infantry, artillery, armor, etc., whose primary duties and objectives involve direct offensive and defensive actions against an armed hostile enemy force. Direct Support: Occupations whose primary function is the direct support of combat troops and whose duties and objectives may at times involve limited direct and extensive indirect combat with an armed hostile force, such as counterintelligence, logistics, engineering, ordnance disposal, etc. Indirect Support: Occupations such as musicians, data processing, legal services, food services, etc., whose primary function is indirect support of combat and direct support occupations and whose duties and objectives do not involve direct or indirect contact with an armed hostile force. Three coding schemes are used for Army personnel: one for enlisted men, one for officers, and another for warrant officers. The coding scheme used by the Marine Corps is different from that of the Army. �ARMY CODES The coding schemes for both the officers and enlisted men use the first two characters of the code to designate an occupational field (i.e., medical,infantry, intelligence). The first three digits are used to designate an occupational field for army warrant officers. Army enlisted MOS codes are five characters long. The first two characters represent a career group; the third character, which is alpha, indicates a specialty; the fourth number is the skill level or grade and the fifth represents special qualifications such as "Ranger" or "Special Forces." An example of an Army MOS and its breakdown is as follows: MOS « 91B2s - 91 represents the medical career group. B, the third alpha character, represents the specialty (medical specialist). 2, the fourth character, indicates the grade or rank. 8, the fifth character, indicates special qualification for special forces. The occupational codes for officers are slightly different in that a three character code is used. For example, 11A indicates infantry officer. Army Enlisted MOS Divided Into Combat, Direct Support and Indirect Support Army Combat: Direct Support: 11, 12, 13, 14, 15, 16, 17, 19 21, 22, 23, 24, 25, 26, 31, 36, 45, 54, 55, 61, 62, 63, 64, 67, 68, 90, 95, 96, 97, 98 Indirect Support: 32, 33, 34, 35, 41, 42, 43, 44, 46, 51, 52, 53, 56, 57, 65, 66, 70, 71, 72, 73, 74, 75, 76, 81, 82, 83, 84, 91, 92, 93, 94, 00, 01, 02, 03, 04, 05, 09 Army Officer MOS Divided Into Combat, Direct Support and Indirect Support Army Combat: 10, 11, 12, 13, 14, 15, 21, 33 Direct Support : 19, 25, 26, 27, 28, 30, 31, 34, 35, 36, 37, 48, 54, 74, 75, 81, 91, 93, 94, 95 Indirect Support: 00, 40, 41, 42, 43, 44, 45, 46, 49, 51, 52, 53, 55, 56, 60, 61, 62, 63, 64, 65, 66, 67, 68, 70, 71, 72, 73, 82, 92, 97 �Marine Codes The military occupational speciality codes for Marines are similar for officers and enlisted men. They codes are based on a four-digit system. For example: Marine MOS 0311 .rifleman; MOS 0302 infantry officer. Marine Enlisted MOS Divided Into Combat, Direct Support and Indirect Support Combat: 03, 08, 18, 86, 87, XX Direct Support: 02, 13, 14, 21, 23, 25, 26, 35, 57, 60, 61, 62, 63, 64, 65, 70, 72, 81, 82, 85, 99 Indirect Support: 01, 04, 11, 15, 28, 30, 31, 33, 34, 40, 41, 43, 44, 46, 55, 58, 59, 68, 73, 80, 84, 88, 89, 90, 98 Marine Officer Mos Divided into Combat, Direct support, and Indirect Support Combat: 03, 08, 18, 75 Direct Support: 02, 04, 13, 14, 20, 25, 28, 35, 57, 58, 59, 62, 65, 67, 71, 73, 99 Indirect Support: 01, 15, 25, 28, 30, 31, 32, 33, 34, 40, 41, 43, 44 46, 49, 55, 60, 68, 70 �APPENDIX C �A SUIXAIT OF TABLES C1-C36 CAICEI UJOI OIGAI STSTIIS CI1CDUT01T, IESFIIATOIT AID DIGESTIVE STSTEIS 1CCID1HS, SUICIDE, VIOL1IC1 AID THOU fllfBf Our I SIT! OIS 0/1 SILICTED DISUSES ACCDRS, HOLmAUIA ion AIIY in nuns OIS 0/1 SELECTED DISEASES 13164 -1.03 CAIDIAC U1EST OIS 0/1 EITSIIAL CADSES 273 1.23 IIOTOI TEI ACCDRS ion. nus ACC. IACC. POISOIII6S ACCDRS, IIOLWAUIA low 1.03 KOMI Til ACCDRS ion. nus ACC. un IACC. NIIOIIKS OIS 0/1 4197 1.05 6io us 511 1.14 3SI4 1.05 493 1.36 461 1.15 II1ICI IAIIIIS . LU1G lOMDUIS LYIPHOI1 130 1.51 35 2.10 _______ ____._..__.____._.._______. KCDRS, TIOimiQIi 11074 1.02 CAIDIAC AUEST I8ITE IACI loniiTi inSCQLOKOIfECTIU TIS 14 3.i2 ALL Onn CAUlIi 2790 i.of IKCDRS, TIOL+TUni nn uccom, vioLmiuu 32(( 1.02 CAIDIAC AIIIST EILISTED IN orricni OTB CA 3) 1.2! ciiDioiTOPini UIT COI1AT IOSC UPPE1 1SSP 11 2,35 ALL Onil CAUSES ICOIllAT 1 STATUS I mill COIBiT KOSC IIElfOOS SYS+SEISE 016 17 2.21 IirLUEHAiPIEtniOIIA 212 1.23 IIOTOI Til ACCDRS (On. THIS ACC. IACC. POISOIIKf 42(4 1.04 54S 1.11 4(4 1.13 3977 1.13 IIOTOI III ACCDRS 1 (32 1.11 249 1.25 IIOTOI TEI ACCDRI IACC. POISOIIKS IALL On ACC./IMOTT K (.21 ion. TUII ACC. 4((4 1.02 IALL «I ACC./XWnT IMIICIDI IS 2.39 HOMICIDE 4757 1.06 5(1 1.15 2S15 1.05 114 i.(( 7(2 1.09 (31 1.09 2I( 1.24 �APPENDIX C DEATHS FROM CANCERS TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE C-l C-2 C-3 C-4 C-5 C-6 C-8 C-9 - ALL ALL ALL ALL ALL ALL ALL ALL CASES ARMY MARINES WHITE SERVICEMEN NON-WHITE SERVICEMEN ENLISTED MEN ENLISTED ARMY IN VIETNAM,COMBAT MOSC VS. NON-COMBAT MOSC ENLISTED MARINES IN VIETNAM,COMBAT MOSC VS. NOW-COMBAT MOSC SELECTED CAUSES OF DEATH BY ORGAN SYSTEM TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE C-10 C-ll C-12 C-13 C-l4 C-l5 C-16 C-17 C-18 - ALL ALL ALL ALL ALL ALL ALL ALL ALL CASES ARMY MARINES WHITE SERVICEMEN NON-WHITE SERVICEMEN ENLISTED MEN OFFICERS ENLISTED ARMY IN VIETNAM, COMBAT MOSC VS. NON-COMBAT MOSC ENLISTED MARINES IN VIETNAM, COMBAT MOSC VS. NON-COMBAT MOSC DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE C-l9 C-20 C-21 C-22 C-23 C-24 C-25 C-26 C-27 - ALL ALL ALL ALL ALL ALL ALL ALL ALL CASES ARMY MARINES WHITE SERVICEMEN NON-WHITE SERVICEMEN ENLISTED MEN OFFICERS ENLISTED ARMY IN VIETNAM, COMBAT MOSC VS. NON-COMBAT MOSC ENLISTED MARINES IN VIETNAM, COMBAT MOSC VS. RON-COMBAT MOSC �DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE TABLE C-28 C-29 C-30 C-31 C-32 C-33 C-34 C-35 C-36 - ALL ALL ALL ALL ALL ALL ALL ALL ALL CASES ARMY MARINES WHITE SERVICEMEN NON-WHITE SERVICEMEN ENLISTED MEN OFFICERS ENLISTED ARMY IN VIETNAM, COMBAT MOSC VS. NON-COMBAT MOSC ENLISTED MARINES IN VIETNAM,COMBAT MOSC VS. NON-COMBAT MOSC �TABLE C-l DEATHS FROM CANCERS (140-208, 230-239) ALL CASES OBSERVED EXPECTED 0/E M-H CHI-SQUARE 1.00 1.00 1.02 1.06 0.99 1.06 0.95 0.97 1.09 0.93 0.91 1.00 0.96 1.16 0.74 0.87 0.98 0.60 0.59 0.96 1.19 0.72 0.92 1.03 0.239 0.009 0.114 0.306 0.000 0.144 0.342 0.000 0.660 0.131 0.157 0.175 0.134 0.780 1.545 0.389 0.001 9.697* 2.696 0.385 0.801 0.292 1.437 0.196 CAUSE ALL OTHER CAUSES (000-136 , 210-228 , 240-E989) CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER 01 (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HODGKINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTH CA ( 163 , 173-4 ,187,190, 195-9 , 208-9 , 230-9 ) 21262 84 51 105 242 40 100 30 762 38 38 181 35 116 13 68 141 54 19 143 114 20 244 335 21265 84 50 99 244 38 105 31 697 41 42 180 36 100 18 78 143 90 32 150 96 28 266 324 TOTAL NUMBER OF CASES OBSERVED « 24235 EXPECTED NUMBERS ARE BASED UPON 26685 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-2 DEATHS PROM CANCERS (140-208, 230-239) ALL ARMY OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-136 , 210-228 , 240-E989) CA - BUCCAL (140-149) CA - ESOPHAOUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER 01 (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HOD6KINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTH: CA (163,173-4,187,190,195-9,208-9,230-9) 17256 17173 71 46 88 209 34 82 29 632 27 30 145 30 90 9 55 116 43 15 108 92 18 202 281 TOTAL NUMBER OF CASES OBSERVED • 19708 EXPECTED NUMBERS ARE BASED UPON 22904 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OP FREEDOM 77 37 78 217 33 94 25 614 33 30 142 32 80 16 63 120 78 25 133 79 23 229 273 1.00 0.92 1.24 1.12 0.96 1.04 0.87 1.14 1.03 0.82 0.99 1.02 0.92 1.12 0.56 0.87 0.97 0.55 0.59 0.81 1.16 0.77 0.88 1.03 1.631 0.060 0.813 0.677 0.062 0.062 0.805 0.183 0.000 0.286 0.008 0.118 0.100 0.557 2.353 0.242 0.003 10.503* 2.312 2.761 0.388 0.188 1.809 0.319 �TABLE C-3 DEATHS FROM CANCERS (140-208, 230-239) ALL MARINES OBSERVED EXPECTED 0/E M-H CHI-SQUARE 0.98 1.95 0.39 0.82 1.26 1.21 1.63 0.18 1.58 1.38 0.71 0.94 1.29 1.29 2.41 0.89 1.07 0.93 0.57 2.10 1.33 0.45 1.14 1.07 3.831 1.038 2.148 0.318 0.632 0.196 0.582 2.844 5.800* 0.051 1.160 0.067 0.059 0.239 0.268 0.210 0.005 0.050 0.384 6.116* 0.679 0.186 0.019 0.053 CAUSE ALL OTHER CAUSES (000-136 , 210-228 , 240-E989 ) CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER 01 (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HODGKINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTHI CA (163,173-4,187,190,195-9,208-9,230-9) 4006 13 5 17 33 6 18 1 130 11 8 36 5 26 4 13 25 11 4 35 22 2 42 54 TOTAL NUMBER OF CASES OBSERVED - 4527 EXPECTED NUMBERS ARE BASED UPON 3781 OBSERVATIONS IN COMPARISON OROUF * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 4092 7 13 21 26 5 11 6 83 8 11 38 4 20 2 15 23 12 7 17 17 4 37 51 �TABLE C-4 DEATHS PROM CANCERS (140-208, 230-239) ALL WHITE SERVICEMEN OBSERVED EXPECTED 0/E M-H CHI-SQUARE 1.00 1.05 0.87 0.99 1.04 1.31 0.97 0.94 1.09 0.99 0.92 0.98 0.71 1.22 0.85 0.79 1.00 0.62 0.59 0.89 1.22 0.65 0.89 0.99 0.797 0.085 0.157 0.018 0.270 0.882 0.072 0.071 0.371 0.018 0.194 0.046 1.475 1.180 0.737 0.856 0.014 8.107* 1.893 1.436 1.001 0.689 1.581 0.027 CAUSE ALL <OTHER CAUSES (000-136, 210-228 , 240-E989) CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER GI (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HODGKINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTH CA (163,173-4,187,190,195-9,208-9,230-9) 16697 16671 64 35 75 193 29 85 25 616 34 34 176 23 110 12 55 128 50 15 120 101 16 212 272 TOTAL NUMBER OF CASES OBSERVED - 19177 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 61 40 75 185 22 87 27 565 34 37 179 33 90 14 70 128 81 25 134 83 24 238 273 �TABLE C-5 DEATHS FROM CANCERS (140-208, 230-239) ALL NON-WHITE SERVICEMEN OBSERVED EXPECTED 0/E M-H CHI-SQUARE 0.99 0.87 1.65 1.27 0.84 0.70 0.84 1.16 1.11 0.60 0.87 3.36 3.21 0.61 0.29 1.59 0.86 0.44 0.58 1.50 1.03 1.24 1.13 1.25 0.723 0.103 1.917 0.755 1.008 0.512 0.764 0.389 0.383 0.419 0.007 2.582 3.441 0.528 1.383 0.351 0.215 1.755 0.820 2.117 0.015 0.408 0.004 2.133 CAUSE ALL OTHER CAUSES (000-136 , 210-228 , 240-E989 CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER 61 (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HODGKINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTH! CA (163,173-4,187,190,195-9,208-9,230-9) 4565 20 16 30 49 11 15 5 146 4 4 5 12 6 1 13 13 4 4 23 13 4 32 63 4595 23 10 24 59 16 18 4 132 7 5 1 4 10 3 8 15 9 7 15 13 3 28 50 TOTAL NUMBER OF CASES OBSERVED - 5058 EXPECTED NUMBERS ARE BASED UPON 5350 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-6 DEATHS FROM CANCERS (140-208, 230-239) ALL ENLISTED MEN OBSERVED EXPECTED 0/E M-H CHI-SQUARE 1.00 0.95 1.00 1.08 0.96 1.00 0.89 1.24 1.10 0.89 0.99 1.00 1.30 1.16 0.70 0.81 0.97 0.49 0.46 1.00 1.20 0.55 0.91 0.99 0.957 0.136 0.150 0.392 0.122 0.029 0.953 0.689 0.785 0.327 0.001 0.113 0.564 0.932 1.612 0.911 0.105 14.323* 4.965* 0.077 0.677 1.599 1.280 0.065 CAUSE ALL OTHER CAUSES (000-136 , 210-228 , 240-E989) CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER GI (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HODGKINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTH CA (163,173-4,187,190,195-9,208-9,230-9) 19962 71 40 93 206 34 80 19937 75 29 660 34 37 153 29 110 12 57 117 38 14 131 104 14 219 284 TOTAL NUMBER OF CASES OBSERVED - 22528 EXPECTED NUMBERS ARE BASED UPON 25022 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 40 86 214 34 90 23 598 38 37 153 22 95 17 70 121 78 30 131 87 25 239 287 �TABLE C-7 DEATHS FROM CANCERS (140-208, 230-239) ALL OFFICERS OBSERVED EXPECTED 0/E M-K CHI-SQUARE 1.00 1.26 0.99 0.96 1.38 2.22 0.97 0.00 1.20 1.44 0.26 0.88 0.61 1.07 3.55 2.12 0.75 1.19 5.73 0.42 0.73 2.06 0.95 1.29 1.654 1.260 0.000 0.411 1.664 1.054 0.075 6.076* 0.606 0.335 2.314 0.003 0.817 0.035 0.085 0.712 0.002 0.220 2.120 2.345 0.252 0.632 0.013 4.492* CAUSE ALL OTHER CAUSES (000-136 , 210-228 , 240-E989) CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER 61 (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HODGKINS LYMPKOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTH[ CA (163,173-4,187,190,195-9,208-9,230-9) 938 10 8 7 32 5 13 0 77 4 1 25 5 5 1 9 18 13 5 9 7 4 21 39 TOTAL NUMBER OF CASES OBSERVED • 1256 EXPECTED NUMBERS ARE BASED UPON 1405 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 942 8 8 7 23 2 13 7 64 3 4 28 8 5 0 4 24 11 1 21 10 2 22 30 �TABLB C-8 DEATHS FROM CANCERS (140-208, 230-239) ALL ARMY ENLISTED MEN IN VIETNAM, COMBAT MOSC VS. NON-COMBAT MOSC OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-136 , 210-228 , 240-B989) CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER GI (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HODGKINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTH CA (163 , 173-4 , 187 , 190 , 195-9 , 208-9 , 230-9 ) 4972 14 10 25 39 9 11 11 135 6 6 26 3 28 2 11 30 10 1 33 25 3 55 57 TOTAL NUMBER OF CASES OBSERVED - 5522 EXPECTED NUMBERS ARE BASED UPON 12767 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 4947 16 8 18 49 8 17 5 122 8 10 43 5 28 2 13 29 9 4 28 28 3 54 68 1.01 0.87 1.23 1.42 0.79 1.17 0.64 2.35 1.11 0.72 0.59 0.61 0.56 1.00 1.02 0.88 1.05 1.06 0.24 1.16 0.88 1.00 1.02 0.84 0.752 0.177 0.382 2.074 1.713 0.247 1.720 4.264* 0.911 0.483 1.404 4.971* 0.763 0.004 0.012 0.050 0.065 0.083 2.144 0.507 0.174 0.008 0.012 1.409 �TABLB C-9 DEATHS FROM CANCERS (140-208, 230-239) ALL ENLISTED MARINES IN VIETNAM, COMBAT MOSC VS. NON-COMBAT MOSC OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-136 , 210-228 , 240-E989) CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER 61 (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HOD6KINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTH CA (163 , 173-4 , 187 , 190 , 195-9 , 208-9 , 230-9) 1743 4 2 8 6 4 4 0 23 4 0 14 1 10 0 4 9 5 1 17 8 0 18 13 TOTAL NUMBER OF CASES OBSERVED - 1898 EXPECTED NUMBERS ARE BASED UPON 2341 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 1740 2 1 2 10 1 5 1 31 5 4 13 2 12 1 4 9 2 0 12 11 0 15 14 1.00 2.06 2.33 3.74 0.60 3.46 0.75 0.00 0.74 0.87 0.00 1.06 0.53 0.82 0.00 1.11 0.98 2.48 2.52 1.43 0.73 0.00 1.17 0.92 0.468 0.105 0.581 4.343* 1.806 0.670 0.306 0.857 