Weisskopf Marc G, Cudkowicz Merit E, Johnson Norman
From the aDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; bDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA; cDepartment of Neurology, Massachusetts General Hospital, Boston, MA; and dCenter for Administrative Records and Applications, US Bureau of the Census, Washington, DC.
Epidemiology. 2015 Nov;26(6):831-8. doi: 10.1097/EDE.0000000000000376.
Military service has been suggested to be associated with an increased risk of amyotrophic lateral sclerosis (ALS), but only one prospective study-of a volunteer cohort-has examined this question.
We prospectively assessed the relation between service in the military and ALS mortality among participants in the National Longitudinal Mortality Study, a population-representative cohort of U.S. men and women surveyed from 1973 through 2002. Participant follow-up was conducted from 1979 through 2002 for ALS mortality. There were 696,743 men and 392,571 women who were 25 years old or more with military service data. In this group, there were 375 male ALS deaths and 96 female ALS deaths. Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards.
Men who served in the military had an increased adjusted ALS death rate [HR: 1.23; 95% confidence interval (CI): 0.98, 1.53] compared with those who did not serve. An increase in ALS mortality was found among those who served during World War II (HR: 1.47; 95% CI: 1.13, 1.91) but not during other time periods. This pattern of results was similar for women, but with larger confidence intervals (HR for military service: 1.26; 95% CI: 0.29, 5.59; HR for service during World War II: 2.03; 95% CI: 0.45, 9.05).
Military personnel have an increased risk of ALS, which may be specific to certain service periods although there was no data on actual deployment. Because of the longer follow-up time for World War II veterans, we cannot rule out that increased risk for those who served during other periods would be seen with further follow-up.
有研究表明服兵役与肌萎缩侧索硬化症（ALS）风险增加有关，但仅有一项针对志愿者队列的前瞻性研究探讨过这一问题。
我们对国家纵向死亡率研究的参与者进行前瞻性评估，该研究是一个具有人口代表性的队列，包含1973年至2002年接受调查的美国男性和女性。对参与者的随访从1979年持续至2002年，以了解ALS死亡率情况。共有696,743名男性和392,571名女性年龄在25岁及以上且有服兵役数据。在这组人群中，有375例男性ALS死亡病例和96例女性ALS死亡病例。使用Cox比例风险模型计算调整后的风险比（HRs）。
与未服兵役者相比，服过兵役的男性调整后的ALS死亡率有所增加[HR：1.23；95%置信区间（CI）：0.98，1.53]。在第二次世界大战期间服役的人员中发现ALS死亡率有所上升（HR：1.47；95%CI：1.13，1.91），但在其他时间段则未发现。女性的结果模式相似，但置信区间更大（服兵役的HR：1.26；95%CI：0.29，5.59；第二次世界大战期间服役的HR：2.03；95%CI：0.45，9.05）。
军事人员患ALS的风险增加，这可能特定于某些服役时期，尽管没有关于实际部署的数据。由于对二战退伍军人的随访时间更长，我们不能排除随着进一步随访，其他时期服役人员的风险增加情况也会显现。
