1 15 14 https://www.nal.usda.gov/exhibits/speccoll/files/original/afc503475f8dac9b1e8778f4ed94b544.pdf b83094460edb1cb45fadfba3dadf3216 PDF Text Text Item ID Number °1786 Author Breslin, Patricia Corporate Author Report/Article Title Proportionate Mortality Study of US Army and US Marine Corps Veterans of the Vietnam War JOlirnal/BOOk TltlB Journal of Occupational Medicine Year 1988 Month/Day Ma Color a Number of Images v 8 Descriptor Notes Monday, June 11, 2001 Page 1787 of 1793 �Proportionate Mortality Study of US Army and US Marine Corps Veterans of the Vietnam War Patricia Breslin, ScD; Han K. Kong, DrPH; Yvonne Lee, MSc; Vicki Burt, ScM; and Barclay M. Shepard, MD The patterns of mortality among 84,835 US Army and Marine Corps Vietnam veterans were compared with that of 86,685 non-Vietnam veterans using standardized proportional mortality ratios. The veterans were a random sample of deceased Vietnam-era veterans identified in a Veterans Administration computerized benefit file. Military service information was obtained from military personnel records, and cause of death information from death certificates. Statistically significant excess deaths were observed among Army Vietnam veterans for motor vehicle accidents, non-motor vehicle accidents, and accidental poisonings. Similar findings have been reported in other studies of Vietnam veterans. Suicides were not elevated among Vietnam veterans. The Marine Corps Vietnam veterans appeared to have an increased mortality from lung cancer and non-Hodgkin's lymphoma. Although exposure to several environmental factors may be speculated, this study did not investigate possible etiologic factors for these elevated malignancies. here concern in the United States that postTserviceismortality among Vietnam are disproportionveterans is unusually high and certain causes of death ately elevated. Traumatic deaths such as motor vehicle accidents, suicides, and homicides are often cited as possible health outcomes associated with military service in Vietnam.1'6 Concern also persists that, as a result of exposure to Agent Orange and other chemicals in Vietnam, Vietnam veterans may be at increased risk for soft tissue sarcomas and other cancers.7"9 ApproxiFrom the Office of Environmental Epidemiology, Veterans Administration, Washington DC 20006-3868. Address correspondence to VA Office of Environmental Epidemiology (10B/AO8) Biddell Bldg, Rm 401, 1730 K St NW, Washington DC 80006-3868. 0096-1736/88/3006-4ia$oa.OO/0 Copyright © by American Occupational Medical Association 412 mately 2 million US military personnel served a oneyear tour in Vietnam during the Vietnam war. Findings of mortality studies of Vietnam veterans reported to date are not consistent with each other.1"6 Whether the variations among the studies are the result of the relatively small number of deaths analyzed, therefore reflecting lack of adequate statistical power, or whether they suggest an underlying difference in the mortality experience among the different Vietnam veteran study populations is not obvious. The number of deaths analyzed in these studies ranged from 246 to 923. In view of the public concern about the potential adverse health effects of military service in Vietnam and inconsistent findings in the scientific literature, a proportional mortality study of Vietnam veterans was undertaken. Approximately one third of all deaths which have occurred among the Vietnam veterans who served in tho US Army or Marine Corps was analyzed in the study. Materials and Methods Selection of Study Subjects Study subjects were restricted to ground troops, men who served in the US Army or Marine Corps at anytime from July 4, 1965 through March 1, 1973. Data published by the US Department of Defense indicate that over 80% of those who served in Vietnam were ground troops.10 Those having served in the Air Force, Navy, or Coast Guard were excluded because it is difficult to determine whether personnel who were considered to have served in the Vietnam theatre of operation were Mortality Study of Vietnam War Veterans/Breslin et al �ever actually "in country" Vietnam. Female veterans were also excluded from the study. It was determined that at least 50,000 eligible cases would be needed for the study in order to obtain adequate statistical power. The sample size of 50,000 deceased Vietnam era veterans would provide statistical power of over 90% for detecting a twofold increased relative risk of non-Hodgkin's lymphoma or lung cancer. The study would have excellent power to detect small increases in certain common causes of death. Potential study subjects who were reported to be deceased as of July 1,1982 were randomly selected from the Veterans Administration Beneficiary Identification and Record Locator Subsystem (BIBLS). The VA maintains the automated information retrieval system to identify and locate records of veterans who have received any of a wide variety of veterans' benefits including death benefits to their families. A study by the National Academy of Sciences indicates that the names of at least 94% of all deceased Vietnam-era veterans identified through independent means are in BIBLS.11 A subfile of 186,000 deceased Vietnam-era veterans who served in the Army or Marine Corps and whose service dates included the period 1964-1975 was assembled from BIBLS. If the service data (branch, service dates) were missing in BIBLS, veterans whose birth dates were between 1935 and 1957 (inclusive) were selected because of the high likelihood that they may have served during the Vietnam era. To achieve the desired sample size of approximately 50,000 eligible veterans, a random sample of 75,617 names was selected from the target population. Extra names were selected to allow for the exclusion of ineligible cases. The military personnel records for all 75,617 potential study subjects were requested from the National Personnel Becord Center in St. Louis, MO. Demographic data and information on military service such as branch of service, length of service, rank at discharge, and military occupational specialty were abstracted. In addition, for those who served in Southeast Asia, dates of service, principal duty, and unit addresses while in the theatre of combat were obtained. Of the 75,617 Vietnam-era veterans selected, 22,332 (29.5%) veterans were found to be ineligible upon reviewing their military personnel records. The ineligible cases included duplicate names; men who did not serve in the military from July 4, 1965 through March 1, 1973; men who served in the Navy, Coast Guard, or Air Force; men who were killed in action or were reported missing in action and subsequently declared dead; men who died in service before 1974; men who died of warrelated injuries; and all women. Eligibility for the study could not be determined for 1,032 veterans (1.4%) and they were excluded. The final sample consisted of 52,253 men who died between July 4, 1965 and July 1, 1982 and who served in the US Army or Marine Corps during the period July 4, 1965 through March 1, 1973. Death certificates were available from the VA files for about 70% of the sample; for the remaining 16,000 cases, the veteran's death certificate was requested from the state of his last known residence. The place of the veteran's death was identified by checking files of the VA, Social Security Administration, Internal Bevenue Service, and National Center for health Statistics National Death Index. Although death certificates were the preferred source of information, casualty reports issued by the Department of Defense were also used for active duty personnel or reservists who died outside the country and for whom no death certificate could be obtained. Most of these deaths were accidents and probably little additional information would have been obtained from the death certificate if it were available. Death certificates were the source of cause of death information for 96.9% of all cases. This was equally true for both those who served in Vietnam and those who did not. The underlying causes of death were coded by experienced nosologists at the National Center for Health Statistics using the International Classification of Diseases, 8th Bevision (ICDA8).ia The nosologists had no knowledge of the military service status of the veteran. Cause of death was ascertained for 51,421 veterans or 98.4% of the men determined to be eligible for the study. The cause of death for the remaining 1.6% was not obtained for one of the following reasons: the veteran died overseas and no certificate or cause of death information was available or the veteran's place of death had not been identified, and therefore the death certificate could not be located. Of the 51,421 men for whom military service data and cause of death information were available, 26,685 had not served in Southeast Asia; 24,235 had served in Vietnam. The remaining 501 were either known to have served elsewhere in Southeast Asia or their place of service in Southeast Asia was unknown. Analyses of mortality data were based on 24,235 Vietnam veterans and 26,685 non-Vietnam veterans. These procedures used to select the subjects are outlined in the Figure. Statistical Analyses The deaths observed among the Vietnam veterans were compared with expected numbers computed by applying the age- and race-specific proportions of deaths for each cause among the non-Vietnam veterans to the total number of deaths in the study group. Differences between observed and expected number of deaths for each cause were summarized in the form of the proportional mortality ratio (SPMB) which is the ratio of the number of deaths observed to that expected.13 The statistical significance of each ratio was tested by a xa with 1 df.14 The 95% confidence intervals for the SPMBs were also computed.10 Proportional mortality ratios standardized for age and race (SPMBs) were calculated separately for Army and Marine Corps Vietnam veterans for all major causes of death and for selected causes of death. The PMB analysis by branch of service was performed because these groups might have had different types of environmental exposure in Vietnam either by virtue of the Journal of Occupational Medicine/Volume 30 No. 5/May 1988 413 �Veterans Administration Beneficiary Identification and Record Locator Subsystem TABLE 1 Racial Characteristics of the 50,920 Deceased Vietnam-era Veterans by Branch and Vietnam Service Army Race Service in Vietnam Yes (N = 19,708), No (N = 22,904), Yes (N = 4,527), No (N = 3,781), 78.1 19.2 2.7 79.5 17.7 83.5 13.7 82.5 14.9 2.8 2.8 2.6 White Black Other Unknown Totals Random Sample (75,617) Marines Service in Vietnam Deceased Vietnam-era Veterans Army Marine Corps or Branch Unknown (186,000) * 100 * 100 100 100 •Less than 0.1%. Military Records Not Found (1,032) Qualified for Study (52,253) TABLE 2 Military Rank of the 50,920 Deceased Vietnam-era Veterans by Branch and Vietnam Service Army Cause of Death Unknown (832) Served in Thailand or Elsewhere in Southeast Asia (501), Excluded from Study Cause of Death Known (51,421) Served in Vietnam (24,235) Rank Served Places Other than Southeast Asia (26,685) Figure. Selection process of study subjects. location of their units or the types of duties they performed. Unlike the Army units, the Marine Corps units were primarily located within the I Corps area of South Vietnam. South Vietnam was divided into four tactical combat zones, I Corps being in the northernmost part of South Vietnam. Results The demographic characteristics of the sample are given in Tables 1 and 3. More than 50% of the veterans died at ages 25 through 34. Some died at ages less than 85 (5.5% of Vietnam and 11.7% of non-Vietnam veterans) and some died at ages older than 65 (0.74% of Vietnam and 8.6% of non-Vietnam veterans). There seemed to be no remarkable differences in the major cause of death categories between the men who served in Vietnam and their counterparts who did not serve in Vietnam with a few exceptions (Table 3). Deaths from external causes (ICDA codes E800-E989) were relatively more frequent among veterans who served in Vietnam than among those who did not. However, this excess is statistically significant only for Army veterans (PMB, 1.03; P< .01). More than half of all the deaths in the study population were due to accidents, accidental poisonings, or violence. Within this broad category, approximately 35% of the deaths were due to motor vehicle accidents 414 Enlisted Warrant officer Officer Unknown Totals Marines Service in Vietnam Service in Vietnam Yes No Yes No (N = 19,708), (N = 22,904), (N = 4,527), (N = 3,781), 92.8 93.4 93.6 95.8 2.1 5.1 1.0 5.5 0.9 5.5 0.3 3.9 * 100 * 100 * 100 100 •Less than 0.1%. (Table 4). Although the magnitude of the relative