与肌萎缩侧索硬化症病因相关的军事服役、部署及接触情况。

Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis etiology.

作者信息

Beard John D, Engel Lawrence S, Richardson David B, Gammon Marilie D, Baird Coleen, Umbach David M, Allen Kelli D, Stanwyck Catherine L, Keller Jean, Sandler Dale P, Schmidt Silke, Kamel Freya

机构信息

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

出版信息

Environ Int. 2016 May;91:104-15. doi: 10.1016/j.envint.2016.02.014. Epub 2016 Feb 23.

DOI:10.1016/j.envint.2016.02.014

PMID:26923711

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4876822/

Abstract

BACKGROUND

Factors underlying a possible excess of amyotrophic lateral sclerosis (ALS) among military veterans remain unidentified. Limitations of previous studies on this topic include reliance on ALS mortality as a surrogate for ALS incidence, low statistical power, and sparse information on military-related factors.

OBJECTIVES

We evaluated associations between military-related factors and ALS using data from a case-control study of U.S. military veterans.

METHODS

From 2005 to 2010, we identified medical record-confirmed ALS cases via the National Registry of Veterans with ALS and controls via the Veterans Benefits Administration's Beneficiary Identification and Records Locator System database. In total, we enrolled 621 cases and 958 frequency-matched controls in the Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis study. We collected information on military service and deployments and 39 related exposures. We used unconditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). We used inverse probability weighting to adjust for potential bias from confounding, missing covariate data, and selection arising from a case group that disproportionately included long-term survivors and a control group that may or may not differ from U.S. military veterans at large.

RESULTS

The odds of ALS did not differ for veterans of the Air Force, Army, Marines, and Navy. We found higher odds of ALS for veterans whose longest deployment was World War II or the Korean War and a positive trend with total years of all deployments (OR=1.27; 95% CI: 1.06, 1.52). ALS was positively associated with exposure to herbicides for military purposes, nasopharyngeal radium, personal pesticides, exhaust from heaters or generators, high-intensity radar waves, contaminated food, explosions within one mile, herbicides in the field, mixing and application of burning agents, burning agents in the field, and Agent Orange in the field, with ORs between 1.50 and 7.75.

CONCLUSIONS

Although our results need confirmation, they are potentially important given the large number of U.S. military veterans, and they provide clues to potential factors underlying the apparent increase of ALS in veteran populations.

摘要

背景

退伍军人中肌萎缩侧索硬化症（ALS）可能过多的潜在因素仍不明晰。此前关于该主题的研究存在局限性，包括依赖ALS死亡率作为ALS发病率的替代指标、统计效力低以及军事相关因素的信息匮乏。

目的

我们利用美国退伍军人病例对照研究的数据，评估军事相关因素与ALS之间的关联。

方法

2005年至2010年期间，我们通过美国退伍军人肌萎缩侧索硬化症国家登记处确定经病历证实的ALS病例，并通过退伍军人福利管理局的受益人识别和记录定位系统数据库确定对照。在“退伍军人肌萎缩侧索硬化症的基因与环境暴露”研究中，我们总共招募了621例病例和958例频率匹配的对照。我们收集了军事服役和部署以及39种相关暴露的信息。我们使用无条件逻辑回归模型来估计比值比（OR）和95%置信区间（CI）。我们使用逆概率加权来调整因混杂、协变量数据缺失以及病例组中不成比例地纳入长期幸存者和对照组可能与全体美国退伍军人存在差异所导致的选择偏倚。

结果

空军、陆军、海军陆战队和海军退伍军人患ALS的几率没有差异。我们发现，最长部署时间为第二次世界大战或朝鲜战争的退伍军人患ALS的几率更高，且与所有部署的总年数呈正相关趋势（OR = 1.27；95% CI：1.06，1.52）。ALS与军事用途除草剂暴露、鼻咽部镭暴露、个人杀虫剂暴露、加热器或发电机废气暴露、高强度雷达波暴露、受污染食物暴露、一英里内爆炸暴露、野外除草剂暴露、燃烧剂混合与施用暴露、野外燃烧剂暴露以及野外橙剂暴露呈正相关，OR在1.50至7.75之间。