2.270 0.047 3.900* 0.010 0.377 0.106 0.598 0.088 0.040 1.521 0.000 0.863 0.383 0.199 0.469 0.160 �TABLE C-10 SELECTED CAUSES OF DEATH BY ORGAN SYSTEM ALL CASES OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (210-28,290-315,740-59,780-96) 859 938 0.92 1.998 INFECTIVE & PARASITIC DISEASES (000-136) 146 177 0.82 2.831 2973 2971 1.00 0.252 157 193 0.81 2.256 40 50 0.81 1.835 194 207 0.94 0.256 CIRCULATORY DISEASES (390-458) 4225 4319 0.98 1.538 RESPIRATORY DISEASES (460-519) 468 500 0.94 0.350 1170 1202 0.97 0.654 GENITOURINARY DISEASES (580-629) 93 124 0.75 5.411* SKIN & SUBCUTANEOUS TISSUES (680-709) 10 15 0.69 0.229 MUSCULOSKELETAL 6 CONNECTIVE TISSUES (710-738) 36 27 1.34 1.203 13864 13514 1.03 14.758* CANCERS (140-209, 230-239) ENDOCRINE, NUTRITIONAL & METABOLIC (240-279) BLOOD & BLOOD-FORMING ORGANS (280-289) NERVOUS SYSTEMS & SENSE ORGANS (320-389) DIGESTIVE DISEASES (520-577) ACCIDENTS, VIOLENCE & TRAUMA (E800-989) TOTAL NUMBER OF CASES OBSERVED - 24235 EXPECTED NUMBERS ARE BASED UPON 26685 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-ll SELECTED CAUSES OF DEATH BY ORGAN SYSTEM ALL ARMY OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (210-28,290-315,740-59,780-96) 709 778 0.91 2.314 INFECTIVE & PARASITIC DISEASES (000-136) 127 159 0.80 3.473 2452 2535 0.97 1.631 135 159 0.85 1.790 32 47 0.68 3.429 167 176 0.95 0.222 CIRCULATORY DISEASES (390-458) 3578 3655 0.98 1.468 RESPIRATORY DISEASES (460-519) 406 435 0.93 0.232 1001 1008 0.99 0.161 80 104 0.77 4.288* 8 11 0.76 0.040 29 19 1.55 1.694 10984 10623 1.03 18.154* CANCERS (140-209, 230-239) ENDOCRINE, NUTRITIONAL & METABOLIC (240-279) BLOOD & BLOOD-FORMING ORGANS (280-289) NERVOUS SYSTEMS & SENSE ORGANS (320-389) DIGESTIVE DISEASES (520-577) GENITOURINARY DISEASES (580-629) SKIN 6 SUBCUTANEOUS TISSUES (680-709) MUSCULOSKELETAL & CONNECTIVE TISSUES (710-738) ACCIDENTS, VIOLENCE & TRAUMA (E800-989) TOTAL NUMBER OF CASES OBSERVED - 19708 EXPECTED NUMBERS ARE BASED UPON 22904 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-12 SELECTED CAUSES OF DEATH BY ORGAN SYSTEM ALL MARINES OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE 150 160 0.94 0.000 19 19 1.02 0.080 521 436 1.20 3.688 22 33 0.66 0.527 8 2 3.22 1.538 27 31 0.86 0.034 CIRCULATORY DISEASES (390-458) 647 663 0.98 0.089 RESPIRATORY DISEASES (460-519) 62 65 0.95 0.176 169 194 0.87 1.588 13 19 0.67 1.265 SKIN & SUBCUTANEOUS TISSUES (680-709) 2 4 0.50 0.409 MUSCULOSKELETAL & CONNECTIVE TISSUES (710-738) 7 8 0.87 0.040 2880 2891 1.00 0.057 ALL OTHER CAUSES (210-28,290-315,740-59,780-96) INFECTIVE & PARASITIC DISEASES (000-136) CANCERS (140-209, 230-239) ENDOCRINE, NUTRITIONAL & METABOLIC (240-279) BLOOD & BLOOD-FORMING ORGANS (280-289) NERVOUS SYSTEMS & SENSE ORGANS (320-389) DIGESTIVE DISEASES (520-577) GENITOURINARY DISEASES (580-629) ACCIDENTS, VIOLENCE & TRAUMA (E800-989) TOTAL NUMBER OF CASES OBSERVED - 4527 EXPECTED NUMBERS ARE BASED UPON 3781 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-13 SELECTED CAUSES OF DEATH BY ORGAN SYSTEM ALL WHITE SERVICEMEN OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (210-28,290-315,740-59,780-96) 553 618 0.90 1.909 INFECTIVE & PARASITIC DISEASES (000-136) 105 119 0.88 0.404 2480 2507 0.99 0.822 111 125 0.89 0.585 27 28 0.98 0.108 149 157 0.95 0.086 CIRCULATORY DISEASES (390-458) 3360 3413 0.98 0.711 RESPIRATORY DISEASES (460-519) 332 356 0.93 0.054 DIGESTIVE DISEASES (520-577) 888 859 1.03 0.166 68 86 0.79 2.497 8 10 0.80 0.004 22 23 0.96 0.014 11074 10877 1.02 6.269* CANCERS (140-209, 230-239) ENDOCRINE, NUTRITIONAL & METABOLIC (240-279) BLOOD & BLOOD-FORMING ORGANS (280-289) NERVOUS SYSTEMS & SENSE ORGANS (320-389) GENITOURINARY DISEASES (580-629) SKIN & SUBCUTANEOUS TISSUES (680-709) MUSCULOSKELETAL 6 CONNECTIVE TISSUES (710-738) ACCIDENTS, VIOLENCE & TRAUMA (E800-989) TOTAL NUMBER OF CASES OBSERVED - 19177 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-14 SELECTED CAUSES OF DEATH BY ORGAN SYSTEM ALL NON-WHITE SERVICEMEN OBSERVED EXPECTED O/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (210-28,290-315,740-59,780-96) 306 320 0.96 0.250 41 58 0.71 4.313* 493 463 1.06 0.723 ENDOCRINE, NUTRITIONAL & METABOLIC (240-279) 46 67 0.68 2.467 BLOOD & BLOOD-FORMING ORGANS (280-289) 13 22 0.59 2.995 NERVOUS SYSTEMS & SENSE ORGANS (320-389) 45 50 0.90 0.263 CIRCULATORY DISEASES (390-458) 865 906 0.95 1.138 RESPIRATORY DISEASES (460-519) 136 145 0.94 0.548 DIGESTIVE DISEASES (520-577) 282 343 0.82 5.168* 25 38 0.67 3.432 2 5 0.44 0.785 14 4 3.62 4.668* 2790 2637 1.06 11.619* INFECTIVE & PARASITIC DISEASES (000-136) CANCERS (140-209, 230-239) GENITOURINARY DISEASES (580-629) SKIN & SUBCUTANEOUS TISSUES (680-709) MUSCULOSKELBTAL & CONNECTIVE TISSUES (710-738) ACCIDENTS, VIOLENCE & TRAUMA (E800-989) TOTAL NUMBER OF CASES OBSERVED • 5058 EXPECTED NUMBERS ARE BASED UPON 5350 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-15 SELECTED CAUSES OF DEATH BY ORGAN SYSTEM ALL ENLISTED MEN OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (210-28,290-315,740-59,780-96) 823 884 0.93 1.082 INFECTIVE & PARASITIC DISEASES (000-136) 137 166 0.83 2.404 2566 2592 0.99 0.984 145 177 0.82 1.949 36 46 0.78 2.089 178 191 0.93 0.262 CIRCULATORY DISEASES (390-458) 3738 3796 0.98 0.576 RESPIRATORY DISEASES (460-519) 444 470 0.95 0.297 1077 1100 0.98 0.435 82 117 0.70 6.726* 9 14 0.66 0.277 27 24 1.13 0.082 13266 12953 1.02 12.871* CANCERS (140-209, 230-239) ENDOCRINE, NUTRITIONAL & METABOLIC (240-279) BLOOD & BLOOD-FORMING ORGANS (280-289) NERVOUS SYSTEMS & SENSE ORGANS (320-389) DIGESTIVE DISEASES (520-577) GENITOURINARY DISEASES (580-629) SKIN & SUBCUTANEOUS TISSUES (680-709) MUSCULOSKBLETAL & CONNECTIVE TISSUES (710-738) ACCIDENTS, VIOLENCE & TRAUMA (E800-989) TOTAL NUMBER OF CASES OBSERVED - 22528 EXPECTED NUMBERS ARE BASED UPON 25022 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-16 SELECTED CAUSES OF DEATH BY ORGAN SYSTEM ALL OFFICERS OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE 27 37 0.74 1.823 9 8 1.15 0.031 318 307 1.04 1.654 ENDOCRINE, NUTRITIONAL & METABOLIC (240-279) 7 12 0.60 1.383 BLOOD & BLOOD-FORMING ORGANS (280-289) 4 4 0.98 0.002 11 9 1.16 0.028 CIRCULATORY DISEASES (390-458) 338 370 0.91 2.309 RESPIRATORY DISEASES (460-519) 19 20 0.93 0.000 DIGESTIVE DISEASES (520-577) 71 71 1.00 0.006 GENITOURINARY DISEASES (580-629) 6 5 1.23 0.032 SKIN & SUBCUTANEOUS TISSUES (680-709) 0 1 0.00 1.319 MUSCULOSKELETAL 6 CONNECTIVE TISSUES (710-738) 6 2 2.72 1.488 440 403 1.09 0.692 ALL OTHER CAUSES (210-28,290-315,740-59,780-96) INFECTIVE & PARASITIC DISEASES (000-136) CANCERS (140-209, 230-239) NERVOUS SYSTEMS & SENSE ORGANS (320-389) ACCIDENTS, VIOLENCE & TRAUMA (E800-989) TOTAL NUMBER OF CASES OBSERVED • 1256 EXPECTED NUMBERS ARE BASED UPON 1405 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-17 SELECTED CAUSES OF DEATH BY ORGAN SYSTEM ALL ARMY ENLISTED MEN IN VIETNAM, COMBAT MOSC VS. NON-COMBAT MOSC OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE 216 205 1.05 0.372 30 37 0.82 1.193 550 575 0.96 0.752 ENDOCRINE, NUTRITIONAL 6 METABOLIC (240-279) 41 32 1.29 1.378 BLOOD & BLOOD-FORMING ORGANS (280-289) 10 9 1.18 0.104 NERVOUS SYSTEMS & SENSE ORGANS (320-389) 47 46 1.01 0.001 CIRCULATORY DISEASES (390-458) 