excess of motor vehicle accidents was about the same in both branches, only the SPMR for Army veterans was statistically significant (PMR, 1.05; P< .085). "Other transport accidents" were seen to be in excess primarily among Army personnel (PMR, 1.36; P < .01); 51% of these were aircraft accidents. Of the men who died in aircraft accidents, 88% had been helicopter pilots or crewmen and 84% of these had served in Vietnam. Many of these died while working as helicoptor pilots or crewmen in civilian life; others died in aircraft accidents while still in the military after the war. The category of "accidental poisonings" was elevated among both Army and Marine Corps veterans who served in Vietnam. In reviewing a sample of 100 of these deaths, it was found that 98% of these deaths were due to narcotic overdose, mostly heroin. Among enlisted Vietnam veterans, veterans with combat-related military occupations died from homicide significantly more frequently than veterans with non-combat-related military occupations: 9% excess for Army veterans (P < .05), 84% excess for Marine Corps veterans (P< .01). It also appeared that the excess deaths from motor vehicle accidents and accidental poisonings were greater during the first ten-year period of observations than the later years of observation for both Army and Marine Corps Vietnam veterans (Table 5). Deaths coded as suicide were relatively less frequent among those who served in Vietnam than among those who did not serve in Vietnam for both Army and Marine Corps veterans. Mortality Study of Vietnam War Veterans/Breslin et al �TABLE 3 Number of Deaths and Proportional Mortality Ratios (PMRs) Among Vietnam Veterans by Major Causes and Branch Army* Cause (ICDA No.) All other causes (210-228, 290315,740-759,780-796) Infective and parasitic diseases (000-136) Malignancies (140-209, 230-239) Endocrine, nutritional, and metabolic (240-279) Blood and blood-forming organs (280-289) Nervous systems and sense organs (320-389) Circulatory diseases (390-458) Respiratory diseases (460-519) Digestive diseases (520-577) Genitourinary diseases (580-629) Skin and subcutaneous tissues (680-709) Musculoskeletal and connective tissues (71 0-738) Accidents, poisonings, and violence (E800-989) Observed Marinest 95% Confidence Interval PMR Observed PMR 95% Confidence Interval 150 0.94 0.63-1.01 19 1.02 0.89-1.17 0.97 0.85 0.93-1.02 0.67-1.08 521 22 1.20 0.66 1 .0-1 .45 0.22-2.01 32 0.68 0.45-1 .03 8 3.22 0.51-20.5 167 0.95 0.77-1.18 27 0.86 0.17-4.44 0.98 0.93 0.99 0.77t 0.76 0.95-1 .01 0.69-1.25 0.94-1 .04 0.60-0.99 0.05-11.19 647 62 169 13 2 0.98 0.95 0.87 0.67 0.50 0.86-1.12 0.75-1 .21 0.70-1.08 0.33-1.35 0.06-4.18 7 0.87 0.22-3.41 2,880 1.00 709 0.91 127 0.80 2,452 135 3,578 406 1,001 80 8 29 10,984 1.55 0.8-3.0 1.03§ 1.02-1.04 * Army: deaths observed = 19,708. Expected numbers are based on 22,904 deaths in Army non-Vietnam veteran comparison group, t Marines: deaths observed = 4,527. Expected numbers are based on 3,781 deaths in Marine non-Vietnam veteran comparison group. :(:P<.05forx 2 with1cff. § P < .01 for x2 with 1 df. TABLE 4 Number of Deaths from Accidents, Accidental Poisonings, and Violence and Proportional Mortality Ratios (PMRs) Among Vietnam Veterans, by Branch Army* Cause (ICDA No.) Motor vehicle accidents (E810E827) Other transportation accidents (E800-E807, E830-E845) Accidental poisonings (E850E877) All other accidents/injury (E880E949, E970-E989) Suicide (E950-E959) Homicide (E960-E969) Marinest Observed PMR 95% Confidence Interval Observed PMR 95% Confidence Interval 3,884 1.05$ 1.01-1.09 1,011 1.07 0.97-1.18 493 1.36§ 1.19-1.56 117 0.75 0.56-1.01 461 1.15$ 1.02-1.30 120 1.10 0.93-1.30 2,323 1.05 0.99-1.11 593 1.01 0.98-1 .04 2,003 0.93§ 1.01 0.88-0.98 0.73-1.40 542 497 0.93 0.98 0.86-1.01 0.89-1 .08 1,816 * Army: deaths observed = 19,708. Expected numbers are based on 22,904 deaths in Army non-Vietnam veteran comparison group, t Marines: deaths observed = 4,527. Expected numbers are based on 3,781 deaths in Marine non-Vietnam veteran comparison group, t P<.025 for x 2 with 1 df. §P<.01for x 2 with1df. When all malignancies were grouped together, Vietnam veterans did not exhibit an excess of cancer when compared to their counterparts who did not serve in Vietnam. Differences between the services, however, were seen for specific cancer sites among those who served in Vietnam relative to men who did not (Table 6). The most interesting differences were the statistically significant elevation for lung cancer (PMR, 1.58; P< .025) and non-Hodgkin's lymphoma (PMR, S.10; P < .025) seen in the Marines who served in Vietnam relative to Marines who served elsewhere. The risk for soft tissue sarcoma was not elevated among Vietnam veterans as a whole or in any subgroup of these veterans. Discussion For most major causes, the distribution of deaths for veterans who served in Vietnam is not markedly different from those who did not serve in Vietnam except for selected malignancies and "accidents, accidental poisonings, and violence." Four states have conducted mortality studies of Vietnam era veterans: Wisconsin,1 West Virginia,8 New York,8 and Massachusetts.4 The Centers for Disease Control also reported the postservice mortality of US Army Vietnam veterans." The results of these studies were similar to what was seen here. They Journal of Occupational Medicine/Volume 30 No. 5/May 1988 415 �TABLE 5 Deaths from Selected Causes Among Enlisted Vietnam Veterans Who Died Between 1965 and 1982, and Who Had Only One Tour of Duty* Army Marines 1965-1975 1976-1982 1965-1975 Cause (ICDA No.) Observed Observed 717 34 1.11f 0.65 2,053 201 1.06 1.10 167 11 77 342 212 232 89 Motor vehicle accidents Other transport accidents Accidental poisonings All other accidents/injury Suicide Homicide Cancers (140-209, 230-239) PMR PMR 1.14 1.00 1.00 0.92 0.74t 255 1,186 1,089 1,008 655 1.09 1.05 0.94 1.03 0.87f 25 82 57 68 25 1976-1982 PMR Observed PMR 1.18 1.04 611 48 1.01 0.82 2.26f 1.01 0.65 1.27 0.61 1 Observed 71 364 368 314 176 1.04 0.93 1.05 0.91 1.31 * PMR, proportional mortality ratio of observed to expected numbers of deaths. Expected number was generated based on deaths from nonVietnam veterans with similar characteristics. tP<.05forx 2 with1df. TABLE 6 Number of Deaths from Malignancies Among Vietnam Veterans by Branch of Service Army* Cause (ICDA No.) Observed All other causes (000-136, 210E989) All malignancies Buccal (140-1 49) Esophagus (150) Stomach (151) Intestines and other gastrointestinal (152-1 54, 158, 159) Liver, bile ducts (155-1 56) Pancreas (157) Upper respiratory (160-161) Lung (162) Bone (170) Soft tissue (171) Melanoma of the skin (1 72) Prostate (185) Testis(186) Bladder (188) Kidney (189) Brain (191) Other nervous system (192) Thyroid and endocrine (193-194) Non-Hodgkin's lymphoma (200, 202) Hodgkin's disease (201) Multiple myeloma (203) Leukemia (204-207) Other cancers (163, 173-4, 187, PMR 17,256 0.97 0.92 1.24 1.12 0.96 34 82 29 632 27 30 145 30 90 9 55 116 43 15 108 1.04 0.87 1.14 1.03 0.82 0.99 1.02 0.92 1.12 0.56 0.87 0.97 0.558 0.59 0.81 92 18 202 281 1.16 0.77 0.88 1.03 95% Confidence Interval 1.00 2,452 71 46 88 209 Marinesf Observed PMR 95% Confidence Interval 4,006 0.98 0.93-1 .01 0.47-1.82 0.78-1.98 0.85-1.47 0.70-1.32 521 13 5 17 33 1.20 1.95 0.39 0.82 1.26 1.0-1.45 0.54-7.04 0.11-1.41 0.41-1.64 0.71-2.24 0.77-1.41 0.64-1.18 0.63-2.07 0.39-1.71 0.80-1.23 0.91-1.14 0.55-1.23 0.84-1.5 0.27-1.18 0.50-1.52 0.29-3.20 0.38-0.79 0.30-1.17 0.63-1.04 6 18 1 130 11 8 36 5 26 4 13 25 11 4 35 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* 0.52-2.83 0.46-5.75 0.03-1.32 1 .09-2.29 0.09-21 .48 0.38-1.32 0.59-1.50 0.16-10.3 0.47-3.57 0.09-66.35 0.54-1 .46 0.16-7.14 0.49-1 .78 0.10-3.37 1.17-3.79 0.73-1.85 0.23-2.53 0.73-1 .06 0.93-1.14 22 2 42 54 1.33 0.45 1.14 1.07 0.67-2.63 0.01-17.13 0.18-7.14 0.60-1.91 190, 195-9, 208-9, 230-9) * Army: deaths observed = 19,708. Expected numbers based on 22,904 deaths in Army non-Vietnam veteran comparison group, t Marines: deaths observed = 4,527. Expected numbers based on 3,781 deaths in Marine non-Vietnam veteran comparison group, t P<. 025 for x2 with 1 off. §P<.01 for x 2 with 1 df. also reported that Vietnam veterans were more likely to die from "accidents, accidental poisonings, and violence" or from a few selected malignancies than their counterparts who did not go to Vietnam. However, within these two broad categories, the findings reported by these studies were not consistent with each other or with what was found here. It should be noted that the data in the state reports were not strictly comparable to the data given in this report. They differed from this 416 study in that numbers of deaths studied were much smaller—less than 1,000-and they included Vietnamera veterans from all branches of service. They also differed somewhat in the analytical methods and used different types of veteran comparison populations. Furthermore, military personnel records of the state study subjects were not reviewed to verify Vietnam service status. The New York,3 Massachusetts,4 and CDC8 studies Mortality Study of Vietnam War Veterans/Breslin et al �reported nonstatistically significant elevations of risk for suicide when veterans with service in Vietnam were compared with other Vietnam-era veterans. In this study no excess of suicides was seen among the veterans who served in Vietnam when compared with other Vietnam-era veterans. The ratio of observed to expected deaths among the Army and Marine Corps veterans who served in Vietnam relative to their counterparts who did not serve in Vietnam was less than one; for veterans who had served in the Army, the deficit was statistically significant at P< .01. Simon16 reported an association between attempted suicide and combat experience in World War II veterans. In our study there was no data element that indicated whether a man had been in combat. As a surrogate measure, enlisted men whose military occupational specialties would be likely to involve combat, ie, rifleman, artilleryman etc, were compared to the other enlisted men who had served in Vietnam. Among the enlisted men who served in Vietnam, those with "combat-related" occupational specialties in both branches of service had relatively fewer suicides than "non-combat" Vietnam veterans in the same branch of service (Army: N = 590, PMR = 0.96; Marines: N = 228, PMR = 0.83). For the Marines, the deficit was statistically significant atP<.05. It is known that suicides are under-reported on death certificates but there was no reason to believe that they were more underreported among veterans who served in Vietnam than among those who did not. Nor was there any reason to believe that suicide was more apt to be underreported among those likely to have been in combat in Vietnam than among other veterans. Several researchers suggested that 1.6% to 5% of motor vehicle accidents may be suicides.17'18 In our study, motor vehicle accidents were relatively less frequent among Vietnam veterans with combat-related occupational specialties than among those with noncombat occupations (Army: N = 1,205, PMR = 0.99; Marines: N = 466, PMR = 0.94). Even if one assumes that some of the motor vehicle accidents are "hidden" suicides, it is unlikely that these could account for the overall deficit in suicides among Vietnam veterans since the possible "hidden" suicides among motor vehicle accidents are reportedly relatively small. The apparent excess of drug-related deaths attributable to heroin use among Vietnam veterans is of concern. This observation was consistent with that of Rohrbaugh et al,19 who found that, whereas Vietnam veterans were no more likely than other Vietnam-era veterans to use drugs in general, they were more likely to use opiates than other illicit drugs. The CDC also reported that accidental drug poisonings were substantially elevated among Vietnam veterans. One of the major concerns of Vietnam veterans has been the possibility of developing cancer as a result of exposure to Agent Orange, a mixture of two phenoxy herbicides. Some studies have shown an association between soft tissue sarcomas and exposure to phenoxy herbicides.7'20'21 Although data from Wisconsin,1 West Virginia,2 and Massachusetts4 indicated that veterans who served in Vietnam may have an increased risk of soft tissue sarcoma, no excess of soft tissue sarcomas was seen among the Vietnam veterans in our study. No association between soft tissue sarcoma and military service in Vietnam was found by Greenwald et alsa in a case control study of 881 men with soft tissue sarcoma from New York State, nor was any association found between military service in Vietnam and 234 cases of soft tissue sarcoma occurring among Vietnam-era veterans