Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs (VA), Orange, Connecticut.
Department of Neurology, Yale School of Medicine, New Haven, Connecticut.
JAMA Netw Open. 2024 Sep 3;7(9):e2431522. doi: 10.1001/jamanetworkopen.2024.31522.
Open burn pits have commonly been used for waste disposal by the US military but have not been systematically investigated as an independent risk factor for headache disorders.
To evaluate the association between exposure to open burn pits and incidence of headache and migraine.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the Veterans Health Administration Headache Cohort along with data from the US Department of Defense and the Airborne Hazards and Open Burn Pit (AH&OBP) Registry to assess registry participants with potential exposure to open burn pits in the Veterans Health Administration from April 1, 2014, through October 31, 2022. Participants were included by linking data from the AH&OBP Registry to their US Department of Defense and Veterans Health Administration electronic health records. Those with preexisting headache were removed from the analytic sample. The analysis was conducted between November 1, 2022, and January 31, 2024.
Open burn pit exposure composite variables based on the registry questionnaire were examined, specifically being near open burn pits, days near open burn pits, and having open burn pit duties.
Primary incident outcomes included medically diagnosed headache disorders and medically diagnosed migraine.
The analytic sample included 247 583 veterans (mean [SD] age, 27.9 [7.7] years; 222 498 [89.9%] male). After covariates were controlled for at baseline, participants who were near an open burn pit with open burn pit duties had the highest adjusted odds of medically diagnosed headache disorders (adjusted odds ratio [AOR], 1.59; 95% CI, 1.46-1.74), migraine (AOR, 1.60; 95% CI, 1.43-1.79), and self-reported disabling migraine (AOR, 1.93; 95% CI, 1.69-2.20) compared with those without exposure. The 2 highest quartiles of cumulative burn pit exposure (290-448 days and >448 days) had significantly higher adjusted odds of medically diagnosed headache (290-448 days: AOR, 1.20; 95% CI, 1.09-1.31; >448 days: AOR, 1.55; 95% CI, 1.41-1.70) and migraine (290-448 days: AOR, 1.19; 95% CI, 1.07-1.34; >448 days: AOR, 1.48; 95% CI, 1.32-1.65).
In this cohort study, a dose-dependent association existed between open burn pit exposure and medically diagnosed headache and migraine. These new data identify potentially important associations between open burn bit exposure and new-onset headache among service personnel as well as a possible health condition that may be encountered more frequently in Veterans Health Administration facilities during mandatory screening for military exposures.
美国军方经常使用露天焚烧坑来处理废物，但尚未将其作为头痛疾病的独立风险因素进行系统调查。
评估接触露天焚烧坑与头痛和偏头痛发病率之间的关联。
设计、设置和参与者：这项回顾性队列研究使用了退伍军人健康管理局头痛队列的数据，以及美国国防部和空气传播危害和露天焚烧坑（AH&OBP）登记处的数据，以评估登记处参与者在退伍军人健康管理局接触露天焚烧坑的潜在风险，时间从 2014 年 4 月 1 日至 2022 年 10 月 31 日。通过将 AH&OBP 登记处的数据与他们的美国国防部和退伍军人健康管理局电子健康记录相链接，参与者被纳入分析样本。那些有预先存在的头痛的人被从分析样本中删除。分析于 2022 年 11 月 1 日至 2024 年 1 月 31 日进行。
根据登记问卷检查了露天焚烧坑暴露综合变量，特别是靠近露天焚烧坑、靠近露天焚烧坑的天数和露天焚烧坑职责。
主要的首发结局包括经医学诊断的头痛疾病和经医学诊断的偏头痛。
分析样本包括 247583 名退伍军人（平均[标准差]年龄，27.9[7.7]岁；222498[89.9%]男性）。在基线时控制了协变量后，有露天焚烧坑职责的靠近露天焚烧坑的参与者患经医学诊断的头痛疾病的调整后优势比（adjusted odds ratio，AOR）最高（AOR，1.59；95%CI，1.46-1.74），偏头痛（AOR，1.60；95%CI，1.43-1.79）和自报告的致残性偏头痛（AOR，1.93；95%CI，1.69-2.20），与无暴露者相比。累积露天焚烧坑暴露量的前 2 个四分位数（290-448 天和>448 天）具有显著更高的经医学诊断的头痛（290-448 天：AOR，1.20；95%CI，1.09-1.31；>448 天：AOR，1.55；95%CI，1.41-1.70）和偏头痛（290-448 天：AOR，1.19；95%CI，1.07-1.34；>448 天：AOR，1.48；95%CI，1.32-1.65）的调整优势比。
在这项队列研究中，露天焚烧坑暴露与经医学诊断的头痛和偏头痛之间存在剂量依赖性关联。这些新数据确定了接触露天焚烧坑与军事人员新发头痛之间可能存在的重要关联，以及在退伍军人健康管理局设施中进行强制性军事暴露筛查时可能更频繁地遇到的一种可能的健康状况。
