AGENT ORANGE AND VIETNAM
RELATED RESEARCH
VA EFFORTS
Vietnam Veterans Mortality Study (Proportionate Mortality Study of Army
and Marine Corps Veterans of the Vietnam War) - The results of this
study were released in September 1987. Patterns of mortality among 24,235
Army and Marine Corps Vietnam veterans were compared with that of 25,685
non- Vietnam veterans using standardized proportional mortality ratios.
The study subjects were a random sample of deceased Vietnam era veterans
identified in a VA computerized benefit file. Military service information
was obtained from military personnel records, and cause of death information
from death certificates.
Statistically significant excess deaths were observed among Army Vietnam
veterans for motor vehicle accidents, non-motor vehicle accidents and
accidental poisonings. Similar findings have been reported in other
studies of Vietnam veterans. Suicides were not elevated among Vietnam
veterans. Marine Corps Vietnam veterans appeared to have an increased
mortality from lung cancer and non-Hodgkin's lymphomas compared to Marines
who did not serve in Vietnam. The study did not investigate possible
causes of these findings. The study was published in the Journal of
Occupational Medicine in May 1988.
Follow-up Proportionate Mortality Study of Army and Marine Corps
Veterans of the Vietnam War - This updates the Vietnam Veterans
Mortality Study. The initial effort included Vietnam-era veterans who
died during the 1965-82 period. The updates include deaths through 1984.
Compared to non-Vietnam veterans, soldiers and Marines who served in
Vietnam had a small but statistically significant excess of deaths from
external causes. Army Vietnam veterans had small excesses of laryngeal
cancer and lung cancer, but the role of such known causes as smoking
could not be determined. The study was published in the Journal of Occupational
Medicine in July 1991.
Proportionate Mortality Among US Army Vietnam Veterans Who Served
in I Corps - This study was designed to determine whether Army veterans,
who were stationed in the same geographical area in Vietnam as Marine
veterans, experienced mortality patterns similar to these Marines. The
post-service mortality experience of 6,668 Army veterans who served
in
Military Region I, also known as "I Corps," was compared to
that of 27,917 Army non-Vietnam veterans.
Statistically significant excesses of deaths were observed for motor
vehicle accidents and accidental poisonings. Deaths due to other major
disease categories, including malignant neoplasms, and suicides were
no more frequent among Army I Corps veterans than their counterparts.
No significant excess of deaths due to non-Hodgkin's lymphomas or lung
cancer was observed. The study results were published in the American
Journal of Epidemiology in October 1990. This was a follow-up research
project in response to results of the Vietnam Veterans Mortality Study.
Soft Tissue Sarcoma Study (Soft Tissue Sarcoma and Military Service
in Vietnam: A Case Control Study) - This study was conducted of
men who were of draftable age during the Vietnam conflict to examine
the association of soft tissue sarcomas with military service in Vietnam
as well as other environmental risk factors. A total of 217 soft tissue
sarcoma cases selected from the Armed Forces Institute of Pathology
were compared to 599 controls for Vietnam service occupational and non-occupational
exposure to various chemicals, occupational history, medical history,
and life-style (smoking, alcohol, coffee, etc.).
The results of the study indicate that Vietnam veterans did not have
an increased risk of soft tissue sarcomas when compared to those men
who had never been in Vietnam. The study was published in the Journal
of the National Cancer Institute in October 1987.
Soft Tissue Sarcoma Review (Soft Tissue Sarcomas and Military Service
in Vietnam: A Case Comparison Group Analysis of Hospital Patients)
- This study reviewed soft tissue sarcoma cases among Vietnam era veterans
who were admitted to VA medical centers during the period 1969-1983.
This effort compared location, histopathology and relative frequency
of soft tissue sarcomas between Vietnam veterans and non-Vietnam veterans.
The study showed that for this group of veterans, service in Vietnam
did not increase the risk of developing this type of cancer. The VA's
Office of Environmental Epidemiology, now known as the Environmental
Epidemiology Service, worked with the VA's Pathology Service on this
research. The findings were published in the Journal of Occupational
Medicine in December 1986.
Adipose Tissue Study (Dioxins and Dibenzofurans in Adipose Tissue
of U.S. Vietnam Veterans and Controls) - VA, in collaboration with
the Environmental Protection Agency (EPA), completed a very detailed
analysis of adipose tissue specimens from 195 men of the Vietnam era
age group. The specimens were analyzed for 2,3,7,8-TCDD, the contaminant
found in one of the ingredients of Agent Orange, and sixteen other related
dioxins and dibenzofurans. Researchers used adipose tissue collected
for the EPA's National Human Adipose Tissue Survey. A total of 36 Vietnam
veterans, 79 veterans who did not serve in Vietnam, and 80 civilians
were selected and their archived tissues were analyzed.
Investigators found that the average level of 2,3,7,8-TCDD in adipose
tissue of Vietnam veterans was not significantly different from that
of the non-Vietnam veterans or the civilians. This was the case both
with and without adjustment for several demographic variables. Furthermore,
the results showed no association between TCDD levels and Agent Orange
exposure opportunity estimations based on military records. The study
was published in the American Journal of Public Health in March 1991.