admitted to Veterans Administration hospitals,23 or 817 soft tissue sarcoma cases referred to the Armed Forces Institute of Pathology.84 The veterans who served in the Marine Corps in Vietnam were seen to have a statistically significant (P < .085) excess of non-Hodgkin's lymphoma when compared with Marines who did not serve in Vietnam. West Virginia veterans with service in Vietnam had a statistically significant excess of Hodgkin's disease when compared with other Vietnam-era veterans.2 None of the other state studies indicated any excess of lymphomas among veterans with service in Vietnam.1'3'* Non-Hodgkin's lymphoma has been associated with exposure to phenoxy herbicides,8'9 arsenicals,86 dapsone,26 and certain viruses.27 The men who served in Vietnam had the potential for exposure to all of these agents. Agent Blue, a herbicide used in Vietnam, was an organic arsenical compound and dapsone, a sulfone, was used as an antimalarial drug by some of the troops in Vietnam. Dapsone26 has been shown to cause lymphomas in laboratory animals. Dapsone was given mainly to troops stationed in I Corps and the central highland areas of Vietnam where falciparum malaria was prevalent. Most of the Marines in Vietnam served in I Corps. It will be interesting to see whether the Army troops who were stationed in I Corps also exhibit an excess of lymphomas. The data necessary for this analysis are now being collected. Lung cancer was significantly elevated (PMR, 1.58; P < .085) among Marines who served in Vietnam relative to Marines who did not serve in Vietnam. The veterans from New York3 with service in Vietnam also had relatively more lung cancer than other Vietnamera veterans but the excess was not statistically significant. Although tobacco is the etiologic agent most commonly associated with lung cancer, this disease has also been associated with exposure to other substances such as arsenic28 and phenoxy herbicides.80'29 A survey of more than 89,000 Vietnam-era veterans in Wisconsin indicated that they were nearly twice as likely to be cigarette smokers as were men in the general population.1 There are no smoking histories available for the Marines in this study. If the lung cancer deaths in this study are associated with an increased use of tobacco by the men who served in Vietnam, lung cancer deaths should also be increased among Army troops in Vietnam. They were not. The present study has certain inherent limitations that make it difficult to draw firm conclusions. First, Journal of Occupational Medicine/Volume 30 No. 5/May 1988 417 �risk estimates obtained from PMR analyses can approximate the results from studies of cause-specific mortality rates or the standardized mortality ratio (SMR).30 However, PMRs may be inflated for certain causes when the overall mortality rate of the study group is lower than that of the comparison population. This would have been the case if the US general population had been chosen for the comparison population in this study. It was shown that the selection process for military service exerted a profound effect on the mortality of veterans after separation from service. The number of deaths among the World War II male Army veterans was only 83.5% of the expected number at concurrent death rates for US white men.31 A recent study published by the CDC showed that the mortality among the Vietnam veteran study population was 17% higher than the rate among the non-Vietnam veteran comparison populations.5 These suggested that SPMRs for lung cancer and nonHodgkin's lymphoma reported in this study could have been biased toward underestimating the risks. Second, it is possible that, with so many comparisons being made, the few significant elevations observed could be interpreted as chance findings. Findings from this study need to be replicated by other Vietnam veteran studies. Third, no exposure data on individual veterans were available so as to evaluate the possible etiologic factors of the malignancies which appeared to be elevated among Marine Vietnam veterans. Additional work needs to be done to find characteristics that may point to possible etiologic factors. Fourth, the observation period in this study, a maximum of 17 years, may have been still insufficient to observe the risk of dying from diseases with a long latency period. A periodic monitoring of Vietnam veteran mortality patterns is warranted. Despite the limitations described above, the present study is the largest mortality study of Vietnam veterans reported to date encompassing approximately one third of all deaths which have occurred among the US Army and Marine veterans who served in Vietnam. Having an equally large number of non-Vietnam veterans whose characteristics are well-defined and are similar to the study population except for service in Vietnam should be considered a major strength. Furthermore, unlike other PMR studies of Vietnam veterans, in this study military personnel records for almost all (98.6%) potential study subjects were retrieved and reviewed to determine eligibility of the veteran. Therefore, the chance of misclassification of the most important study variable, namely service in Vietnam, is minimal. In summary, the study shows no significant differences in the major cause of death between Vietnam veterans and non-Vietnam veterans with a few exceptions. Accidental and drug-related deaths were relatively more frequent among Army Vietnam veterans. Suicides were less frequent among Vietnam veterans. Vietnam veterans who served in the Marine Corps were seen to have statistically significant excess of lung cancer and non-Hodgkin's lymphoma. 418 Acknowledgments The Veterans Administration wishes to acknowledge the assistance and support received from many individuals and agencies without which the VA mortality study could not have been successfully completed. We are grateful to Gilbert Beebe, PhD (NIH), Chin Long Chiang, PhD (UC Berkeley), Joseph Fleiss, PhD (Columbia University), the late Bernard Greenberg, PhD (University of North Carolina), the late Abraham Lillenfeld, MD (Johns Hopkins University), and Richard Monson, MD (Harvard University) for their reviews of the study protocol and the many suggestions and recommendations made on the conduct of the study. We also would like to acknowledge the contributions of David Peterson and Carolyn Brooks of the National Archives Records Administration; Paul Gray, National Personnel Records Center; Richard Christian, US Army and Joint Services Environmental Support Group; Robert Bilgrad, National Center for Health Statistics, National Death Index; and the Social Security Administration; the National Institute for Occupational Safety and Health; and the Internal Revenue Service. John Ward of Westat and Elaine Kokiko of Moshman Associates assisted us in the collection of military service data and death certificates, respectively. The guidance provided by William Page, PhD (National Academy of Sciences) and Alvin Young, PhD (White House Office of Science and Technology Policy) in planning for the study is greatly appreciated. References 1. Anderson HA, Hanrahan LP, Jensen M, et al: Wisconsin Vietnam Veteran Mortality Study, Final Report. State of Wisconsin Dept of Health and Social Services, Division of Health, 1986. 8. Bailey C, Baron BC, Basanao E, et al: West Virginia Vietnam Era Veterans Mortality Study. West Virginia Residents 1968-1988, Preliminary Report. West Virginia Health Dept, 1986. 3. Lawrence CE, Reilly AA, Quickenton P, et al: Mortality patterns of New York State Vietnam veterans. Am J Public Health 1985:75:377-879. 4. Kogan MD, Clapp RW: Mortality Among Vietnam Veterans in Massachusetts, 1978-83. Massachusetts Office of Commissioner of Veterans Services, Agent Orange Program, Massachusetts Dept of Public Health, Division of Health Statistics, 1985. 5. The Centers for Disease Control: Postservice mortality among Vietnam veterans. JAMA 1987;857:790-795. 6. Hearst N, Newman TB, Hully SB: Delayed effects of the military draft on mortality: A randomized natural experiment. N Eng-1 J Mod 1986;314:680-684. 7. Hardell L, Sandstrom A: Case control study: Soft tissue sarcoma and exposure to phenoxyacetic acids of chlorophenols. Br J Cancer 1979;39:711-717. 8. Hardell L, Ericksson M, Lenner P, et al: Malignant lymphoma and exposure to chemicals especially organic solvents, chlorophenols and phenoxy acids: A case-control study. Br J Cancer 1981;43:169176. 9. Hoar SK, Blair A, Holmes FF, et al: Agricultural herbicide use and risk of lymphoma and soft-tissue sarcoma. JAMA 1986;856:11411146. 10. Dept of Defense, Directorate for Information, Operations, and Reports: Selected Manpower Statistics, Fiscal Year 1981. 11. National Academy of Sciences Commission on the Life Sciences Medical Follow-up Agency: Ascertainment of Mortality in the U.S. Vietnam Veteran Population. Report of Contract V101 (93) P-937, Washington, DC, 1985. 18. Eighth Revision International Classification of Disease, Adapted for Use in the United States. US Public Health Service, Washington, DC. 13. Monson RR: Analysis of relative survival and proportional mortality. Comp Blamed Res 1974;7:385-338. 14. Mantel N, Haenszel W: Statistical aspects of the analysis of data from retrospective studies of disease. JNCI 1959;88:719-748. 15. Spiegelman D, Wang JD, Wegman D: Epidemiologlc programs for computers and calculators. Am J Epidemiol 1983;118:599-607. 16. Simon W: Attempted suicide among veterans. J Nerv Ment Dls 1950;lll:451-468. Mortality Study of Vietnam War Veterans/Breslin et al �17. Huffine GL: Equivocal single-auto traffic fatalities. Life Threatening Behav 1971;l:83-95. 18. Schmidt QW, Shaffer JW, Zlotowitz HI, et al: Suicide by vehicular crash. Am J Psychiatry 1977;184:176-177. 19. Rohrbaugh M, Bads O, Press S, et al: Effects of Vietnam Experience on Subsequent drug use among servicemen. Int J Addict 1974;9:S6-40. SO. Lynge E: A followup study of cancer incidence among workers in manufacture of phenoxy herbicides in Denmark. Br J Cancer 1985:58:859-870. 21. Erickson M, Hardell L, Berg NO, et al: Soft tissue sarcomas and exposure to chemical substances: A case referrant study. Br JInd Med 1981:38:87-33. 88. Greenwald P, Kovasznay B, Collins DN, et al: Sarcoma of soft tissues after Vietnam service. JNCI 1984;73:1107-1109. 83. Rang H, Weatherbee L, Breslin P, et al: Soft tissue sarcoma and military service in Vietnam: A case comparison group analysis of hospital patients. J Occup Med 1986:88:1815-1818. 34. Rang HK, Enzinger FW, Breslin P, et al: Soft tissue sarcoma and military service in Vietnam: A case control study. JNCI 1987;79:693-«99. 85. Axelson O, Dahlgren E, Jansson CD, et al: Arsenic exposure and mortality: A case referrent study for a Swedish copper smelter. BrJInd Med 1978;35:8-15. 86. National Cancer Institute Carcinogenesis Technical Report; Series No. 80: Bioassay of dapsone for possible carcinogenicity. DHEW publication No. NIH 77-880. Washington, DC 1977. 87. Schottenfeld D, Fraumeni <TF: Cancer Epidemiology and Prevention. Philadelphia, W. B. Saunders Co, 1988, pp 770-771. 88. Ott MG, Holder BB, Goldon HL, et al: Respiratory cancer and occupational exposure to arsenicals. Arch Environ Health 1974:89:850-855. 89. Zack JA, Oaffey WR: A mortality study of workers employed at the Monsanto Company plant in Nitro, West Virginia. Environ Sci Res 1983:86:575-591. 30. Decoufle P, Thomas TL, Pickle LW: Comparison of the proportionate mortality ratio and standardized mortality ratio risks measures. Am JEpidemiol 1980;lll:863-869. 31. Seltzer CC, Jablon S: Effects of selection on mortality. Am J Epidemlol 1974:100:367-378. Journal of Occupational Medicine/Volume 30 No. 5/May 1988 419 � 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. 