Sagiraju Hari Krishna Raju, Živković Sasa, VanCott Anne C, Patwa Huned, Gimeno Ruiz de Porras David, Amuan Megan E, Pugh Mary Jo V
Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, 500 Foothill Drive Bldg. 182, Salt Lake City, UT 84148.
Division of Epidemiology, University of Utah, 383 Colorow Dr, Suite203, Salt Lake City, UT 84108.
Mil Med. 2020 Mar 2;185(3-4):e501-e509. doi: 10.1093/milmed/usz350.
Amyotrophic lateral sclerosis (ALS) is a recognized military service-connected condition. Prior prevalence studies of ALS among U.S. war Veterans were not able to address concerns related to neurodegenerative sequelae of traumatic brain injury (TBI) and disregarded risk heterogeneity from occupational categories within service branches.
We identified the prevalence of definite and possible ALS and cumulative incidence of definite ALS among Post-9/11 U.S. Veterans deployed in support of Post-9/11 conflicts (mean age 36.3) who received care in the Veterans Health Administration during fiscal years 2002-2015. Using a case-control study design, we also evaluated the association of TBI and major military occupation groups with ALS adjusting for demographics and comorbidities.
The prevalence of ALS was 19.7 per 100,000 over 14 years. Both prevalence and cumulative incidence of definite ALS were significantly higher among Air Force personnel compared to other service branches and among tactical operation officers and health care workers compared to general and administrative officers. Neither TBI nor younger age (<45 years) was associated with ALS. Depression, cardiac disease, cerebrovascular disease, high blood pressure, and obstructive sleep apnea were clinical comorbidities significantly associated with ALS in this population of Veterans.
This study among a cohort of relatively young Veterans showed a high ALS prevalence, suggesting an early onset of ALS among deployed military service members. The higher prevalence among some military specific occupations highlights the need to determine which occupational exposures specific to these occupations (particularly, Air Force personnel, tactical operations officers, and health care workers) might be associated with early onset ALS.
肌萎缩侧索硬化症（ALS）是一种被认可的与军事服役相关的疾病。先前针对美国退伍军人中ALS的患病率研究无法解决与创伤性脑损伤（TBI）的神经退行性后遗症相关的问题，并且忽视了各军种内不同职业类别的风险异质性。
我们确定了在2002 - 2015财年期间在退伍军人健康管理局接受治疗的、为支持9·11后冲突而部署的9·11后美国退伍军人（平均年龄36.3岁）中确诊和可能的ALS患病率以及确诊ALS的累积发病率。采用病例对照研究设计，我们还评估了TBI和主要军事职业群体与ALS之间的关联，并对人口统计学和合并症进行了调整。
14年间ALS的患病率为每10万人中有19.7例。与其他军种相比，空军人员中确诊ALS的患病率和累积发病率显著更高；与普通和行政官员相比，战术行动军官和医护人员中确诊ALS的患病率和累积发病率显著更高。TBI和较年轻年龄（<45岁）均与ALS无关。在这群退伍军人中，抑郁症、心脏病、脑血管疾病、高血压和阻塞性睡眠呼吸暂停是与ALS显著相关的临床合并症。
这项针对一群相对年轻退伍军人的研究显示ALS患病率较高，表明在部署的军事人员中ALS发病较早。某些军事特定职业中较高的患病率凸显了确定这些职业（特别是空军人员、战术行动军官和医护人员）特有的哪些职业暴露可能与ALS早发相关的必要性。
