Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
Minimally Invasive Surgery Research Center, Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran.
JAMA Netw Open. 2020 Dec 1;3(12):e2028894. doi: 10.1001/jamanetworkopen.2020.28894.
The prevalence and severity of long-term health complications after exposure to sulfur mustard are unknown.
To investigate the long-term health outcomes among survivors exposed to sulfur mustard during the Iran-Iraq War.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, late-onset health complications of 64 190 Iranian survivors exposed to sulfur mustard during the Iran-Iraq War from 1980 to 1988 were investigated using descriptive statistics. Data involving affected organs and symptom severity were extracted from the Veterans and Martyr Affair Foundation (VMAF) database from 1980 to 2019. Assessments were conducted across 3 groups depending on whether survivors were (1) evacuated and admitted (EA) to a hospital; (2) not evacuated or admitted (NEA) to a hospital; or (3) evacuation or admission status was not documented.
Analysis of chronic symptom severity following exposure to sulfur mustard.
Mild, moderate, or severe rankings of symptoms in lungs, eyes, and skin of survivors exposed to sulfur mustard using data from the VMAF database.
Of 64 190 chemical survivors registered in the VMAF database, 60 861 met the inclusion criteria. Of the included survivors, 98.0% were male, and the mean (SD) age was 23.5 (7.7) years. Most survivors (53 675 [88.2%]) had no symptoms or mild lesions, and 7186 survivors (11.8%) had moderate or severe complications. Moderate to severe lung (6540 [10.7%]), eye (335 [0.6%]), or skin (725 [1.2%]) injuries were documented in the exposed population. The proportion of moderate plus severe late complications in eyes was 3 times as high in male survivors compared with female survivors (0.6% [95% CI, 0.53%-0.65%] vs 0.2% [95% CI, 0.09%-0.73%]; P < .001), whereas dermal complications were significantly more common in female survivors (3.9% [95% CI, 2.92%-5.11%] vs 1.14% [95% CI, 1.06%-1.23%]; P < .001). Mild lung lesions were more prevalent in the NEA group than in the EA group (73.9% [95% CI, 73.4%-74.4%] vs 11.0% [95% CI, 10.6%-11.3%]; P < .001). In the NEA group, 83.2% (n = 23 866) developed lung injuries that were mostly mild or moderate, whereas 77% (n = 24 766) of the EA group did not develop lung injuries (P < .001).
The present study found sex differences in the frequencies of eye and skin complications following sulfur mustard exposure, and lung complications were more prevalent years after sulfur mustard exposure than soon after exposure. Mild lung lesions were observed more frequently among sulfur mustard-exposed survivors who had not been evacuated or hospitalized than among those who had been evacuated or hospitalized. These differences may be due to physiological response or dose of exposure. Close monitoring over an extended period may be required for detection of late pulmonary complications in individuals exposed to sulfur mustard.
暴露于芥子气后长期健康并发症的发生率和严重程度尚不清楚。
调查在伊朗-伊拉克战争中暴露于芥子气的幸存者的长期健康结果。
设计、设置和参与者：在这项回顾性队列研究中，使用描述性统计方法研究了 1980 年至 1988 年间伊朗幸存者在伊朗-伊拉克战争中暴露于芥子气后的迟发性健康并发症。来自退伍军人和烈士事务基金会（VMAF）数据库的数据涉及受影响的器官和症状严重程度，时间跨度为 1980 年至 2019 年。评估分为 3 组，具体取决于幸存者是否（1）撤离并住院（EA）；（2）未撤离或住院（NEA）；或（3）撤离或住院状态未记录。
分析暴露于芥子气后慢性症状严重程度。
使用 VMAF 数据库中的数据，对暴露于芥子气的幸存者的肺部、眼睛和皮肤的慢性症状严重程度进行轻度、中度或重度分级。
在 VMAF 数据库中登记的 64190 名化学幸存者中，有 60861 名符合纳入标准。在纳入的幸存者中，98.0%为男性，平均（SD）年龄为 23.5（7.7）岁。大多数幸存者（53675[88.2%]）没有症状或仅有轻度病变，7186 名幸存者（11.8%）有中度或重度并发症。在暴露人群中记录了中度至重度肺部（6540[10.7%]）、眼部（335[0.6%]）或皮肤（725[1.2%]）损伤。与女性幸存者相比，男性幸存者中中度加重度晚期眼部并发症的比例高 3 倍（0.6%[95%CI，0.53%-0.65%]比 0.2%[95%CI，0.09%-0.73%]；P<0.001），而女性幸存者皮肤并发症明显更常见（3.9%[95%CI，2.92%-5.11%]比 1.14%[95%CI，1.06%-1.23%]；P<0.001）。NEA 组轻度肺部病变比 EA 组更常见（73.9%[95%CI，73.4%-74.4%]比 11.0%[95%CI，10.6%-11.3%]；P<0.001）。在 NEA 组中，83.2%（n=23866）发展为轻度或中度肺部损伤，而 EA 组中 77%（n=24766）未发展为肺部损伤（P<0.001）。
本研究发现，性别差异与暴露于芥子气后的眼部和皮肤并发症的频率有关，且暴露于芥子气后多年的肺部并发症比暴露后不久更常见。与已撤离或住院的幸存者相比，未撤离或住院的幸存者中更常观察到轻度肺部病变。这些差异可能是由于生理反应或暴露剂量所致。对于暴露于芥子气的个体，可能需要进行长期密切监测以检测晚期肺部并发症。