1786 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 Han K. Kang Yvonne Lee Vicki Burt Barclay M. Shepard Source A related resource from which the described resource is derived Journal of Occupational Medicine Date A point or period of time associated with an event in the lifecycle of the resource 1988-05-01 Title A name given to the resource Proportionate Mortality Study of US Army and US Marine Corps Veterans of the Vietnam War Subject The topic of the resource VA Mortality Study mortality trends cancer risk assessment ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/df8d66e51c40779e9d002e14c30e9caf.pdf a7bbaebbe750a995b0af55bc3d939eb6 PDF Text Text Item ID Number 01735 Author Keller, Carl A. Corporate Author RODOrt/ArtlOlO TitlO Typescript: Review of Vietnam Veterans Mortality Study, September 14,1987 Journal/Book Title oooo Month/Day Color Number of Images n 1 Doscripton Notes Monday, June 11, 2001 Page 1786 of 1793 �REVIEW OF VIETNAM VETERANS MORTALITY STUDY A study of proportionate mortality among U.S. Army and Marine veterans who served between July 4, 1965 and March 1, 1973 and died before March 1, 1982 was reported by the Veterans Administration. The study included 19708 Army and 4527 Marine veterans who had served in Vietnam and 22904 Army and 3781 Marine veterans who had not served in Southeast Asia during tis period. The study included a random sample of about one-third of the potentially elligible veterans who had died during this period. The selection of study subjects and recovery of information on them appears to have been unbiased and appropriate. The major findings from this study included a statistically significant excess of accidental and drug related deaths and paucity of suicides among Army veterans who had served in Vietnam compared to those who had not served in Southeast Asia. In addition, there was a statistically significant excess of lung cancer and non-Hodgkins lymphoma among Marine veterans who had served in Vietnam compared to those who had not. Several other findings were not mentioned in either the conclusions nor in the narrative, but are evident in the tables. These include a statisically significant decrease in mortality due to genitourinary diseases and cancer of the extra-cranial nervous system among Army Vietnam veterans. In addition, there appears to have been a signifcant decrease in cancer deaths among enlisted Army veterans with only one tour of duty in Vietnam, and among similar Marine veterans before 1975. There was also a significant increase in accidental poisonings among enlisted Marine Vietnam veterans dying before 1975. The authors computed Standardized Proportionate Mortality Ratios (SPMR) and tested with the Chi-Square statistic (not presented in the tables). According to the reference used to justify this procedure (ref # 13), Professor Monson suggests using the Poisson approximation of the variance of the expected deaths, i.e., that the expected number of deaths approximates the variance. If this procedure is applied to the information which can be deduced from the observed number of deaths and the SPMR as given in the tables, several additional SPMRs appear to be statistically significant. These include an excess of all cancer deaths among Marine veterans who served in Vietnam, particularly single tour enlisted Marines after 1975. Other possibly significant findings would include a decrease in deaths due to infectious diseases and diseases of the blood, an increase in deaths due to musculoskeletal and connective tissue diseases, and a decrease in deaths from thyroid cancer and non-Hodgkins lymphoma among Army Vietnam veterans. While there is no way to determine which statistical procedures are "correct", these results indicate that more significant findings are available in these data than have been dicussed in the manuscript. While this does not make it any easier to interpret the results, it does serve to point out the selective nature of the findings which have been emphasized in the manuscript. In particular, the inclusion of one-seventh of the abstract and considerable dicussion in the narrative to Agent Orange is misleading. Other possible explanations for the findings should receive relatively more emphasis. Carl A. Keller, Ph.D. Epidemiologist, NIEHS � 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. 1785 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 Keller, Carl A. Title A name given to the resource Typescript: Review of Vietnam Veterans Mortality Study, September 14, 1987 Subject The topic of the resource VA Mortality Study mortality trends study criticism cancer risk assessment ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/0397ef45f6a5749c72a829b6264147b2.pdf e95d695e5c8772b844e37ed1186077ad PDF Text Text Item ID Number 01734 Author Houk, Vernon N. Corporate Author RepOrt/ArtiClB TltlO Memorandum: Review of VA Mortality Study, from Vernon N. Houk to Ronald W. Hart, September 11, 1987 Journal/Book Title Year 000 ° Month/Day Color D Number of unaoos 2 Desorlpton Notes Monday, June 11, 2001 Page 1785 of 1793 �DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Centers for Disease Control Memorandum Date From .September 11, 1987 Director Center for Environmental Health and Injury Control Review of VA Mortality Study Subject To Ronald W. Hart, Ph.D. Director National Center for Toxicological Research i The Veterans Administration (VA) has conducted a proportionate mortality study (PMR) of 24,235 deaths among U.S. Army and U.S. Marine male veterans who served in Vietnam and 26,685 deaths among male veterans of the same two services who did not serve anywhere in Southeast Asia. All deaths were identified from the VA BIRLS file and occurred between July 4, 1965, and March 1, 1982. These deceased veterans had to have served in the military sometime between July 4, 1965, and March 1, 1973. Career and non-career, officers, and enlisted men, as well as reservists, were included. In-service deaths occurring before 1974 and men dying from war-related injuries were excluded. In service deaths after 1973 were included. Within the group of Vietnam veterans, the fraction of all deaths attributable to a particular cause was computed and compared to the corresponding proportion for non-Vietnam veterans. The comparison was done using the proportionate mortality ratio (PMR) technique in which age at death, race, and branch of service were taken into account. There was no adjustment for calendar year of death or rank. Altogether, PMRs were computed for 18 major cause of death groupings and for 23 specific cancer sites. We will address our concerns in data collection, data analysis, and interpretation. Data Collection. Are the BIRLS tapes truly at least 94 percent complete? From the CDC Mortality Study which used multiple sources of mortality we found that BIRLS was less complete. Data Analysis. Why do the authors emphasize only the statistically significant positive findings? Why were not the significant decreases in deaths from genitourinary diseases (Table 3) and the decrease in deaths *. from all cancers for one-tour of duty veterans (Table 5) not discussed? The lack of association between service in be reevaluated in light of the CDC finding in the first 5 years after discharge. CDC discharge rather than year of death. This Vietnam and suicide needs to that they were increased only used the time period since subject was repeatedly brought �Page 2 - Ronald W. Hart, Ph.D. up with the VA prior to completion of their analysis. The CDC study would indicate that grouping by 10 year periods would minimize the effect. The findings for lung cancer and NHL in Marine Vietnam veterans are provocative, although similar observations were not made in other studies of Vietnam veterans. The absence of unusual mortality from soft-tissue cancers is consistent with some previous studies but at variance with others. Because so many statistical tests were done on the data set, these ^apparent findings could be due to chance. It would be helpful to see a more detailed analysis in which mortality from these cancer sites is examined by calendar year in Vietnam, rank, MOS, and principal duty. These additional analyses would help in deciding whether some factor related to the Vietnam experience is responsible for the apparent association. Interpretation. The authors suggest that these were major differences in the findings of previous studies cited, but there are in fact few major differences in the findings. Referenced studies were not critically discussed. There has never been, for example, an association demonstrated between lung cancer and phenoxy herbicides except in the Zack Study (Ref. 29) where 3.6 cases were expected and 6 were found in those exposed to 2,4,5-T. Those authors state that they cannot evaluate trends in lung cancer deaths as they relate to occupation because of "limitation in the data." As noted above, it is not surprising to encounter the small number of statistical departures from expected mortality seen in this study. These could easily have arisen by chance alone. This study, as originally designed, cannot conclusively clarify mortality risks for Vietnam veterans, let alone elucidate possible causative factors within, or outside of, the Vietnam experience. Reasons include lack of a defined population-at-risk, incomplete ascertainment of deaths, and absence of "exposure" data on individual veterans. This PMR study appears to be well executed in mechanics. However, the presentation and discussion of the results do not provide the necessary caution in interpretation and allow the uninitiated to make causal inferences where they do not exist. Vernon N. Houk, M.D. Assistant Surgeon General � 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. 1784 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 Houk, Vernon N. Title A name given to the resource Memorandum: Review of VA Mortality Study, from Vernon N. Houk to Ronald W. Hart, September 11, 1987 Subject The topic of the resource VA Mortality Study BIRLS study criticism cancer risk assessment ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/303056d230e58afc50f49f117e65dcf4.pdf 74d93fdd921ad400779edc1c34632f44 PDF Text Text Item ID Number 01733 Author Barnes, Donald G. Corporate Author Roport/Artido TitlO Typescript: Comments on "Proportionate Mortally Study of Army and Marine Corps Veterans of the Vietnam War," Septembers, 1987 Journal/Book Titlo Year oooo Month/Day Color n Number of Images 1 Doscrlpton Notes Monday, June 11, 2001 Page 1784 of 1793 �9/8/87 COMMENTS ON "PROPORTIONATE MORTALITY STUDY OF ARMY AND MARINE CORPS VETERANS OF THE VIETNAM WAR" Donald G. Barnes U.S. Environmental Protection Agency 1. Proportionate mortality studies have inherent limitations which restrict their interpretation and conclusions; e.g., reduced PMR in one area necessitates increased PMR in another area. This particular study is a generally welldesigned example of this type of investigation. The report clearly discusses the procedures, methods of analysis, and the conclusions, including caveats. The results should not be cited without an thorough appreciation of these caveats. 2. The study is a descriptive study which essentially suggests hypotheses for further investigation. As such, the study does not test any particular association, let alone prove any cause-effect relationship. 3. It should be noted that of all the PMRs the two identified as being of concern, while statistically significant, are modest (roughly 2) — a tribute to the scale of the study. 4. Among the areas of concern is the question of whether there is an inherent difference between Marines in Vietnam, compared to non-Vietnam Marines and all Army troops. It has been suggested that the Marines in Vietnam had attitudes and behaviors (e.g., risk takers) which were distinguishable from other troops. 5. The diagnosis of Non-Hogkins lymphoma is not easy. There might be a bias in the recording of this diagnosis in cases in which it was known that the patient had served in Vietnam. 6. If one is concerned about the etiology of cancer vis a vis Vietnam, it would be preferable to exclude any cancers that' appear prior to some minimal latency period; e.g., 10 years. 7. It would be enlightening to look at the proportionate cancer mortality ratios (PMCRs), which would examine the relative cancer experience in greater detail. 8. Possible followups include: a. An I Corps study of the Army veterans — planned b. A periodic updating of the current study to take into account latency, etc. — planned? c. A cohort study of the Marines d. A case-control study of the NHL and lung cancers in the Marines. The question of exposure still remains. Given the recent results of the CDC exposure validation study, it is not clear that options c and d are tenable. � 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. 1783 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 Barnes, Donald G. Title A name given to the resource Typescript: Comments on "Proportionate Mortality Study of Army and Marine Corps Veterans of the Vietnam War," September 8, 1987 Subject The topic of the resource VA Mortality Study lymphomas study criticism ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/93a1d4b92c903d16c2fd8681bac5be25.pdf c48fbd9edfd45b05704367bfe00b1744 PDF Text Text Item ID Number Author 01732 Youn 9-J F Corporate Author Report/Article TltlB Typescript: Summary of Review of VA Submission to JAMA, "Proportional Mortality Study of Army and Marine Corps Veterans of the Vietnam War" by P. Breslin, et al., September 8, 1987 Journal/Book Title Year 000 ° Month/Day Color Number of Images L 1 Descrlpton Notes Monday, June 11, 2001 Page 1783 of 1793 �Summary of Review of VA submission to JAMA "Proportional Mortality Study of Army and Marine Corps Veterans of the Vietnam War" by P. Breslin, H.K. Kang, Y. Lee, V. Burt, and B.M. Shepard Summary prepared by J.F. Youngj D.W. Gaylor, R.L. Kodell, and J. Chen National Center for Toxicological Research Jefferson, Arkansas 7E079 September 8? 