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越南职业性接触除草剂的陆军化学兵退伍军人的死亡率模式。

Mortality patterns of Army Chemical Corps veterans who were occupationally exposed to herbicides in Vietnam.

机构信息

Department of Veterans Affairs, Washington, DC 20420, USA.

出版信息

Ann Epidemiol. 2010 May;20(5):339-46. doi: 10.1016/j.annepidem.2010.02.003.

Abstract

PURPOSE

This research examined the risk of disease-related mortality of the Army Chemical Corps (ACC) veterans who handled/sprayed herbicides in Vietnam in comparison with their non-Vietnam veteran peers or U.S. men.

METHODS

Vital status was determined through December 31, 2005. All-cause mortality and cause-specific mortality were compared for individuals who served in Vietnam (n = 2872) versus those who did not (n = 2737). Similar analyses were completed on a subset of the original Vietnam cohort that consisted of individuals who either reported spraying herbicide (n = 662) or not (n = 811). The observed deaths for each of the two base cohorts were also compared with expected deaths for U.S. men.

RESULTS

Statistically significant excess mortality was found for ACC Vietnam veterans for chronic obstructive pulmonary disease (adjusted relative risk [ARR], 4.82; 95% confidence interval [95% CI], 1.10-21.18). When examining patterns for veterans in the Vietnam veteran subset, we found nonsignificant elevated ARRs among herbicide sprayers for all-cause, respiratory system disease, and respiratory system cancer mortality. Compared with U.S. men, the Vietnam veteran cohort had significant excess mortality for all-causes (standardized mortality ratio [SMR], 1.13; 95% CI, 1.04-1.23), respiratory system cancer (SMR, 1.35; 95% CI, 1.03-1.73), nonmalignant respiratory system disease (SMR, 1.58; 95% CI, 1.08-2.23), and miscellaneous malignant cancers (SMR, 1.77; 95% CI, 1.03-2.84).

CONCLUSIONS

The risk of mortality from respiratory disease (malignant or nonmalignant) was significantly greater for ACC Vietnam veterans in comparison with their non-Vietnam veteran peers and U.S. men. Herbicide exposure could be contributing to the patterns observed. Because of the unique nature of their military duties and study limitations, findings may not be generalizeable to Vietnam veterans as a whole.

摘要

目的

本研究比较了在越南接触/喷洒除草剂的陆军化学兵(ACC)退伍军人与非越南退伍军人或美国男性退伍军人的疾病相关死亡率风险。

方法

通过 2005 年 12 月 31 日确定所有参与者的生存状态。将在越南服役的退伍军人(n=2872 人)与未在越南服役的退伍军人(n=2737 人)的全因死亡率和死因死亡率进行比较。还对原始越南队列中的一个子集进行了类似的分析,该子集包括报告喷洒除草剂的个体(n=662 人)和未报告喷洒除草剂的个体(n=811 人)。还将两个基础队列的观察死亡人数与美国男性的预期死亡人数进行了比较。

结果

对于慢性阻塞性肺疾病,ACC 越南退伍军人的死亡率明显过高(调整后的相对风险[ARR],4.82;95%置信区间[95%CI],1.10-21.18)。在检查越南退伍军人子队列中退伍军人的模式时,我们发现除草剂喷洒者的全因、呼吸系统疾病和呼吸系统癌症死亡率均有升高,但无统计学意义。与美国男性相比,越南退伍军人队列的全因死亡率(标准化死亡率比[SMR],1.13;95%CI,1.04-1.23)、呼吸系统癌症(SMR,1.35;95%CI,1.03-1.73)、非恶性呼吸系统疾病(SMR,1.58;95%CI,1.08-2.23)和其他恶性癌症(SMR,1.77;95%CI,1.03-2.84)均存在显著过高。

结论

与非越南退伍军人同伴和美国男性相比,ACC 越南退伍军人的呼吸系统疾病(恶性或非恶性)死亡率风险明显更高。接触除草剂可能是导致观察到的模式的原因。由于其军事职责的独特性质和研究限制,这些发现可能不适用于整个越南退伍军人群体。

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