796 842 0.95 2.439 RESPIRATORY DISEASES (460-519) 108 107 1.01 0.067 DIGESTIVE DISEASES (520-577) 243 270 0.90 1.824 26 18 1.44 1.780 2 2 0.99 0.008 10 5 2.08 2.745 3443 3374 1.02 3.295 ALL OTHER CAUSES (210-28,290-315,740-59,780-96) INFECTIVE & PARASITIC DISEASES (000-136) CANCERS (140-209, 230-239) GENITOURINARY DISEASES (580-629) SKIN & SUBCUTANEOUS TISSUES (680-709) MUSCULOSKELETAL & CONNECTIVE TISSUES (710-738) ACCIDENTS, VIOLENCE & TRAUMA (E800-989) TOTAL NUMBER OF CASES OBSERVED - 5522 EXPECTED NUMBERS ARE BASED UPON 12767 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-18 SELECTED CAUSES OF DEATH BY ORGAN SYSTEM ALL ENLISTED MARINES IN VIETNAM, COMBAT MOSC VS. NON-COMBAT MOSC OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE 63 77 0.82 1.387 7 13 0.55 1.186 155 158 0.98 0.468 ENDOCRINE, NUTRITIONAL & METABOLIC (240-279) 9 7 1.25 0.059 BLOOD & BLOOD-FORMING ORGANS (280-289) 0 6 0.00 5.000* 17 7 2.28 4.479* CIRCULATORY DISEASES (390-458) 175 193 0.91 1.376 RESPIRATORY DISEASES (460-519) 28 16 1.70 1.963 DIGESTIVE DISEASES (520-577) 67 52 1.29 2.187 GENITOURINARY DISEASES (580-629) 2 5 0.41 1.709 SKIN & SUBCUTANEOUS TISSUES (680-709) 1 1 1.04 0.005 4 1 3.79 1.613 1362 1.01 0.586 ALL OTHER CAUSES (210-28,290-315,740-59,780-96) INFECTIVE & PARASITIC DISEASES (000-136) CANCERS (140-209, 230-239) NERVOUS SYSTEMS & SENSE ORGANS (320-389) MUSCULOSKELETAL 6 CONNECTIVE TISSUES (710-738) ACCIDENTS, VIOLENCE & TRAUMA (E800-989) 1370 TOTAL NUMBER OF CASES OBSERVED - 1898 EXPECTED NUMBERS ARE BASED UPON 2341 OBSERVATIONS IK COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-19 DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL CASES OBSERVED EXPECTED O/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-398, 580-B989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CERBBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTBRIOLES, CAPILLARIES (440-448) DIS OF VEINS, LYMPHATICS & OTHERS (450-458) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTH DIGESTIVE DISEASES (520-529, 540-570, 572-576) 19936 19883 61 123 77 141 1059 1116 142 273 520 142 133 196 7 254 52 95 80 424 449 80 209 TOTAL NUMBER OF CASES OBSERVED - 24235 EXPECTED NUMBERS ARE BASED UPON 26685 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 126 222 518 139 127 183 10 258 56 96 70 405 480 94 235 1.00 0.80 0.87 0.95 1.13 1.23 1.00 1.02 1.05 1.07 0.68 0.98 0.93 0.99 1.15 1.05 0.94 0.85 0.89 0.222 1.284 0.716 2.088 1.820 4.805* 0.006 0.334 0.494 0.413 1.207 0.002 0.029 0.020 0.496 0.005 0.228 1.050 1.390 �TABLE C-20 DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL ARMY OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-398, 580-E989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CEREBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTERIOLBS, CAPILLARIES (440-448) DIS OF VEINS, LYMPHATICS & OTHERS (450-458) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTH DIGESTIVE DISEASES (520-529, 540-570, 572-576) 16061 50 102 877 113 229 436 126 111 170 5 227 46 82 60 374 390 67 182 16023 67 112 949 95 194 437 126 109 148 10 230 53 76 55 337 421 74 191 TOTAL NUMBER OF CASES OBSERVED - 19708 EXPECTED NUMBERS ARE BASED UPON 22904 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 1.00 0.74 0.91 0.92 1.19 1.18 1.00 1.00 1.02 1.15 0.49 0.98 0.87 1.08 1.09 1.11 0.93 0.90 0.95 0.236 1.584 0.325 3.182 1.827 3.006 0.178 0.142 0.458 1.210 1.988 0.007 0.033 0.085 0.138 0.277 0.332 0.440 0.383 �TABLE C-21 DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL MARINES OBSERVED EXPECTED O/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-398, 580-E989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CEREBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTERIOLES, CAPILLARIES (440-448) DIS OF VEINS, LYMPHATICS & OTHERS (450-4S8) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTH DIGESTIVE DISEASES (520-529, 540-570, 572-576) 3881 10 21 178 26 43 79 15 21 25 2 30 9 10 19 56 61 11 30 3876 10 24 162 30 28 82 11 15 30 0 33 3 18 16 74 60 13 43 TOTAL NUMBER OF CASES OBSERVED - 4527 EXPECTED NUMBERS ARE BASED UPON 3781 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 1.00 1.00 0.89 1.10 0.86 1.54 0.96 1.40 1.40 0.83 0.91 2.60 0.55 1.22 0.76 1.01 0.87 0.70 0.009 0.128 0.090 1.060 0.005 1.942 0.114 1.272 0.234 0.426 0.754 0.050 0.433 1.909 0.323 1.677 0.002 0.331 2.249 �TABLE C-22 DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL WHITE SERVICEMEN OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (0-398, 580-989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CEREBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTERIOLES , CAPILLARIES (440-448) DIS OF VEINS, LYMPHATICS & OTHERS (450-458) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTH DIGESTIVE DISEASES (520-529, 540-570, 572-576) 15967 28 100 842 93 212 372 116 89 131 6 167 40 59 62 320 342 60 171 15991 40 107 885 71 173 369 110 88 132 8 177 50 60 51 287 358 52 168 TOTAL NUMBER OF CASES OBSERVED - 19177 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 1.00 0.70 0.94 0.95 1.30 1.23 1.01 1.05 1.01 0.99 0.74 0.94 0.81 0.98 1.21 1.11 0.96 1.14 1.02 0.126 1.090 0.172 2.102 2.629 4.616* 0.034 0.351 0.206 0.007 0.842 0.031 0.456 0.010 0.677 0.513 0.029 0.480 0.008 �TABLE C-23 DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL NON-WHITE SERVICEMEN OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-398, 580-E989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CEREBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTERIOLES, CAPILLARIES (440-448) DIS OF VEINS, LYMPHATICS & OTHERS (450-458) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTH DIGESTIVE DISEASES (520-529, 540-570, 572-576) 3977 38 22 212 47 61 140 26 41 63 1 87 9 37 20 105 112 18 42 3869 35 32 234 58 49 151 31 37 52 4 88 9 34 20 117 125 42 73 TOTAL NUMBER OF CASES OBSERVED • 5058 EXPECTED NUMBERS ARE BASED UPON 5350 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 1.03 1.10 0.69 0.91 0.81 1.25 0.93 0.83 1.11 1.21 0.26 0.99 1.06 1.09 1.00 0.89 0.90 0.43 0.58 5.124* 0.011 1.463 0.312 0.104 0.452 0.861 0.083 0.227 0.891 1.772 0.004 0.011 0.001 0.025 0.745 0.334 8.649* 5.999* �TABLE C-24 DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL ENLISTED MEN OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-398, 580-E989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CEREBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTERIOLES, CAPILLARIES (440-448) DIS OF VEINS, LYMPHATICS & OTHERS (450-458) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTK DIGESTIVE DISEASES (520-529, 540-570, 572-576) 18653 54 107 912 127 249 475 124 116 181 7 245 48 89 72 396 414 74 185 18612 71 120 969 120 200 470 119 112 171 10 239 55 91 66 372 429 89 214 TOTAL NUMBER OF CASES OBSERVED - 22528 EXPECTED NUMBERS ARE BASED UPON 25022 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 1.00 0.76 0.89 0.94 1.06 1.25 1.01 1.04 1.04 1.06 0.70 1.02 0.88 0.98 1.09 1.06 0.97 0.83 0.86 0.154 1.581 0.696 2.040 0.579 4.845* 0.004 0.303 0.165 0.487 1.029 0.156 0.280 0.054 0.113 0.174 0.010 1.126 2.085 �TABLE C-25 DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL OFFICERS OBSERVED EXPECTED O/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-398, 