1987 Regardless of any possible methodological flaws, this study can not be used to infer anything about Agent Orange or any other specific cause of effect other than being a Vietnam veteran. From the write up, one can not check the statistical procedures and therefore must assume that it was done correctly using acceptable methods; however, a more detailed description of the methods with references would be helpful. From this study Non-Hodgkins expected but risk is less the Marines have an increased risk due to Lymphomas? however, the Army risk is lower than not significantly. When combined, the overall than expected with a PMR *" 0.95. The manuscript is for the most part written clearly; however, there are still obvious errors and statements made that are not well documented. Positive findings are pointed out but corresponding negative findings are not discussed. Statements are made on page I ft that PMR values may be inflated or deflated. Life-table analyses could be conducted to overcome these limitations. It is not clear how age and race adjustments were made in the analyses. Were the average age of the Vietnam and non-Vietnam groups the same? � 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. 1782 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 Young, J.F. D.W. Gaylor R.L. Kodell J. Chen Title A name given to the resource Typescript: Summary of Review of VA Submission to JAMA, "Proportional Mortality Study of Army and Marine Corps Veterans of the Vietnam War" by P. Breslin, et al., September 8, 1987 Subject The topic of the resource VA Mortality Study lymphomas study criticism ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/063bb16d96e7401f4e4643efa67413a3.pdf 91410704d340733b48e2ed1c52d0fb24 PDF Text Text Item ID Number 01731 Author Fingerhut, Marilyn Corporate Author RdpOrt/ArtiClO TltlB Typescript: Comments on "Proportionate Mortality Study of Army and Marine Corp Veterans of the Vietnam War" by P. Breslin et al., Septembers, 1987 Journal/Book Title Year 000 ° Month/Day Color Number of Images D 1 Descrlpton Notes Monday, June 11, 2001 Page 1782 of 1793 �Comments on "Proportionate Mortality Study of Army and Marine Corp Veterans of the Vietnam War" by P. Breslin et_ al. Marilyn Fingerhut September 6, 1987 Use of BIRLS for a PMR study is reasonable. Structure of PMR study is reasonable: Random sample of complete file of BIRLS, with Vietnam exposure confirmed; death certificates obtained (96.9% followup), adequate size (at least for Army). PMR studies are usually used to generate, not test hypotheses. The article appropriately recommends further work to evaluate etiological factors. The media reports have not conveyed this information. The problem at hand results from the timing of the release of the article, and the inclusion of a sentence in the Abstract (inappropriately) referring to Agent Orange exposure. The structure of the study is appropriate; the scientific weakness of the article lies in the analysis and interpretation of the results. The authors can revise the article for submission to a journal. The weakness of the article results from 1) the absence of data evaluating elevations in other smoking related diseases in the Marines, 2) absence of latency evaluations for the malignancy outcomes, 3) lack of data evaluating the adequacy of the marine comparison group, and 4) inadequate evaluation of the limitations of the PMR study design. No evaluation of latency is presented for lymphoma or lung outcomes. Service was '64-'73, deaths were '65-'82. The article does not evaluate the relationship of time of exposure to time of death. No data are provided to show whether other circulatory or respiratory deaths were elevated in army and marines for conditions associated with smoking. It is unclear whether the cancer outcomes were obtained in the overall PMR, or in a separate Proportionate Cancer Mortality Ratio (PCMR). The results for deaths from external causes and accidental poisonings are consistent with other studies of veterans and point out problems for veterans following this war. The nonVietnam comparison group for the Army is large, so the numbers can be expected to be stable; the same may not be true for the marines. It would have been helpful if, 1) the authors had carefully presented data to show that the marine Vietnam vs. nonVietnam populations were truly comparable, and 2) the authors had provided a table showing the expected numbers for each cause of death if the national population had been used as the comparison. � 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. 1781 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 Fingerhut, Marilyn Title A name given to the resource Typescript: Comments on "Proportionate Mortality Study of Army and Marine Corp Veterans of the Vietnam War" by P. Breslin et al., September 6, 1987 Subject The topic of the resource VA Mortality Study BIRLS study criticism cancer risk assessment ao_seriesIII 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. 1780 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 Dan, Bruce B. Title A name given to the resource Letter: from Bruce B. Dan to Han K. Kang, July 14, 1987 Subject The topic of the resource VA Mortality Study study protocol study criticism ao_seriesIII 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. 1779 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 K. Title A name given to the resource Letter: from Han K. Kang to Bruce B. Dan, May 19, 1987 Subject The topic of the resource VA Mortality Study study protocol study criticism ao_seriesIII 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. 1778 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 K. Title A name given to the resource Letter: from Han K. Kang to Bruce B. Dan, May 14, 1987 Subject The topic of the resource VA Mortality Study study protocol study criticism ao_seriesIII 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. 1777 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 Dan, Bruce B. Title A name given to the resource Letter: from Bruce B. Dan to Han K. Kang, April 20,1987 Subject The topic of the resource VA Mortality Study study protocol study criticism 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 . 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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 https://www.nal.usda.gov/exhibits/speccoll/files/original/0b3b4e39b54c0e21e0862d51dbdd07d8.pdf dc7521f9bc623c1d1751220869506a01 PDF Text Text Item ID Number 01775 Author Burt vickiL ' Office of Environmental Epidemiology, Department of Su Roport/Artide TltlB Typescript: Non-Hodgkin's Lymphoma in the Vietnam Veterans Mortality Study, September 1986 Journal/Book Title 000 Yoar ° Month/Day Color n Number of Images 14 Dosorlpton Notes Monday, June 11, 2001 Page 1776 of 1793 �NON-HODGKIN'S LYMPHOMA IN THE VIETNAM VETERANS MORTALITY STUDY Vicki L. Burt Patricia Breslin Han Rang Yvonne Lee Michael Feil Office of Environmental Epidemiology Department of Surgery and Medicine Veterans Administration Washington, D. C. 20306-6000 September, 1986 �INTRODUCTION This paper describes the findings related to non-Hodgkin's lymphoma(NHL) in the Vietnam Veteran Mortality Study conducted by the Veterans Administration. This study was undertaken in response to concerns that elements of the veterans' experience, including herbicide exposure, may make the Vietnam veteran group more susceptible to various diseases. This proportionate mortality analysis is of deaths found in the Veterans Administration Beneficiary Identification and Records Locator Subsystem(BIRLS). This system includes all veterans whose beneficiaries receive a death benefit. This file contains a relatively complete roster of veterans' deaths. The Office of Environmental Epidemiology requested an ascertainment of mortality in the United States Vietnam era veteran population by the National Academy of Science. Results of this study showed 97.6 percent of deaths among veterns who served in Vietnam were recorded in BIRLS and 82.5 percent of the other Vietnam era veterans' deaths were shown in BIRLS. Of those not serving in Vietnam the distribtion of causes of death is not different between the 82.5 percent present and the 17.5 percent not found in BIRLS for cancer or other causes. See Appendix for distribution of causes of death. METHODS Study Population Proceeding under the assumption that the BIRLS system had the potential for yielding a reasonably complete roster of deceased Vietnam era veterans, it was necessary to devise strategies to select these deaths from among all deaths recorded in BIRLS. The selection process was done in several stages. First, it was necessary to obtain as complete a list as possible of all veterans who were likely to have served during the Vietnam era. To do this, all veterans whose service dates included the period 1964-1975 were selected. In addition, for those records where the service dates were missing, veterans whose birthdates 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 August 5, 1964 to May 7, 1975. Prior to July 1965 and after January 1973 there were relatively few troops in Vietnam. Thus, if one sampled deaths among those who served before 1965 or after January 1, 1973, there would be relatively few decedents who had �served in Vietnam. Thus the study population was limited to military personnel who were in the Armed Forces on July 4, 1965 or who entered service after that date but before March 1, 1973. Data published by the Department of Defense indicate that 81 percent 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 often is not so clear cut. It may be difficult to determine whether Navy personnel who were considered to have Vietnam service were ever actually "in country" of if Air Force personnel who were in the Vietnam theatre of operations and flew missions over Vietnam or to Vietnam were ever "in country". Hence the study population was limited even furthur to persons who served in the Army or Marine Corps between the dates given above. Since this was to be a proportional mortality study and deaths related to the operations of war could only occur in those who served in Southeast Asia and not among those who served elsewhere, deaths occuring among personnel on active duty before the end of 1973 wre excluded. The target population as defined by these criteria consisted of 186,000 veterans who died between July 4, 1965 and February 1982 when the study was initiated. In order to achieve adequate statistical power, it was determined that the study should consist of at least 50,000 eligible cases. It was assumed that some of the cases selected from the target population would not meet the criteria for the study. Therefore the sample size was increased to allow for these anticipated losses. Ultimately, 76,517 names of veterans were randomly selected from the target population. Military records were searched for all these names (Table 1). Records were found for all but 1032(1.4%) of the names selected; 52,283 of the veterans whose records were found were determined to meet the criteria of the study. That is, they had served with the Army or Marine Corps any time between July 4, 1965 and March 1, 1973. For those men who met the criteria of the study, dates, place of service, military occupation; type of discharge and other demographic data were abstracted from their military records. Cause of death information has been obtained for 51,421 (98.4%) of the 52,283 men who were determined to be eligible for the study(Table 2). The cause of death in all cases was coded by trained nosologists using the International Classification of Disease, 8th edition (ICDA-8). All data given in this report will be based on the 51,421 veterans for whom both military service data and cause of death information are available. Abstracted Information Items of information abstracted from the death certificates �were: age at last birthday, date of death, underlying cause of death, sex, state of death, race, and histology type if cause of death was cancer. From the military record the following information was obtained: date first in service, date last in service, branch, date of birth, sex, race, military occupation specialty codes(MOSC), education level, and whether served in Southeast Asia or not. For those serving in Southeast Asia additional information was collected: date first in Southeast Asia, date last in Southeast Asia, units served in, and countries served in. STATISTICAL ANALYSIS