Department of Oncology and Molecular Medicine, Istituto Superiore di Sanita, Rome, Italy.
Aerospace Medicine Institute, Italian Air Force, Rome, Italy.
Environ Res. 2022 Aug;211:113029. doi: 10.1016/j.envres.2022.113029. Epub 2022 Feb 26.
The health profile of military veterans deployed in foreign operative theatres was assessed by several international studies because of potential exposure to depleted uranium and other pollutants. Here we reported results of 15-year epidemiological surveillance assessing long-term health effects in a cohort of Italian soldiers deployed in Iraq in 2004-2005 and participating in a biomonitoring campaign to identify potential genotoxic exposure to environmental xenobiotics before and after deployment (n = 981, SIGNUM cohort).
We evaluated mortality and hospitalization risks of the SIGNUM cohort retrospectively until 2016 and 2018 respectively. A wide cohort of military personnel never deployed abroad (n = 114,260) and the general Italian population were used as control populations in risk assessment. Causes of death and diagnoses of hospitalization were derived through deterministic record linkage with official national databases of mortality and hospital discharge. Standardized Mortality Ratio (SMR) and Standardized Hospitalization Ratio (SHR) were computed adjusting according to sex, age, area of birth, and calendar year. Differential pre-post deployment in xenobiotics concentrations and early effect biomarkers (oxidative DNA alterations and micronuclei) measured in blood serum were analysed in relation to cancer hospitalization.
Mortality risk due to pathologies was more than halved compared to the general population (SMR = 0.41, 95% CI 0.11-1.05) and not significantly different compared to soldiers never deployed abroad (SMR = 0.69, 95% CI 0.19-1.68). Similarly overall hospitalization risk due to pathologies was decreased with respect to the general population (SHR = 0.86, 95% CI 0.80-0.92) and comparable to the control military group (SHR = 0.99, 95% CI: 0.93-1.06). For haematological cancers a decreased hospitalization risk compared to the Italian general population was observed (SHR = 0.38, 95% CI 0-0.92). No statistically significant differences emerged in the patterns of biomarkers in association with cancer hospitalization.
The study confirms the so called 'healthy warrior' effect for the SIGNUM veterans and showed no correlation between cancer occurrence and biomonitoring markers measured on field.
由于潜在的贫铀和其他污染物暴露，一些国际研究评估了在国外作战区部署的退伍军人的健康状况。在这里，我们报告了对意大利士兵的一项为期 15 年的流行病学监测结果，这些士兵于 2004 年至 2005 年部署在伊拉克，并参加了一项生物监测运动，以在部署前后（n=981，SIGNUM 队列）确定对环境外来物的潜在遗传毒性暴露。
我们分别回顾性评估了 SIGNUM 队列在 2016 年和 2018 年的死亡率和住院风险。一个从未在国外部署过的广泛军事人员队列（n=114260）和一般意大利人口被用作风险评估中的对照人群。通过与官方国家死亡率和住院出院数据库的确定性记录链接，得出死亡原因和住院诊断。根据性别、年龄、出生地和日历年份，计算标准化死亡率比（SMR）和标准化住院率比（SHR）。分析了血液中测量的外来化合物浓度和早期效应生物标志物（氧化 DNA 改变和微核）的前后差异与癌症住院之间的关系。
与普通人群相比，由于疾病导致的死亡率风险降低了一半以上（SMR=0.41，95%CI 0.11-1.05），与从未部署过的士兵相比没有显著差异（SMR=0.69，95%CI 0.19-1.68）。同样，与普通人群相比，由于疾病导致的总体住院风险降低（SHR=0.86，95%CI 0.80-0.92），与对照组军事人员相当（SHR=0.99，95%CI：0.93-1.06）。与意大利普通人群相比，观察到血液系统癌症的住院风险降低（SHR=0.38，95%CI 0-0.92）。在癌症住院与生物监测标志物之间的关联模式中，没有出现统计学上显著的差异。
该研究证实了 SIGNUM 退伍军人的所谓“健康战士”效应，并表明癌症发生与现场测量的生物监测标志物之间没有相关性。