580-E989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CBREBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTERIOLES , CAPILLARIES (440-448) DIS OF VEINS, LYMPHATICS & OTHERS (450-458) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTH DIGESTIVE DISEASES (520-529, 540-570, 572-576) 930 7 16 108 16 15 27 15 12 11 0 12 2 6 7 25 28 5 14 TOTAL NUMBER OF CASES OBSERVED - 1256 EXPECTED NUMBERS ARE BASED UPON 1405 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 916 3 19 111 3 22 34 22 15 13 0 15 1 5 3 18 30 3 18 1.02 2.23 0.85 0.97 6.21 0.69 0.79 0.67 0.80 0.88 0.00 0.80 2.61 1.33 2.74 1.40 0.92 1.75 0.77 0.024 0.284 0.521 0.014 9.622* 0.511 0.575 0.293 0.277 0.247 0.079 0.278 0.198 0.060 2.123 0.409 0.079 0.270 0.159 �TABLE C-26 DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL ARMY ENLISTED MEN IN VIETNAM, COMBAT MOSC VS. NON-COMBAT MOSC OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-398, 580-E989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CEREBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTERIOLES, CAPILLARIES (440-448) DIS OF VEINS, LYMPHATICS & OTHERS (450-458) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTH DIGESTIVE DISEASES (520-529, 540-570, 572-576) 4664 11 22 179 35 52 107 36 21 41 1 61 9 24 9 108 88 18 36 TOTAL NUMBER OF CASES OBSERVED • 5522 EXPECTED NUMBERS ARE BASED UPON 12767 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM 4595 14 20 206 26 56 115 25 31 50 2 64 10 24 17 96 103 19 50 1.02 0.81 1.10 0.87 1.34 0.93 0.93 1.43 0.67 0.83 0.57 0.95 0.94 1.00 0.53 1.13 0.85 0.94 0.71 4.556* 0.405 0.204 2.436 2.067 0.391 0.599 2.950 2.512 1.199 0.260 0.130 0.017 0.096 3.029 1.470 1.814 0.025 2.874 ��TABLE C-28 DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA (E800-E989) ALL CASES OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE 10373 10734 0.97 15.535* 4897 4643 1.05 9.355* OTH. TRANSPORT. ACC. (E800-E807 ,E830-E845) 610 517 1.18 9.730* ACC. POISONINGS (E850-E877) 581 508 1.14 6.349* ALL OTH ACC. /INJURY (E880-E949 , E970-E989) 2917 2788 1.05 3.313 SUICIDE (E950-E959) 2543 2735 0.93 9.851* HOMICIDE (E960-E969) 2314 2310 1.00 0.009 ALL OTHER CAUSES (000-799) MOTOR VEH ACCIDENTS (E810-E827) TOTAL NUMBER OF CASES OBSERVED - 24235 EXPECTED NUMBERS ARE BASED UPON 26685 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-29 DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA (E800-E989) ALL ARMY OBSERVED EXPECTED O/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-799) 8728 9097 0.96 18.774* MOTOR VER ACCIDENTS (B810-E827) 3884 3693 1.05 7.502* OTH. TRANSPORT. ACC . (E800-E807 , E830-E845) 493 361 1.36 19.394* ACC. POISONINGS (E850-E877) 461 399 1.15 5.068* ALL OTH ACC. /INJURY (E880-E949 , E970-E989) 2323 2202 1.05 2.761 SUICIDE (E950-E959) 2003 2152 0.93 6.633* HOMICIDE (E960-E969) 1816 1804 1.01 0.004 TOTAL NUMBER OF CASES OBSERVED - 19708 EXPECTED NUMBERS ARE BASED UPON 22904 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-30 DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA (E800-B989) ALL MARINES OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-799) 1647 1638 1.01 0.040 MOTOR VEH ACCIDENTS 1011 948 1.07 1.778 OTH. TRANSPORT. ACC . (E800-E807 , B830-E845) 117 156 0.75 3.551 ACC. POISONINGS (E850-E877) 120 109 1.10 1.289 ALL OTH ACC. /INJURY (E880-E949 , E970-E989) 593 585 1.01 0.523 SUICIDE (E950-E959) 542 583 0.93 3.321 HOMICIDE (E960-E969) 497 507 0.98 0.163 (E810-E827) TOTAL NUMBER OF CASES OBSERVED • 4527 EXPECTED NUMBERS ARE BASED UPON 3781 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-31 DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA (E800-E989) ALL WHITE SERVICEMEN OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-799) 8109 8312 0.98 6.487* MOTOR VER ACCIDENTS 4264 4107 1.04 4.169* OTH. TRANSPORT. ACC . (E800-E807 , E830-E845) 548 463 1.18 8.333* ACC. POISONINGS (E850-E877) 464 411 1.13 4.414* ALL OTH ACC. /INJURY (E880-B949 , E970-E989) 2341 2253 1.04 1.745 SUICIDE (E950-E959) 2247 2442 0.92 9.974* HOMICIDE (E960-E969) 1204 1189 1.01 0.015 (E810-E827) TOTAL NUMBER OF CASES OBSERVED - 19177 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-32 DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA (E800-E989) ALL NON-WHITE SERVICEMEN OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE 2269 2422 0.94 11.547* 632 536 1.18 9.172* 62 54 1.15 1.446 ACC. POISONINGS (E850-E877) 117 97 1.21 2.054 ALL OTH ACC. /INJURY (E880-E949 , E970-E989) 575 536 1.07 1.936 SUICIDE (E950-E959) 295 293 1.01 0.309 1108 1120 0.99 0.112 ALL OTHER CAUSES (000-799) MOTOR VEH ACCIDENTS (E810-E827) OTH. TRANSPORT. ACC . (E800-E807 , E830-E845) HOMICIDE (E960-B969) TOTAL NUMBER OF CASES OBSERVED - 5058 EXPECTED NUMBERS ARE BASED UPON 5350 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-33 DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA (E800-E989) ALL ENLISTED MEN OBSERVED EXPECTED O/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-799) 9264 9586 0.97 13.473* MOTOR VEH ACCIDENTS (E810-E827) 4757 4492 1.06 10.730* OTH. TRANSPORT. ACC . (E800-E807 , E830-B845) 420 417 1.01 0.257 ACC. POISONINGS (E850-E877) 568 495 1.15 6.427* ALL OTH ACC. /INJURY (E880-E949 , E970-E989) 2815 2673 1.05 4.457* SUICIDE 2428 2586 0.94 7.965* 2276 2277 1.00 0.023 (E950-E959) HOMICIDE (E960-E969) TOTAL NUMBER OF CASES OBSERVED - 22528 EXPECTED NUMBERS ARE BASED UPON 25022 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-34 DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA (E800-E989) ALL OFFICERS OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-799) 816 846 0.96 0.753 MOTOR VEH ACCIDENTS (E810-E827) 113 102 1.11 0.389 OTH. TRANSPORT. ACC. (E800-E807 , E830-E845) 114 69 1.66 4.156* ACC. POISONINGS (E850-E877) 13 7 1.81 0.935 ALL OTH ACC. /INJURY (E880-K949 , B970-B989) 76 91 0.83 1.195 SUICIDE (E950-E959) 96 121 0.79 1.996 HOMICIDE (B960-E969) 28 13 2.22 3.109 TOTAL NUMBER OF CASES OBSERVED • 1256 EXPECTED NUMBERS ARE BASED UPON 1405 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-35 DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA (E800-E989) ALL ARMY ENLISTED MEN IN VIETNAM, COMBAT MOSC VS. NON-COMBAT MOSC OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-799) 2081 2151 0.97 3.433 MOTOR VEH ACCIDENTS (E810-E827) 1205 1217 0.99 0.088 93 119 0.78 4.189* ACC. POISONINGS (E850-E877) 153 142 1.08 0.746 ALL OTH ACC. /INJURY (E880-E949 , E970-K989) 762 696 1.09 4.694* SUICIDE (E950-E959) 590 613 0.96 0.684 HOMICIDE (E960-E969) 638 583 1.09 3.924* OTH. TRANSPORT. ACC. (E800-E807 ,E830-E845) TOTAL NUMBER OF CASES OBSERVED - 5522 EXPECTED NUMBERS ARE BASED UPON 12767 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �TABLE C-36 DEATHS PROM ACCIDENTS, SUICIDES AND TRAUMA (E800-E989) ALL ENLISTED MARINES IN VIETNAM, COMBAT MOSC VS. NON-COMBAT MOSC OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-799) 528 536 0.98 0.586 MOTOR VEH ACCIDENTS 466 496 0.94 0.573 OTH. TRANSPORT. ACC. (E800-E807 ,E830-B845) 34 32 1.05 0.036 ACC. POISONINGS 67 53 1.26 2.116 ALL OTH ACC. /INJURY (E880-E949 , E970-E989) 289 276 1.05 0.758 SUICIDE (E950-E959) 228 274 0.83 4.599* HOMICIDE (E960-E969) 286 230 1.24 7.034* (E810-E827) (E850-E877) TOTAL NUMBER OF CASES OBSERVED - 1898 EXPECTED NUMBERS ARE BASED UPON 2341 