Proportionate mortality ratios, standardized for age(SPMRs) were calculated. Categories of age were: less than 20, 2024,...,60-64 and 65 and over. SPMRs for categories of cancer are presented in this paper. Vietnam era veterans that did not serve in Southeast Asia were the reference population. Of the 51,421 veterans' deaths in this study 24,736 had served in Southeast Asia, 26,685 had not(Table 3). Southeast Asia veterans that did not go to Vietnam were at most 1.8 percent. SPMRs were calculated for the following subgroups: all army, all marines, and white and nonwhite for army and marines. The Mantel-Haenszel chi-square statistic was calculated for each category to indicate whether the deviation from unity was likely to be seen by chance. A more detailed analysis of non-Hodgkin's lymphoma(NHL) for Marine Corps veterans and black Army veterans is presented. Case control analyses(Miettinen and Wang) were carried out to examine the relationship between mortality from non-Hodgkin's lymphoma and service in Southeast Asia. Controls for this analysis were all cardiovascular deaths(ICDA-8 codes: 390.0458.9). These were chosen because both in this mortality study and several others (Anderson, et al; Holmes, et al; Kogan and Clapp; and The Surgeon General, USAF) no association was found between Vietnam service and cardiovascular mortality. Also, no biologic hypothesis exists suggesting a relationship between service in Vietnam or synonymously Southeast Asia and cardiovascular mortality. All analyses were standardized by age to control for confounding by age. The disadvantages of the SPMR are well known. For example, if the overall mortality rate is different in the exposed and. non-exposed populations the SPMR will not approximate the standardized mortality ratio(SMR). That is, if the overall mortality rate is less in other Vietnam era veterans then the cause specific SPMRs will be overestimated for the Southeast Asia veterans. Also, the cause specific SPMR is dependent on the relative distribution of other causes of death. For example, if Southeast Asia veterans had a higher mortality rate for accidents than the referrent population, then the SPMR for cancer might be abnormally decreased. The case control analysis is not dependent on this second factor. Also, 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. Because of the relative homogeneity of several variables (education, type of discharge, and grade) and correlation of others, it was not felt that significant information would be gained from a multivariate analysis. RESULTS The SPMRs presented in Table 4 reveal that only those for lung cancer and non-Hodgkin's lymphoma in Marines are significantly greater that 1 using the Mantel-Haenszel chi-square statistic. The results in the following Tables refer only to NHL, detailed analysis of lung cancer deaths in the Marine Corps wil be presented in a separate paper. Nineteen of twenty-four nonwhite Southeast Asia veterans whose race was not white veterans with NHL were black Army veterans, 3 were in the Marine Corps, and 2 were Army Southeast Asia veterans with race unknown. The SPMR of 1.53 for nonwhite Southeast Asia veterans has a chisquare statistic of 2.30 and corresponding p-value of 0.14. Because the majority are black Army veterans and despite the lack of statistical significance for the nonwhite category, parallel analyses of NHL were done for the subgroup, black Army veterans, as well as for the Marine Corps. The black Marines are included in the Marine analysis. Those with unknown race were excluded from furthur analysis. The comparison group for the MORs and SMORs in Tables 5-7f are all cardiovascular deaths. Table 5 presents the age distribution of NHL deaths in these two subgroups. In Table 6 age specific MORs are presented. Marines age 30 through 39 at death have a mortality odds ratio of 5.07 and lower 95% level of 1.49. An overall SMOR, 2.05, standardized for age is presented in Table 7a. The lower 95 percent confidence level is 1.81. Tables 7b-7g present SMORs for various categories of data collected for these individuals. Grade in service, education level and type of discharge are not presented because of lack of variation of these variables. Ninety-seven percent of the individuals of Table 5 were enlisted personnel, 96 percent were honorable discharges, and more that three quarters had a high school education with other education levels sparsely distributed. Because the values for the categories in Tables 7d and 7e are only present for Southeast Asia veterans all other Vietnam era veterans served as the comparison group for each category. In Tables 7b, 7c, and 7f all veterans have recorded data for the categories therefore the comparison group is all other Vietnam era veterans for that specific category. In Table 7g each ICDA-8 code was compared to all cardiovascular deaths. Military Occupation Specialty Codes(MOSCs) were categorized as combat troops, direct support of combat troops, and indirect �MOSCs(Table Ic) had the highest SMOR for military occupations at 6.23. A description of the categories of MOSC appear in the Appendix. Our data base included the dates a veteran first and last served in Southeast Asia. If the difference between these two dates was greater than 13 months there is a significant likelihood this veteran went to Southeast Asia more that once, therefore this analysis is presented as a potential proxy for more than one tour in Southeast Asia. Table 7e presents SMORs by the first year the veteran was in Southeast Asia. Because of the different volumes and contamination of herbicides used during the Vietnam conflict, veterans deaths were categorized by year of first Southeast Asia service. The overwhelming majority of herbicides were applied in 1967 through 1969. Southeast Asia veterans first going to Southeast Asia these years had the highest SMORs. Table 7f is a categorizaion of the interval between first going in the military and final discharge. Some veterans may have had 2 or more non-contiguous enlistments. Because this is relatively rare the greater than 4 years category may represent veterans that made the military a "career1. These individuals serving more that 4 years did not have an increased SMOR. Table 7g presents SMORs by ICDA-8 coding. The Marine Corps SMOR for ICDA-8 code 200 is elevated. This code includes reticulum-cell sarcoma and lymphosarcoma. In contrast, black Army veterans have a SMOR of 3.82 for ICDA-8 code 202(giant follicular lymphoma, mycosis fungoides, and other lymphomas). DISCUSSION Numerous studies have, revealed an association between herbicide use and NHL. A recent population based case control study(Hoar, et al) presented an odds ratio of 2.2(CI 1.2-4.1) for farmers ever using phenoxyacetic acids. A matched case control study(Hardell, et al) of malignant lymphomas(Hodgkin's disease and NHL) showed a calculated relative risk of 4.8 for exposure to phenoxy acids. In that study persons with concommittant high-grade exposure to chlorophenols were excluded. Because Agent Orange and other herbicides used in Vietnam contain phenoxyacetic acids, it is essential to attempt to associate a level of exposure to one or more of these agents to a particular individual. Future efforts of the Office of Environmental Epidemiology include associating location of a Southeast Asia veteran's unit with known spraying missions. Also, an additional sample of veterans' deaths from 1982-1984 is being prepared. From this furthur data we hope to see if disproportionate deaths from NHL continues to occur among veterans with Southeast Asia exposure. �BIBLIOGRAPHY Anderson, Henry A., et al. Wisconsin Vietnam Veteran Mortality Study. March, 1986. Decoufle, Pierre, Thomas, Terry L. an Pickle, Linda W. "Comparison of the Proportionate Mortality Ratio and Standardized Mortality Ratio Risk Measures." American Journal of Epidemiology 111: 263-69, 1980. Directorate for Information, Operations and Reports. Department of Defense Selected Manpower Statistics Fiscal Year 1981. Hardell, L., et al. "Malignant Lymphoma and Exposure to Chemicals Especialy Organic Solvents, Chlorophenols and Phenoxy Acids: A Case-Control Study". British Journal of Cancer 43: 169-76. 1981. Hoar, S. K., et al. "Agricultural Herbicide Use and Risk of Lymphoma and Soft-Tissue Sarcoma". Journal of the American Medical Association 256: 1141-47. September 5, 1986. Holmes, Alan P., et al. West Virginia Vietnam-Era Veterans Mortality S tudy. January, 1986. Kogan, Michael D. and Clapp, Richard W. Mortality Among Vietnam Veterans in Massachusetts. 1972-1983. January 25, 1985. Kupper, L. L., et al. "On the Utility of Proportional Mortality Analysis." Journal of Chronic Disease 31: 15-22, 1978. Lawrence, Charles E. et al. "Mortality Patterns Among Vietnam and Vietnam Era Veterans." American Journal of Public Health 75: 277-79, 1985. Milham, Jr., Samuel. "Methods of Occupational Mortality Studies." Journal of Occupational Medicine 17: 581-85. Miettinen, O. S. and Wang, J. "An Alternative to the Proportionate Mortality Ratio". Amerian Journal of Epidemiology 114: 144-48. 1981. National Academy of Sciences, National Research Council, Commission on Life Sciences, Medical Follow-up Agency. Ascertainment of Mortality in the U. S. Vietnam Veteran Population. 1985. Public Health Service. Eighth International Classification of Diseases Adapted to the United States. Spiegelman, D., Wang, J., and Wegman, D. "Epidemiologic Programs for Computers and Calculators". American Journal of Epidemiology 118: 599-607. 1983. The Surgeon General, United States Air Force. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. June 30, 1983. APPENDIX 1. The following is a description of the Military Occupation Service Codes. The exact codes used are identical to those used in the Wisconsin Vietnam Veteran Mortality Study (Anderson,et al). �Combat. Occupations with primary duty involving direct offensive and defensive actions against an armed hostile enemy force. For example: rifleman, assaultman, field artillary batteryman, or mortar man. Direct. Occupations with combat troops that may involve indirect contact with an armed electrical systems technician, field radio operator. primary duty involving support of limited direct and/or extensive hostile force. For example: bulk fuel specialist, wireman or Indirect. Occupations with primary duty involving indirect support of combat and/or direct support troops that does not involve contact with an armed hostile force. For example: cook, aircraft ballistics computer technician, radar repairman, and clerk. 2. The following are ICDA-8 codes associated with the categorization of cancer mortality in Table 4. Category Other causes Buccal Esophagus Stomach Intestines, etc. Liver, biliary Pancreas Upper resp. Lung Bone Soft tissue Melanoma Prostate Testis Bladder Kidney Brain Other nervous system Thyroid and endocrine Non-Hodgkin's lymphoma Hodgkin's Multiple Myeloma Leukemia Other cancer ICDA-8 Code 0-136,210-228,240-989 140-149 150 151 152-154,158,159 155-156 157 160-161 162 170 171 172 185 186 188 189 191 192 193-194 200,202 201 203 204-207 163,173-174,187,190,195199,208-209,230-239 �3* The following is the distribution of caus,es of death from the National Academy of Sciences Ascertainment of Mortality in the U. S. Vietnam Veteran Population for all veterans not • going to Vietnam. Forty-five percent of these veterans were Vietnam era veterans. The 'other1 category includes cardiovascular disease. Cause Cancer Other Motor Vehicle Suicide Homocide Other Trauma Unknown Total Found in BIRLS No.(%) 97(9.7) 231(23.0) Not Found in Birls No.(%) 237(23.6) 163(16.2) 123(12.2) 42(4.2) 112(11.1) 23(9.6) 58(24.2) 52(21.7) 25(10.4) 38(15.8) 13(5.4) 31(12.9) 1005(100.0) 240(100.0) �TABLE 1: The Study Sample—Military Records Search. Number Percent 75617 100.0% 1032 1.4% Records found, ineligible 22302 29.5% Records found, eligible 52283 69.1% All names selected Records not found Ineligibility was based on: a. wrong branch of service, b. wrong time of service Table 2: Results of Death Certificate Search. Number 52283 Coded cause of death Table 3; 1.6% 51421 No cause of death 100.0% 862 Eligible cases Percent 98.4% Distribution of Eligible Deaths by Branch of Service, Race, and Place of Service. Army Marines Other Service Southeast Asia 15734 1 Nonwhite 4399 18215 3943 3120 4689 760 661 20133 22904 4603 3781 Southeast Asia White 1 Nonwhite includes unknown race. Other Service �Table 4; Standardized Proportionate Mortality Ratios (SPMRs) by Branch of Service and Race. 1 2 SPMR Army Marines Other causes Buccal Esophagus Stomach Intestines, etc. Liver, biliary Pancreas Upper resp. Lung Bone Soft tissue Melanoma Prostate Testis Bladder Kidney Brain Other nervous Thyroid, endo. Non-Hodgkin ' s Hodgkin ' s Multiple Myeloma Leukemia Other cancer 1.00 0.92 1.29 1.13 0.97 0.98 2.21 0.39 0.81 1.25 1.20 1.62 0.18 1.57* 1.35 0.70 0.93 1.29 1.26 2.39 0.95 1.05 0.92 0.56 2.08* 1.37 0.45 1.12 1.06 1.01 0.88 1.19 1.03 0.86 1.03 1.04 0.89 1.11 0.61 0.89 0.96 0.55* 0.58 0.82 1.15 0.80 0.88 1.03 White Nonwhite 1.00 1.09 0.90 0.99 1.05 1.28 0.98 0.99 1.09 1.03 0.93 0.99 0.68 1.20 0.90 0.83 0.99 0.62* 0.58 0.89 1.22 0.68 0.89 1.00 * p-value for Mantel-Haenszel chi-square 1 degree of freedom < .05. 