Kang Han K, Dalager Nancy A, Needham Larry L, Patterson Donald G, Lees Peter S J, Yates Katherine, Matanoski Genevieve M
Veterans Health Administration, Department of Veterans Affairs, Washington, District of Columbia 20420, USA.
Am J Ind Med. 2006 Nov;49(11):875-84. doi: 10.1002/ajim.20385.
U.S. Army Chemical Corps veterans handled and sprayed herbicides in Vietnam resulting in exposure to Agent Orange and its contaminant 2,3,7, 8-tetrachlorodibenzo-p-dioxin (TCDD or dioxin). This study examined the long-term health effects associated with herbicide exposure among these Vietnam veterans.
A health survey of these 1,499 Vietnam veterans and a group of 1,428 non-Vietnam veterans assigned to chemical operations jobs was conducted using a computer-assisted telephone interview (CATI) system. Exposure to herbicides was assessed by analyzing serum specimens from a sample of 897 veterans for dioxin. Logistic regression analyses were used to estimate the risk of selected medical outcomes associated with herbicide exposure.
Odds ratios for diabetes, heart disease, hypertension, and chronic respiratory disease were elevated, but not significantly (P>0.05) for those who served in Vietnam. However, they were significantly elevated among those Vietnam veterans who sprayed herbicides: diabetes, odds ratio (OR)=1.50 (95% confidence interval [95%CI]=1.15-1.95); heart disease, OR=1.52 (1.18-1.94); hypertension, OR=1.32 (1.08-1.61); and chronic respiratory condition, OR=1.62 (1.28-2.05). Hepatitis was associated with Vietnam service, but not with herbicide application.
Vietnam veterans who were occupationally exposed to herbicide experienced a higher risk of several chronic medical conditions relative to other non-Vietnam veterans. A potential selection bias is of concern. However, there were relatively high participation rates in both the Vietnam and non-Vietnam veteran groups, and the prevalence rates of some of these medical conditions among non-Vietnam veterans were comparable to general populations. Therefore, self-selection factors are considered unlikely to have biased the study results.
美国陆军化学兵部队的退伍军人在越南接触并喷洒了除草剂，导致接触橙剂及其污染物2,3,7,8-四氯二苯并对二恶英（TCDD或二恶英）。本研究调查了这些越南退伍军人中除草剂接触相关的长期健康影响。
使用计算机辅助电话访谈（CATI）系统对这1499名越南退伍军人和1428名被分配到化学作业岗位的非越南退伍军人进行了健康调查。通过分析897名退伍军人样本的血清标本中的二恶英来评估除草剂接触情况。采用逻辑回归分析来估计与除草剂接触相关的特定医疗结局的风险。
越南服役人员患糖尿病、心脏病、高血压和慢性呼吸道疾病的比值比有所升高，但无统计学意义（P>0.05）。然而，在那些喷洒过除草剂的越南退伍军人中，这些疾病的比值比显著升高：糖尿病，比值比（OR）=1.50（95%置信区间[95%CI]=1.15-1.95）；心脏病，OR=1.52（1.18-1.94）；高血压，OR=1.32（1.08-1.61）；慢性呼吸道疾病，OR=1.62（1.28-2.05）。肝炎与在越南服役有关，但与使用除草剂无关。
职业接触除草剂的越南退伍军人相对于其他非越南退伍军人患几种慢性疾病的风险更高。存在潜在的选择偏倚问题。然而，越南和非越南退伍军人组的参与率相对较高，并且这些疾病在非越南退伍军人中的患病率与一般人群相当。因此，自我选择因素不太可能使研究结果产生偏差。