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM �APPENDIX D �APPENDIX D DEATHS IN CALIFORNIA, MASSACHUSETTS, NEW YORK, WISCONSIN AND WEST VIRGINIA USING ALL U.S. VETERANS.AS COMPARISON GROUP DEATHS IN CALIFORNIA TABLE D-l: DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA TABLE D-2: DEATHS FROM CANCERS TABLE D-3: DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS TABLE D-4: SELECTED CAUSES OF DEATH BY ORGAN SYSTEM DEATHS IN MASSACHUSETTS TABLE D-5: DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA TABLE D-6: DEATHS FROM CANCERS TABLE D-7: DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS TABLE D-8: SELECTED CAUSES OF DEATH BY ORGAN SYSTEM DEATHS IN NEW YORK TABLE D-9 : DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA TABLE D-10: DEATHS FROM CANCERS TABLE D-ll: DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS TABLE D-12: SELECTED CAUSES OF DEATH BY ORGAN SYSTEM DEATHS IN WISCONSIN TABLE D-13: DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA TABLE D-14: DEATHS FROM CANCERS TABLE D-l5: DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS TABLE D-16: SELECTED CAUSES OF DEATH BY ORGAN SYSTEM DEATHS IN WEST VIRGINIA TABLE D-17: DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA TABLE D-18: DEATHS FROM CANCERS TABLE D-l9: DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS TABLE D-20: SELECTED CAUSES OF DEATH BY ORGAN SYSTEM �DEATHS IN CALIFORNIA USING NON-VIETNAM SERVICE VETERANS WHO DIED IN CALIFORNIA AS COMPARISON GROUP TABLE D-21: DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA TABLE D-22: DEATHS FROM CANCERS TABLE D-23: DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS TABLE D-24: SELECTED CAUSES OF DEATH BY ORGAN SYSTEM �TABLE D-l DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA (E800-E989) ALL WHITE SERVICEMEN WHO DIED IN CALIFORNIA OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-799) 795 851 0.93 8.622* MOTOR VEH ACCIDENTS 446 446 1.00 0.001 OTH. TRANSPORT. ACC. (E800-E807 , E830-E845) 54 51 1.06 0.301 ACC. POISONINGS (E850-E877) 97 45 2.17 52.662* ALL OTH ACC. /INJURY (E880-E949 , E970-E989) 197 242 0.81 9.686* SUICIDE (E950-E959) 280 262 1.07 1.480 HOMICIDE (E960-E969) 158 130 1.22 5.518* (E810-E827) TOTAL NUMBER OF CASES OBSERVED - 2027 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP �TABLE D-2 DEATHS FROM CANCERS (140-208, 230-239) ALL WHITE SERVICEMEN WHO DIED IN CALIFORNIA OBSERVED EXPECTED 0/E M-H CHI-SQUARE 1.01 1.33 1.01 1.22 0.56 0.97 0.98 0.60 1.16 1.01 0.67 0.97 0.00 1.72 0.62 0.68 1.00 0.26 0.60 0.66 1.11 1.69 1.05 0.62 1.623 0.135 CAUSE ALL OTHER CAUSES (000-136 , 210-228 , 240-E989) CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER GI (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HODGKINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTH CA (163,173-4,187,190,195-9,208-9,230-9) 1782 7 5 10 11 2 9 2 67 4 3 18 0 17 1 5 13 2 2 9 10 5 25 18 TOTAL NUMBER OF CASES OBSERVED - 2027 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP 1765 5 5 8 20 2 9 3 58 4 4 19 3 10 2 7 13 8 3 14 9 3 24 29 0.056 0.141 2.815 0.008 0.001 0.280 0.525 0.000 0.520 0.001 3.374 4.545* 0.468 0.850 0.014 4.092* 0.625 1.155 0.082 1.969 0.008 4.159* �TABLE D-3 DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL WHITE SERVICEMEN WHO DIED IN CALIFORNIA OBSERVED EXPECTED O/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-398, 580-E989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CEREBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTERIOLES , CAPILLARIES (440-448) DIS OP VEINS, LYMPHATICS & OTHERS (450-458) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTH DIGESTIVE DISEASES (520-529, 540-570, 572-576) 1684 3 5 100 12 6 36 9 6 15 2 17 6 4 5 48 45 12 12 1705 5 12 TOTAL NUMBER OF CASES OBSERVED • 2027 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP 86 7 15 37 10 9 14 1 18 5 7 5 29 37 6 19 0.99 0.66 0.42 1.17 1.64 0.39 0.97 0.91 0.70 1.04 2.43 0.93 1.24 0.55 0.95 1.67 1.23 2.08 0.63 1.266 0.234 3.928* 1.584 2.609 5.540* 0.098 0.160 1.146 0.212 0.118 0.028 0.032 1.148 0.000 9.414* 1.482 7.322* 1.961 �TABLE D-4 DEATHS FROM DISEASES OF SELECTED ORGAN SYSTEMS ALL WHITE SERVICEMEN WHO DIED IN CALIFORNIA OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE 59 64 0.93 0.213 3 11 0.26 6.010* 245 262 0.93 1.639 ENDOCRINE, NUTRITIONAL & METABOLIC (240-279) 3 13 0.23 7.646* BLOOD & BLOOD-FORMING ORGANS (280-289) 3 3 1.09 0.023 13 16 0.82 0.303 CIRCULATORY DISEASES (390-458) 314 342 0.92 3.206 RESPIRATORY DISEASES (460-519) 32 38 0.84 0.879 116 88 1.32 8.491* GENITOURINARY DISEASES (580-629) 4 10 0.42 2.394 SKIN & SUBCUTANEOUS TISSUES (680-709) 1 1 0.97 0.000 MUSCULOSKELBTAL 6 CONNECTIVE TISSUES (710-738) 2 3 0.66 0.306 1232 1177 1.05 8.307* ALL OTHER CAUSES (210-28,290-315,740-759,780-796) INFECTIVE & PARASITIC DISEASES (000-136) CANCERS (140-209, 230-239) NERVOUS SYSTEMS & SENSE ORGANS (320-389) DIGESTIVE DISEASES (520-577) ACCIDENTS, VIOLENCE & TRAUMA (B800-E989) TOTAL NUMBER OF CASES OBSERVED - 2027 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP �TABLE D-6 DEATHS FROM CANCERS (140-208, 230-239) ALL WHITE SERVICEMEN WHO DIED IN MASSACHUSETTS OBSERVED EXPECTED O/E M-H CHI-SQUARE 1.02 0.00 2.43 1.04 0.44 0.00 0.00 0.00 0.84 0.00 3.81 0.00 0.00 1.40 0.00 2.46 1.14 0.00 5.95 1.59 0.81 0.00 0.29 0.84 1.204 0.700 0.804 0.002 0.729 0.269 1.015 0.204 0.152 0.503 4.089* 2.543 0.369 0.226 0.148 1.717 0.029 1.163 7.982* 0.606 0.041 0.262 1.745 0.097 CAUSE ALL OTHER CAUSES (000-136, 210-228 , 240-E989) CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER 01 (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE j( 193-194) CA - NON-HODGKINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTHI CA (163,173-4,187,190,195-9,208-9,230-9) 251 0 1 1 1 0 0 0 5 0 2 0 0 2 0 2 2 0 2 3 1 0 1 3 TOTAL NUMBER OF CASES OBSERVED 277 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP 245 1 0 1 2 0 1 0 6 1 1 3 0 1 0 1 2 1 0 2 1 0 3 4 �TABLE D-7 DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL WHITE SERVICEMEN WHO DIED IN MASSACHUSETTS OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-398, 580-E989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CEREBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTERIOLES, CAPILLARIES (440-448) DIS OF VEINS, LYMPHATICS & OTHERS (450-458) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTH DIGESTIVE DISEASES (520-529, 540-570, 572-576) 227 0 2 13 0 3 5 0 0 2 0 2 0 3 1 2 9 1 7 TOTAL NUMBER OF CASES OBSERVED 277 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP 238 0 1 10 1 2 5 1 1 2 0 2 1 1 1 4 4 1 2 0.95 0.00 1.68 1.27 0.00 1.41 1.07 0.00 0.00 1.17 0.00 0.84 0.00 3.69 1.49 0.56 2.10 1.59 3.21 3.950* 0.476 0.580 0.843 0.974 0.382 0.020 1.322 1.158 0.046 0.118 0.059 0.546 5.600* 0.156 0.669 5.086* 0.211 10.245* �TABLE D-8 DEATHS FROM DISEASES OF SELECTED ORGAN SYSTEMS ALL WHITE SERVICEMEN WHO DIED IN MASSACHUSETTS OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (210-28,290-315,740-59,780-96) 9 9 1.04 0.015 INFECTIVE & PARASITIC DISEASES (000-136) 1 2 0.59 0.272 26 32 0.82 1.212 ENDOCRINE, NUTRITIONAL & METABOLIC (240-279) 2 2 1.27 0.107 BLOOD & BLOOD-FORMING ORGANS (280-289) 0 0 0.00 0.403 NERVOUS SYSTEMS & SENSE ORGANS (320-389) 3 2 1.34 0.254 