1 See Appendix from respective ICDA-8 codes. 2 Nonwhite includes unknown race. 0.99 0.85 1.72 1.33 0.82 0.69 0.82 1.13 1.11 0.59 1.06 3.33 3.16 0.60 0.28 1.56 0.85 0.43 0.57 1.53 1.01 1.21 1.14 1.23 �Table 5; Age Distribution of Non-Hodgkin's Lymphoma. Black Army Marines SE Asia Service Non SE Asia Service SE Asia Service Non SE Asia Service 20-29 7 4 4 3 30-39 23 3 13 4 40-49 2 2 2 1 50-59 2 1 0- 1 60+ 1 0 0 0 35 10 19 10 Total 1 Table 6: Age Specific Mortality Odds Ratios for Non-Hodgkin's Lymphoma. Marines Black Army MOR(LCI,UCI) MOR(LCI,UCI) 20-29 2.17(0.60,7.75) 3.15(0.67,14.8) * 30-39 5.07(1.49,17.2) 2.86(0.92,8.86) 40-49 0.28(0.04,2.02) 0.53(0.07,3.85) 50-59 0.95(0.08,10.7) 60+ 1.58(0.05,48.8) ** * p-value for Mantel-Haenszel chi square < .01. ** number of exposed cases is one. 1 Cardiovascular deaths are the control population. �1 Table 7a; Overall Standardized Mortality Odds Ratio for Non-Hodgkin's Lymphoma. Marines SMOR(LCI,UCI) 2.05(1.81,2.30) Black Army SMOR(LCI,UCI) 1.78(0.93,3.42) 1 Cardiovascular deaths are the control population. Table 7b; 1 Standardized Mortality Odds Ratio for Non-Hodgkin's Lymphoma by Year of Death. Marines SMOR(LCI,UCI) Black Army SMOR(LCI,UCI) 1965-76 2.70(0.80,9.19) 0.58(0.00,280.) 1977-79 1.79(0.51,6.21) 1.79(0.64,5.06) 1980-82 2.57(0.94,7.06) 2.90(0.76,11.0) 1 Cardiovascular deaths are the control population. Table 7c; 1 Standardized Mortality Odds Ratio for Non-Hodgkin's Lymphoma by Military Occupation Specialty Code(MOSC). Marines SMOR(LCI,UCI) Combat Black Army SMOR(LCI,UCI) Direct 6.23(1.28,30.2) 2 0.72( , ) 2.20(0.58,8.38) 1.35(0.58,3.15) Indirect 2.31(0.39,13.9) 1.95(0.57,6.73) 1 Cardiovascular deaths are the control population. 2 Confidence interval not calculated. �Table 7d: Standardized Mortality Odds Ratio for Non-Hodgkin's Lymphoma by Potential Tours of Service in Southeast Asia. Marines SMOR(LCI,UCI) Black Army SMOR(LCI,UCI) LE 13 MO 2.39(1.26,4.53) 1.73(0.79,3.80) GT 13 MO 1.23(0.78,1.93) 1.92(0.91,4.05) 1 Cardiovascular deaths are the control population, Table 7e: Standardized Mortality Odds Ratio for Non-Hodgkin's Lymphoma by First Year in Southeast Asia. Marines SMOR(LCI,UCI) Black Army SMOR(LCI,UCI) 1965-66 1.76(1.02,3.03) 1.89(0.72,4.95) 1967-69 2.51(1.22,5.21) 1.96(0.94,4.10) 1970+ 1.68(0.39,7.18) 0.73(0.11,4.81) * Number of exposed cases is one. 1 Cardiovascular deaths are the control population. Table 7f: Standardized Mortality Odds Ratio for Non-Hodgkin's Lymphoma by Potential Years in Military Service. Marines SMOR(LCI,UCI) Black Army SMOR(LCI,UCI) LE 4 YRS 3.61(1.49,8.73) 2.93(1.29,6.66) GT 4 YRS 0.85(- 0.55(0.12,2.57) 1 Cardiovascular deaths are the control population. 2 Confidence interval not calculated. �1 Table 7q; Standardized Mortality Odds Ratio for Non-Hodgkin's Lymphoma by ICDA-8 Code. Marines SMOR(LCI,UCI) Black Army SMOR(LCI,UCI) Code=200 2.33(1.12,4.85) 1.12(0.65,1.92) Code=202 1.85(0.82,4.18) 3.82(1.15,12.7) 1 Cardiovascular deaths are the control population, � 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. 1775 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 Burt, Vicki L. Patricia Breslin Han Kang Yvonne Lee Michael Feil Description An account of the resource <strong>Corporate Author: </strong>Office of Environmental Epidemiology, Department of Surgery and Medicine, VA Title A name given to the resource Typescript: Non-Hodgkin's Lymphoma in the Vietnam Veterans Mortality Study, September 1986 Subject The topic of the resource VA Mortality Study lymphomas cancer risk assessment mortality trends ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/db08da78cd51027626714d9c0366e5d8.pdf 526bee336bb2ceaf796a1d07fa663656 PDF Text Text Item ID Number 01734 Author Young, Alvin L. Corporate Author RopOrt/ArtiClB TltlU Memorandum: Veterans Administration Agent Orange Briefing, from Alvin L. Young to Bernadine Bulkley, October 23, 1984 Journal/Book Title Year 000 ° Month/Day Color D Number of Imagos 6 Dascripton Notes Monday, June 11, 2001 Page 1735 of 1793 �EXECUTIVE OFFICE OF THE PRESIDENT OFFICE OF SCIENCE AND TECHNOLOGY POLICY WASHINGTON, D.C. 20506 October 23, 1984 MEMORANDUM FOR BERN.ADINE BULKLEY FROM: AL YOUNG SUBJECT: Veterans Administration Agent Orange Briefing A briefing has been set for October 23, 1984 at 2:30 p.m. on the Agent Orange and Vietnam Experience Health Studies currently being conducted by the Veterans Administration. John A. Gronvall, M.D., Acting Chief Medical Director, and Barclay M. Shepard, M.D., Director, Agent Orange Projects Office, will present the briefing. You should be aware of the extensive research program that has been initiated by the Veterans Administration. Three investigations are retrospective epidemiologic studies; namely, the VA Mortality Study (a study of 75,000 deaths), the VA/AFIP (Armed Forces Institute of Pathology) Soft Tissue Sarcoma Study (a study of 400 cases and 800 controls), and the VA/EPA Adipose Tissue Study (a study of the dioxin content of 500 human fat samples). In addition, the VA has health surveillance programs consisting of the Agent Orange Registry and the Patient Treatment File. I have attached a review of the VA studies. The VA has had difficulty conducting morbidity Studies of Vietnam Veterans. Congress mandated the VA to conduct an epidemiologic study of ground troops exposed to Agent Orange. After more than two years of preparation and protocol development, select members of Congress requested that the Administration transfer the conduct of the study from the VA to the Centers for Disease Control. Although the VA has an extensive program, Veterans have the perception that the Agency has minimal involvement and that the CDC is responsible for the conduct of credible human health studies, It is for that reason that the VA Vietnam Experience Twin Study is so important. This study has been widely advertized by the VA, the twin Registry has been established with the National Academy of Sciences Medical Follow-Up Agency, and the protocol has passed two extensive and comprehensive reviews. As I discussed with you, this study appears to be in peril of cancellation. Its cost is estimated at $9 million. I believe some internal politics are behind this effort, rather than good science. Dr. Gronwall should give us an update. I believe the Administration, and especialy the VA will loose credibility with the Vietnam Veteran if this study is cancelled at this late date. �DEPARTMENT OP MEDICINE AND SURGERY AGENT ORANGE PROJECTS OFFICE (10A7) STATUS REPORT OF AGENT ORANGE RESEARCH ACTIVITIES 1. Vietnam Veterans Mortality Study The Vietnam Veterans Mortality Study is designed to assess mortality patterns of U.S. servicemen in the Army or Marines who served during a portion of the Vietnam era. A sample of 75,000 veteran deaths has been selected from the VA files. For each of the deaths, military service and cause of death information are being collected and coded. The two types of data will be merged and analyzed to compare the mortality experience of veterans who served in Vietnam with veterans of the same era who did not serve in Vietnam. Various analytical approaches are being studied including classical proportionate mortality ratio (PMR) analyses as well as categorical data analyses. As of August 1984 the military records search and abstracting have been conmpleted for 95% of total cohort of 75,000. Ninety five percent of the expected 72,000 death records have been received, ftwever, about 15% of the records received did not include the cause of death information. Extensive tracing efforts have been made using both internal records and records maintained by other government agencies. Data collection will be completed by the end of 1984 and the final report is expected in June 1985. 2. VA/AFIP Soft Tissue Sarcoma Study (STSS) The possibility that exposure to phenoxy herbicides may induce rare forms of cancer in humans such as soft tissue sarcoma (STS) has been suggested from recent studies in Sweden. Subsequently, there is much concern in the United States that many veterans who served in Vietnam might have had a significant exposure to the phenoxy herbicides including Agent Orange and, therefore, might be at increased risk of developing STS. In view of the concern raised by many veterans and conflicting findings in the scientific literature, the VA, in collaboration with the Armed Forces Institute of Pathology (AFIP), is conducting an independent epidemiologic study to determine the relationship of Vietnam service, probable Agent Orange exposure and other factors to the risk of developing STS. �2. VA/AFIP Soft Tissue Sarcoma Study (STSS) - Continued The study is conducted in two phases. Phase I of the study will investigate whether service in Vietnam during 1965-1971 increased the risk of developing STS. Providing that the Environmental Support Group of Department of the Army can develop a rough but acceptable exposure ranking scheme based on military records, an attempt will be made to determine a trend in the odds of developing STS with increasing probability of exposure to Agent Orange. In addition, the histopathology and anatomic site of STS will be compared among Vietnam veterans, non-Vietnam veterans and non-veterans. Military service status of cases and controls will be determined through cross-checking the VA BIRLS (Beneficial Identification and Records Location System) file, the National Personnel Records Center files and the military personnel records center files of each branch of service. Phase II of the study will investigate other host and environmental risk factors for the dvelopment of STS based on information obtained from telephone interviews with the subjects or their next-6f-kin. Information on risk factors such as occupational and non-occupational exposure to phenoxy herbicides, ionizing radiation, asbestos, arsenic, vinyl chloride, genetic syndromes, and immunologic deficiency will be obtained from the interviews and analyzed individually and jointly with respect to the risk of developing STS. The study protocol has been reviewed by scientific groups {AOW3, Science Panel; VA Advisory Committee on Health-Related Effects of Herbicides; Armed Forces Epidemiological Board) and the study subject selection process has begun. As of August 1984, a total of 180 hospitals have selected three controls per STS case and sent in requisite patient information. The RFP for tracing and conducting interviews for the study subjects was approved by the Administrator on May 2, 1984, and announced in the Commerce Business Daily beginning in late May. Evaluation of both technical and business proposals were completed in September and the contract is expected to be awarded in October 1984. The Office of Management and Budget is still reviewing our request for questionnaire approval. Data collection will "be completed by December 1985 and the final report is expected in June 1986. �3. Retrospective Study of Dioxins and Fucans in Adipose Tissue Since 1970, the Environmental Protection Agency (EPA) has been collecting human adipose tissue from the general population to be analyzed for residues of selected pesticide-related chemicals and ploychlorinated biphenyls (PCBs). Within the bank of approximately 8,000 tissue specimens available for further chemical analysis there are specimens from 524 males born between 1937 and 1952. Many of these individuals will have served in the military during the Vietnam era and some will have served in Vietnam during the period of Agent Orange use. A retrospective study of selected chlorinated dioxins and furans will provide data on background levels of 2,3,7,8-TCDD in the U.S. male population and will determine if service in Vietnam has had an effect on the levels of TCDD in adipose. The study will be conducted in three phases. In phase I the names and social security numbers of the approximately 524 males noted above will be obtained to determine military service status. Phase II will be the development of analytic methods for the determination of selected rigorous interlaboratory validation by an independent analytic referee, e.g., the Association of Official Analytical Chemists. Phase III will be the analysis of the adipose tissue and the presentation of a final report. A draft study protocol is being prepared for the AOWG Science Panel review. Once the panel completes its review and necessary resources are secured, the study will take approximately two years to complete. 4. A Review of the Soft Tissue Sarcoma Cases in Patient Treatment File (PTF) for Vietnam Era Veterans In a parallel effort to the VA/AFIP Soft Tissue Sarcoma Study, the VA's Agent Orange Projects Office (AOPO), in collaboration with VA's Pathology Service and AFIP, is reviewing the soft tissue sarcoma cases in the VA's Patient Treatment File (FY 69-83) for Vietnam era veterans. We are comparing anatomic site, histopathology and frequency of soft tissue sacoma between Vietnam veterans and non-Vietnam veterans. A total of 418 patients with International Classification of Diseases (ICD) 171 (malignant neoplasm of connective and other soft tissue) were identified in the PTF between 1969 and 1982. A review of the pathology reports for these cases was made by an "independent" VA pathologist. Military service information for these cases (Vietnam vs. non-Vietnam) was obtained through the National Personnel Records Center in St. Eouis. It was found that 36% of the STS cases served in Vietnam whereas in the overall PTF, 41% of the Vietnam era patients served in Vietnam. This �4. A Review of the Soft Tissue Sarcoma^Casesin Patient Treatment File (PTF) for Vietnam Era Veterans - Continued suggests that for Vietnam era veterans treated in the VA Medical Centers the frequency of the STS among veterans who served in Vietnam is not greater than those who did not serve in Vietnam. As Phase II of this review, we plan to have the tissue specimens for these cases actually examined by an outside expert pathologist to confirm the original diagnosis. We are in process of selecting an outside expert pathologist and receiving the specimens from the VA medical centers. The final report is expected in May 1985. 5. Other Projects a. Agent Orange Register Review - The Agent Orange Register is a computerized information retrieval system that abstracts both medical and non-medical information from the Agent Orange Registry. The medical information includes syirptoms attributed by the veteran to exposure to Agent Orange and pertinent diagnosis made by VA physicians. The non-medical information includes veterans' demographic data, veterans' self-reported information on their military service and their recollection of exposure to Agent Orange. There are some differences in format between the "old" code sheet and the "new" code sheet, but in general both code sheets cover similar areas. Because of the self-selective nature of the Registry participants, this group of veterans cannot, with any scientific validity be viewed as being representational of Vietnam veterans as a whole. The information in the Registry can, however, be used to detect suggested health trends and provide some descriptors as to the characteristics of the group itself. The Agent Orange Register of 86,000 Vietnam veterans was reviewed and results were reported to the VA Advisory Committee on Health-Related Effects of Herbicides in September, 1983. The monitoring of the Agent Orange Register is continuing. �b. Pat lent Treatment File JPTE1') Review - The VA also continues to review health problems of Vietnam veterans treated in its hospitals. Questions have been asked many tiroes by Congress and others whether Vietnam veterans oome to the VA hospitals with different or unique health problems as compared to their counterparts who did not serve in Vietnam. An-initial review of a sample of 13,000 Vietnam era veterans (EY 69-82) and another review of a random sample of 1,000 veterans' (FY 83) military records and PTF medical data reveal no significant difference in the distribution of diagnoses between Vietnam veterans and non-Vietnam veterans treated in VA hospitals. These findings were also reported to the VA Advisory Committee on June 5, 1984. This effort of monitoring health problems of Vietnam veterans hospitalized in the VA medical facilities will continue. c. PTF/Cancer Study - In collaboration with the AFIP, the VA plans to conduct a pathological evaluation of malignant neoplasms among Vietnam era veterans treated in the VA medical facilities. There are several published reports which suggest that exposure to phenoxy herbicides may contribute to a higher risk of developing soft tissue sarcoma, lymphoma, nasal cancer, and possibly liver cancer. In general, it takes over a decade for cancer to manifest itself if it is caused by environmental chemicals. It has been more than a decade since the last U.S. troops were exposed to defoliants in Vietnam and about 20 years since the first massive spraying of Agent Orange there. Therefore, the time is about right for evaluating cancer problems in Vietnam veterans. About 5,000 cancer cases among Vietnam era veterans treated in the VA medical facilities in the last 3 years will be selected for this study. The AFIP will make a pathological diagnosis without knowing Vietnam service status of cases and the Army Environmental Support Group will determine military service status and Agent Orange exposure likelihood for each case without knowing the pathological diagnosis. The VA's Agent Orange Projects Office will coordinate this effort and perform data analyses once all the information is collected. This study will serve as a built-in quality control program for the VA's Pathology Service by systematically comparing diagnosis made by the VA pathologist with that of the AFIP experts. d. The In-depth Review of Suicide Among Vietnam Veterans - In addition to the above en-going research efforts, the VA's AOPO is actively cooperating with the Readjustment Counseling Service in designing an in-depth review of the cases listed as suicide or possible suicide in the mortality study being conducted. This will enable the VA to determine whether the frequency of suicide among Vietnam veterans is higher than among non-Vietnam veterans and also will help to develop a clinical profile of Vietnam veteran suicides which may assist in preventing suicides in the years to come. � 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. 064 Folder The folder containing the original item. 1734 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 Young, Alvin L. Title A name given to the resource Memorandum: Veterans Administration Agent Orange Briefing, from Alvin L. Young to Bernadine Bulkley, October 23, 1984 Subject The topic of the resource Vietnam Experience Study VA Mortality Study VA/AFIP STSS Agent Orange Registry ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/28a87752e7dea2c38f0c97bee0045161.pdf bf51b580aefbcf6ce6c4d73eb3d04568 PDF Text Text Item ID Number 01437 Author Corporate Author RODOrt/ArtlClB TltlO Typescript: Updates on various Vietnam Veteran Health Studies, March 11, 1987 Journal/Book Title Year Month/Day Color n Number of Images 3 Desorlpton Notes Tuesday, May 15, 2001 Page 1437 of 1514 �Vietnam Veterans Mortality Study: The study was designed to assess mortality patterns ot U.S. servicemen in the Army or Marines who served during a portion of the Vietumn era (1965-1975). A sample of 75,000 veteran deaths was selected from the VA files. For each of the veteran deaths, military service and cause of death information were collected and coded. The two types of data were merged and analysed to compare the mortality experience of veterans who served in Vietnam with veterans of the same era who did not serve in Vietnam. This study began in December 1982 and the final report was completed in December 1986. Updato of the Vietnam Veterans Mortality Study: The Vietnam Veterans Mortality Study (WMS) will provid© the initial data on the mortality patterns of veterans who served in Vietnam and those who served elsewhere. However some of the diseases that were suggested as being associated with Agent Orange exposure or Vietnam service may take a long time to develop. For example, it takss about 20 years for certain cancers to manifest themselves if they are caused by environmental chemicals such as Agent Orange. We plan to periodically update the mortality data and monitor Vietnam veteran® mortality patterns. Retrospective Study of Dioxins and Furans in Adipose Tissue: The VA, in cooperation with the Environmental Protection Agency (EPA), i« performing a very detailed analysis of tissue specimens from approximately 200 males of th© Vietnam era ag© group. Th© specimens are analyzed for 2,3,7,8-TCDD and several other related dioxins and furans to determine if service in the military, especially service in Vietnam has resulted in increased levels of these compounds as compared to non-Vietnam veterans or civilians of the same age group. The final report for this study, which began in October 1983 is targeted for December 1987. Prospective Study of Dioxins and Furans in Adipose Tissue: A recent study estimated the half-life of dioxin in adipose tissue to bo 5-3 years. Therefore, among Army Vietnam veterans,dioxin in adipose tissue may still reflect exposure to Agent Orange during the Vietnam war. Prospective collection of adipose tissue specimens based on prescribed protocol will afford bettor control of factors that may influence the final outcome than retrospective specimen collection. This study will strengthen the retrospective study results and help to clarify the relationship between dioxin levels in the body and the risk of developing medical problems. �Soft Tisaue Sarcoma Study: In vic>w of the concerns raised by many veterans and conflicting findings in tha scientific literature, an independent epidsroiologic study was undertaken to determine r.he relationship of Vietnam service, probable Agent Orange exposure and other factors to the risk of developing STS. Thia study began in March 1983 and the final report was completed in December 1986. Cohort Mortality Study of Marine Vietnam Veterans; The CDC Epidemiology Study of Vietnam veterans includes only Army veterans in the study. The VVMS results suggest a possible difference in mortality patterns between Army veterans and Marine veterans. This proposed study will determine the overall mortality rate as well as cause specific mortality rats® of Marine* veterans who served in Vietnam and those who served elsewhere. This study is designed to complement the CDC study. Women Vietnam Veterans Mortality Study: None of the studies that were already completed or on-going is specifically designed to study women Vietnam veterans. This cohort study will assess mortality experience of women veterans who served in Vietnam compared to thosa women veteran© who served eluewhere during tha Vietnam war. Women Vietnam Vet«rana Health Study: Public kaw 99-272 mandates the* conduct of an epidamiologic study of any long-term adverse health effects {particularly gender-specific health effects) which have been experienced by women who served in the Armed Forces of the U.S. in the Republic of Vietnam during the Vietnam ara. These include health affects which may have resulted from traumatic experiences during Vietnam service, or from exposure to phenoxy herbicides (including Agent Orange), othesr herbicides, chemicals, medications, environmental hazards, or from any other experience or exposure during such service. This study will assist in determining appropriate treatment of condition®, if any, possibly related to that experience. The contract, for protocol development waa awarded to the New England Research Institute in October 1986, with anticipated completion of protocol development in July 1987. The target date for awarding a contract for the conduct of tha study is December 1987. Case Control Study of Non-Hodgkin's Lymphoma: Several epidemiologic studies suggested that individuals exposed to phonoxyherbici'Ses had a substantial increase in risk of non-Hodgkin'a lymphoma (NHL). A case control study is planned to investigate the possible association between NHL and Vietnam service, Agent Orange exposure or other possible environmental risk factors. �Health Surveillance of Vietnam Era Veterans: The existing VA records, such as the Pstiont Treatment File (FTP) and Agent Grange Registry, will be monitored periodically to duterrain® whether there are any unusual pattern© or trends that way indicate a need for an in-d«pth review. � 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. 054 Folder The folder containing the original item. 1437 Series The series number of the original item. Series III Subseries II 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 Typescript: Updates on various Vietnam Veteran Health Studies, March 11, 1987 Subject The topic of the resource veteran health and hygiene VA Mortality Study Women Vietnam Veterans Health Study VA/EPA TCDD Assay ao_seriesIII