CIRCULATORY DISEASES (390-458) 39 41 0.95 0.119 RESPIRATORY DISEASES (460-519) 7 4 1.59 1.542 18 11 1.67 4.892* GENITOURINARY DISEASES (580-629) 0 1 0.00 1.086 SKIN & SUBCUTANEOUS TISSUES (680-709) 0 0 0.00 0.150 MUSCULOSKELETAL & CONNECTIVE TISSUES (710-738) 0 0 0.00 0.308 172 173 0.99 0.024 CANCERS (140-209, 230-239) DIGESTIVE DISEASES (520-577) ACCIDENTS, VIOLENCE & TRAUMA (800-989) TOTAL NUMBER OF CASES OBSERVED 277 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP �TABLE D-9 DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA (E800-E989) ALL WHITE SERVICEMEN WHO DIED IN NEW YORK OBSERVED EXPECTED O/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-799) 334 253 1.32 46.536* MOTOR VEH ACCIDENTS 137 188 0.73 18.820* OTH. TRANSPORT. ACC. (E800-B807 , E830-E845) 17 21 0.82 0.615 ACC. POISONINGS (E850-E877) 31 19 1.65 7.811* 106 101 1.05 0.267 SUICIDE (E950-E959) 70 109 0.64 16.492* HOMICIDE (E960-E969) 51 55 0.94 0.272 (E810-E827) ALL OTH ACC. /INJURY (E880-E949 , E970-E989) TOTAL NUMBER OF CASES OBSERVED • 746 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP �TABLE D-10 DEATHS FROM CANCERS (140-208, 230-239) ALL WHITE SERVICEMEN WHO DIED IN NEW YORK OBSERVED EXPECTED 0/E M-H CHI-SQUARE 1.00 0.00 2.79 0.87 1.87 1.71 1.38 2.16 1.23 0.00 0.70 0.15 0.00 0.23 0.00 0.63 1.21 0.00 0.00 1.37 1.60 0.00 1.26 1.14 0.007 1.395 2.215 0.042 3.865* 0.239 0.315 0.661 0.652 1.428 0.121 5.045* 0.453 2.476 0.335 0.231 0.219 3.147 0.817 0.633 1.326 0.593 0.595 0.124 CAUSE ALL OTHER CAUSES (000-136 , 210-228 , 240-E989) CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER 61 (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HODGKINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTH! CA (163,173-4,187,190,195-9,208-9,230-9) 667 0 2 2 10 1 3 1 15 0 1 1 0 1 0 1 6 0 0 7 6 0 12 10 TOTAL NUMBER OF CASES OBSERVED 746 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP 668 1 1 2 5 1 2 0 12 1 1 7 0 4 0 2 5 3 1 5 4 1 10 9 �TABLE D-ll DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL WHITE SERVICEMEN WHO DIED IN NEW YORK OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-398, 580-E989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CEREBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTERIOLES, CAPILLARIES (440-448) DIS OF VEINS, LYMPHATICS & OTHERS (450-458) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTH DIGESTIVE DISEASES (520-529, 540-570, 572-576) 589 1 3 35 6 6 15 2 3 12 0 6 1 1 2 29 20 6 9 TOTAL NUMBER OF CASES OBSERVED • 746 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP 652 1 2 23 3 5 12 3 3 4 0 6 1 2 2 9 10 2 6 0.90 0.91 1.26 1.54 2.37 1.21 1.23 0.68 1.11 2.68 0.00 0.99 0.98 0.46 1.16 3.17 1.95 3.20 1.63 47.769* 0.006 0.143 6.607* 4.190* 0.196 0.602 0.299 0.023 11.912* 0.309 0.000 0.000 0.607 0.052 37.872* 8.301* 7.472* 2.107 �TABLE D-12 DEATHS FROM DISEASES OF SELECTED ORGAN SYSTEMS ALL WHITE SERVICEMEN WHO DIED IN NEW YORK OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (210-28,290-315,740-59,780-96) 54 23 2.34 39.423* INFECTIVE & PARASITIC DISEASES (000-136) 12 4 2.78 12.564* CANCERS (140-209, 230-239) 79 78 1.01 0.006 ENDOCRINE, NUTRITIONAL & METABOLIC (240-279) 3 4 0.80 0.139 BLOOD & BLOOD-FORMING ORGANS (280-289) 0 1 0.00 1.209 NERVOUS SYSTEMS & SENSE ORGANS (320-389) 7 6 1.18 0.185 CIRCULATORY DISEASES (390-458) 106 94 1.13 1.862 RESPIRATORY DISEASES (460-519) 7 10 0.67 1.135 64 27 2.35 46.341* GENITOURINARY DISEASES (580-629) 1 3 0.35 1.179 SKIN & SUBCUTANEOUS TISSUES (680-709) 0 0 0.00 0.385 MUSCULOSKBLETAL £ CONNECTIVE TISSUES (710-738) 1 1 1.08 0.002 412 494 0.83 47.099* DIGESTIVE DISEASES (520-577) ACCIDENTS, VIOLENCE & TRAUMA (E800-B989) TOTAL NUMBER OF CASES OBSERVED 746 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP �TABLE D-13 DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA (E800-E989) ALL WHITE SERVICEMEN WHO DIED IN WISCONSIN OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-799) 100 108 0.93 1.105 MOTOR VEH ACCIDENTS (E810-E827) 105 78 1.34 12.196* OTH. TRANSPORT. ACC. (E800-E807 , E830-E845) 4 9 0.45 2.762 ACC. POISONINGS (E850-B877) 4 8 0.50 2.071 ALL OTH ACC. /INJURY (E880-E949 , E970-E989) 45 42 1.06 0.194 SUICIDE (E950-E959) 49 45 1.08 0.314 7 23 0.31 11.870* HOMICIDE (E960-E969) TOTAL NUMBER OF CASES OBSERVED 314 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP �TABLE D-14 DEATHS FROM CANCERS (140-208, 230-239) ALL WHITE SERVICEMEN WHO DIED IN WISCONSIN OBSERVED EXPECTED 0/E M-H CHI-SQUARE 1.00 0.00 3.32 0.00 1.31 0.00 1.13 0.00 0.96 0.00 5.11 0.69 0.00 2.86 0.00 1.36 1.46 0.00 0.00 0.93 1.32 0.00 1.01 0.54 0.037 CAUSE ALL OTHER CAUSES (000-136 , 210-228 , 240-E989) CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER GI (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HODGKINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTH CA (163 , 173-4 , 187 , 190 , 195-9 , 208-9 , 230-9) 280 0 1 0 3 0 1 0 5 0 3 2 0 5 0 1 3 0 0 2 2 0 4 2 TOTAL NUMBER OF CASES OBSERVED 314 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP 281 1 0 1 2 0 1 0 5 1 1 3 0 2 0 1 2 1 0 2 2 0 4 4 0.619 1.590 0.968 0.219 0.229 0.011 0.229 0.014 0.548 9.287* 0.264 0.198 5.557* 0.131 0.092 0.422 1.338 0.336 0.012 0.154 0.276 0.000 0.789 �TABLE D-15 DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL WHITE SERVICEMEN WHO DIED IN WISCONSIN OBSERVED EXPECTED O/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-398, 580-E989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CEREBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTERIOLES, CAPILLARIES (440-448) DIS OF VEINS, LYMPHATICS & OTHERS (450-458) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTH DIGESTIVE DISEASES (520-529, 540-570, 572-576) 278 0 2 6 2 3 6 3 1 2 0 1 1 2 0 4 1 0 2 TOTAL NUMBER OF CASES OBSERVED 314 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP 274 0 1 10 1 2 5 1 1 2 0 3 0 1 1 4 4 1 2 1.02 0.00 1.78 0.61 1.81 1.42 1.16 2.41 0.86 1.02 0.00 0.39 2.29 2.19 0.00 1.01 0.23 0.00 0.85 0.599 0.452 0.677 1.603 0.727 0.350 0.133 2.450 0.024 0.000 0.132 0.956 0.650 1.272 0.807 0.001 2.612 0.784 0.051 �TABLE D-17 DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA (E800-E989) ALL WHITE SERVICEMEN WHO DIED IN WEST VIRGINIA OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE 113 108 1.05 0.617 57 55 1.04 0.099 OTH. TRANSPORT. ACC. (E800-B807 , E830-E845) 5 6 0.81 0.217 ACC. POISONINGS (E850-E877) 5 5 0.92 0.039 ALL OTH ACC. /INJURY (E880-E949 , B970-K989) 40 30 1.33 3.713 SUICIDE (E950-E959) 20 33 0.60 6.218* HOMICIDE (E960-E969) 14 16 0.86 0.319 ALL OTHER CAUSES (000-799) MOTOR VEH ACCIDENTS (E810-E827) TOTAL NUMBER OP CASES OBSERVED 254 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP �TABLE D-18 DEATHS FROM CANCERS (140-208, 230-239) ALL WHITE SERVICEMEN WHO DIED IN WEST VIRGINIA OBSERVED EXPECTED 0/E M-H CHI-SQUARE 1.01 2.62 0.00 2.17 0.85 0.00 0.00 3.47 1.13 1.95 0.00 0.00 3.17 1.69 0.00 1.07 1.11 0.00 0.00 0.00 0.92 0.00 0.93 1.17 0.183 1.928 0.423 1.290 0.048 0.261 1.036 1.668 0.110 0.459 0.504 2.525 1.396 0.577 0.162 0.006 0.022 1.093 0.339 1.799 0.007 0.274 0.015 0.101 CAUSE ALL OTHER CAUSES (000-136 , 210-228 , 240-E989) CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER GI (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HODGKINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTH: CA (163,173-4,187,190,195-9,208-9,230-9) 224 2 0 2 2 0 0 1 8 1 0 0 1 2 0 1 2 0 0 0 1 0 3 4 TOTAL NUMBER OF CASES OBSERVED 254 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP 222 1 0 1 2 0 1 0 7 1 1 2 0 1 0 1 2 1 0 2 1 0 3 3 �TABLE D-19 DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL WHITE SERVICEMEN WHO DIED IN WEST VIRGINIA OBSERVED EXPECTED O/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-398, 580-E989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CBREBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTERIOLES, CAPILLARIES (440-448) DIS OF VEINS, LYMPHATICS & OTHERS (450-458) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTH DIGESTIVE DISEASES (520-529, 540-570, 572-576) 204 0 0 14 2 3 13 1 1 2 0 2 0 2 0 7 3 0 0 TOTAL NUMBER OF CASES OBSERVED 254 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP 213 1 1 11 1 2 5 1 1 2 0 2 1 1 1 4 5 1 2 0.96 0.00 0.00 1.26 2.07 1.41 2.76 0.70 0.88 1.19 0.00 0.84 0.00 2.44 0.00 1.89 0.64 0.00 0.00 2.640 0.552 1.441 0.782 1.065 0.384 14.218* 0.132 0.015 0.058 0.111 0.057 0.632 1.657 0.653 2.938 0.626 0.671 2.097 �TABLE D-20 DEATHS FROM DISEASES OF SELECTED ORGAN SYSTEMS ALL WHITE SERVICEMEN WHO DIED IN WEST VIRGINIA OBSERVED EXPECTED O/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (210-28,290-315,740-759,780-796) 6 8 0.74 0.558 INFECTIVE & PARASITIC DISEASES (000-136) 0 2 0.00 1.634 30 32 0.93 0.185 ENDOCRINE, NUTRITIONAL & METABOLIC (240-279) 1 2 0.61 0.242 BLOOD & BLOOD-FORMING ORGANS (280-289) 0 0 0.00 0.386 NERVOUS SYSTEMS & SENSE ORGANS (320-389) 2 2 0.94 0.008 CIRCULATORY DISEASES (390-458) 57 44 1.29 5.239* RESPIRATORY DISEASES (460-519) 5 5 1.08 0.033 11 11 0.98 0.003 GENITOURINARY DISEASES (580-629) 1 1 0.85 0.025 SKIN & SUBCUTANEOUS TISSUES (680-709) 0 0 0.00 0.111 MUSCULOSKBLBTAL 6 CONNECTIVE TISSUES (710-738) 0 0 0.00 0.287 141 146 CANCERS (140-209, 230-239) DIGESTIVE DISEASES (520-577) ACCIDENTS, VIOLENCE & TRAUMA (E800-989) TOTAL NUMBER OF CASES OBSERVED 254 EXPECTED NUMBERS ARE BASED UPON 21335 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM ALL U.S. VETERANS WITH NO VIETNAM SERVICE USED AS COMPARISON GROUP 0.96 0.648 �TABLE D-21 DEATHS FROM ACCIDENTS, SUICIDES AND TRAUMA (E800-989) ALL WHITE SERVICEMEN WHO DIED IN CALIFORNIA OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-799) 796 823 0.97 0.532 MOTOR VEH ACCIDENTS 446 449 0.99 0.074 OTH. TRANSPORT. ACC. (E800-807 , E830-845) 54 55 0.98 0.001 ACC. POISONINGS (E850-877) 97 91 1.06 0.485 ALL OTH ACC. /INJURY (E880-949 ,E970-989) 196 156 1.26 4.203* SUICIDE (E950-959) 280 305 0.92 1.515 HOMICIDE (E960-969) 158 147 1.07 0.125 (E810-827) TOTAL NUMBER OF CASES OBSERVED • 2027 EXPECTED NUMBERS ARE BASED UPON 2080 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM NON-VIETNAM SERVICE VETERANS WHO DIED IN CALIFORNIA USED AS COMPARISON GROUP �TABLE D-22 DEATHS PROM CANCERS (140-208, 230-239) ALL WHITE SERVICEMEN WHO DIED IN CALIFORNIA OBSERVED EXPECTED 0/E M-H CHI-SQUARE 1.01 2.15 2.73 1.72 0.42 0.71 1.12 9.00 1.38 1.32 0.56 0.70 0.00 2.87 0.48 0.63 0.78 0.76 0.24 0.52 1.43 1.62 0.85 0.74 0.966 0.740 0.634 0.435 4.141* 0.078 0.105 0.352 2.017 0.016 0.722 0.161 3.898* 5.384* 1.236 0.999 0.254 0.260 3.154 1.675 0.316 1.037 0.649 2.013 CAUSE ALL OTHER CAUSES (000-136, 210-228 , 240-E989) CA - BUCCAL (140-149) CA - ESOPHAGUS (150) CA - STOMACH (151) CA - INTESTINES & OTHER 61 (152-154,158,159) CA - LIVER, BILE DUCTS (155-156) CA - PANCREAS (157) CA - UPPER RESPIRATORY (160-161) CA - LUNG (162) CA - BONE (170) CA - SOFT TISSUES (171) CA - MELANOMA OF THE SKIN (172) CA - PROSTATE (185) CA - TESTIS (186) CA - BLADDER (188) CA - KIDNEY (189) CA - BRAIN (191) CA - OTHER NERVOUS SYSTEM (192) CA - THYROID & ENDOCRINE (193-194) CA - NON-HODGKINS LYMPHOMA (200,202) CA - HODGKINS DISEASE (201) CA - MULTIPLE MYELOMA (203) CA - LEUKEMIA (204-207) OTH CA ( 163 , 173-4 , 187 , 190 , 195-9 , 208-9 , 230-9) 1782 7 5 10 11 2 9 2 67 4 3 18 0 17 1 5 13 2 2 9 10 5 25 18 1767 3 2 6 26 3 8 0 49 3 5 26 5 6 2 8 17 3 8 17 7 3 29 24 TOTAL NUMBER OF CASES OBSERVED - 2027 EXPECTED NUMBERS ARE BASED UPON 2080 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM NON-VIETNAM SERVICE VETERANS WHO DIED IN CALIFORNIA USED AS COMPARISON GROUP �TABLE D-23 DEATHS FROM SELECTED DISEASES OF THE CIRCULATORY, RESPIRATORY AND DIGESTIVE SYSTEMS ALL WHITE SERVICEMEN WHO DIED IN CALIFORNIA OBSERVED EXPECTED O/E M-H CHI-SQUARE CAUSE ALL OTHER CAUSES (000-398, 580-E989) HYPERTENSIVE DISEASE (400-404) ACUTE MYOCARDIAL INFARCTION (410) OTHER ISCHEMIC HEART DISEASE (411-414) CARDIOMYOPATHY (425) CARDIAC ARREST (427.2) CEREBROVASCULAR DISEASES (430-438) DIS OF ARTERIES, ARTERIOLES , CAPILLARIES (440-448) DIS OF VEINS, LYMPHATICS & OTHERS (450-458) OTH HEART DISEASES (420-424,426-427.1,427.3-429) UPPER RESPIRATORY (460-466, 500-508) INFLUENZA & PNEUMONIA (470-486) CHRONIC BRONCHITIS & EMPHYSEMA (491-492) OTHER RESPIRATORY (490, 493, 510-519) DIS OF ESOPHAGUS, STOMACH, DUODENUM (530-537) CIRRHOSIS - ALCOHOLIC (571.0) CIRRHOSIS - OTHER/UNSPECIFIED (571.8, 571.9) DISEASES OF PANCREAS (577) OTH DIGESTIVE DISEASES (520-529, 540-570, 572-576) 1684 4 4 98 12 6 34 10 6 14 2 18 6 4 5 53 43 12 12 1711 6 5 100 10 3 36 8 11 10 1 17 1 4 5 46 41 3 10 TOTAL NUMBER OF CASES OBSERVED • 2027 EXPECTED NUMBERS ARE BASED UPON 2080 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM NON-VIETNAM SERVICE VETERANS WHO DIED IN CALIFORNIA USED AS COMPARISON GROUP 0.98 0.70 0.74 0.98 1.18 1.99 0.93 1.31 0.53 1.43 3.59 1.05 8.88 1.01 1.06 1.14 1.06 3.96 1.24 0.560 0.200 1.136 0.189 0.454 1.851 0.058 0.005 0.762 2.156 0.014 0.011 2.447 0.003 0.354 0.302 0.001 4.740* 0.014 �TABLE D-24 DEATHS FROM SELECTED ORGAN SYSTEMS ALL WHITE SERVICEMEN WHO DIED IN CALIFORNIA OBSERVED EXPECTED 0/E M-H CHI-SQUARE CAUSE 59 50 1.19 1.097 3 18 0.17 6.259* 245 260 0.94 0.966 ENDOCRINE, NUTRITIONAL & METABOLIC (240-279) 3 25 0.12 11.714* BLOOD & BLOOD-FORMING ORGANS (280-289) 3 1 2.12 0.659 13 20 0.66 0.019 (390-458) 314 304 1.03 0.135 RESPIRATORY DISEASES (460-519) 32 25 1.28 0.200 116 103 1.12 0.462 GENITOURINARY DISEASES (580-629) 4 10 0.41 0.282 SKIN & SUBCUTANEOUS TISSUES (680-709) 1 5 0.19 1.937 MUSCULOSKELBTAL & CONNECTIVE TISSUES (710-738) 2 3 0.65 0.629 1232 1204 1.02 0.591 ALL OTHER CAUSES (210-28,290-315,740-759,780-796) INFECTIVE & PARASITIC DISEASES (000-136) CANCERS (140-209, 230-239) NERVOUS SYSTEMS & SENSE ORGANS (320-389) CIRCULATORY DISEASES DIGESTIVE DISEASES (520-577) ACCIDENTS, VIOLENCE & TRAUMA (E800-989) TOTAL NUMBER OF CASES OBSERVED - 2027 EXPECTED NUMBERS ARE BASED UPON 2080 OBSERVATIONS IN COMPARISON GROUP * P<0.05 FOR CHI-SQUARE WITH 1 DEGREE OF FREEDOM NON-VIETNAM SERVICE VETERANS WHO DIED IN CALIFORNIA USED AS COMPARISON GROUP � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 066 Folder The folder containing the original item. 1776 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Breslin, Patricia Yvonne Lee Han Kang Vicki Burt Barclay Shepard Title A name given to the resource Typescript: A Preliminary Report: The Vietnam Veterans Mortality Study, October 1986 Subject The topic of the resource VA Mortality Study mortality trends lymphomas ao_seriesIII