National Vietnam Veterans Readjustment Study - This study found
that a majority of Vietnam theater veterans have made a successful re-entry
to civilian life and currently experience few symptoms of post-traumatic
stress disorder (PTSD) or other readjustment problems. Although in general,
male Vietnam theater veterans do not differ greatly in their current
life adjustment from their era veteran counterparts, there is some evidence
that female theater veterans currently experience more readjustment
problems than other Vietnam Era veteran women of similar age and military
occupation. The study found that 15.2 percent of all male Vietnam veterans
and 8.5 percent of Vietnam veteran women currently suffer from PTSD.
The study also indicated that PTSD in the Vietnam veteran population
is associated with significant levels of morbidity, reflected in higher
levels of unemployment, family and educational difficulties. The rates
of PTSD are higher for black and Hispanic veterans than among white
veterans.
Combat Experience and Postservice Psychosocial Status as Predictors
of Suicide in Vietnam Veterans - Potential risk factors for suicide
among 38 Vietnam veterans were examined using Vietnam veterans who died
from motor vehicle accidents as a comparison group. Veterans were selected
from Los Angeles County Medical Examiner's files.
No military service factor was associated with suicide. The characteristics
of Vietnam veterans suicide cases were not substantially different from
non-Vietnam veteran suicides with respect to known demographic risk
factors. The psychological profile for Vietnam veteran suicide cases
was also similar to non-Vietnam veteran suicide cases in most instances.
Symptoms related to PTSD were observed more frequently among suicide
cases than accident cases. However, suicides were not associated with
specific combat experiences or military occupation. The extent of combat
experience in Vietnam per se as measured in this study was not a good
predictor of suicide death. These results were published in the Journal
of Nervous and Mental Disease in January 1990.
Army Chemical Corps Study - This study examined health effects
of chemical exposures during military service in Vietnam among men assigned
to Army chemical units, which were responsible for detecting and counteracting
enemy chemical warfare by using riot control agents and for defoliating
vegetation using phenoxy herbicides. Because they were involved in the
mixing and application of these chemicals, these men were likely to
have had heavier exposure to them than ground troops. Nearly 1,000 men
who served in Army chemical units in Vietnam between 1965 and 1971 were
identified from unit morning reports, by the U.S. Army and Joint Services
Environmental Support Group. Fifty-three deaths were observed through
December 1987.
Based on rates for U.S. men adjusted for race, age, and calendar period,
there were statistically significant excesses of digestive disease deaths,
primarily due to alcohol-related diseases, and from motor vehicle accidents.
Two deaths were observed from leukemia (with 0.5 expected) and two from
brain cancer (0.4 expected). A total of 257 of the veterans had received
VA inpatient care and/or the VA Agent Orange Registry medical examinations
during the study period. Two veterans had confirmed diagnoses of Hodgkin's
disease (0.7 expected).
Because of the small study group size and the lack of specificity of
information regarding exposure, these results cannot be attributed to
any single chemical agent. The study results were published in the American
Journal of Industrial Medicine in December 1990.
Non-Hodgkin's Lymphoma Among Vietnam-era Veterans - This was
a hospital-based case-control study undertaken to examine the association
between military service in Vietnam and non-Hodgkin's lymphomas. The
case group of about 201 Vietnam-era veterans who were treated in VA
medical centers between 1969 and 1985 with diagnoses of non-Hodgkin's
lymphomas was compared with 358 Vietnam-era veterans with diagnoses
other than malignant lymphomas.
Military service in Vietnam did not increase the risk of non-Hodgkin's
lymphomas either in general or with increased latency period, defined
as the duration in years from the first service in Vietnam to hospital
discharge. Service in a specific military branch, a specific region
of Vietnam, or combat role (as determined by military occupational specialty)
were not associated with any increased risk of non-Hodgkin's lymphomas.
The study was published in the Journal of Occupational Medicine in July
1991.
A Case Control Analysis of Post-Traumatic Stress Disorder Among Vietnam
Veterans in the Agent Orange Registry - This case control study
compared demographic and military variables of 374 Vietnam veterans
with PTSD diagnoses with a similar number of Vietnam veterans who did
not have PTSD. All of these veterans were selected from the VA Agent
Orange Registry, a computerized data base of about 220,000 Vietnam veterans
who voluntarily reported to a VA health care facility for a medical
examination. (For more information about the VA Agent Orange Registry,
see Agent Orange Brief, B1.) Cases and controls
were matched by age, year of Agent Orange Registry examination, and
race.
Investigators confirmed that being wounded in Vietnam and having a combat
job in Vietnam were risk factors for PTSD. Data analysis also revealed
that those who had noncombat jobs but were wounded had the highest risk
of PTSD. The study was published in the Annals of Epidemiology
in November 1991.
Women Vietnam Veterans Mortality Study - Approximately 4,500
women Vietnam veterans and 6,500 women veterans who never served in
Vietnam were identified from military records and followed for vital
status on December 31, 1987.
Investigators found that women Vietnam veterans had lower than expected
mortality from all causes compared to U.S. women non-Vietnam veterans.
Suicide rates were about the same in both groups. There was a slight
excess of mortality from external causes among women Vietnam veterans
compared with non-Vietnam veterans, primarily due to an excess of motor
vehicle accidents. In comparison to U.S. women, mortality from cancers
of the pancreas and uterine corpus was elevated among women Vietnam
veterans but the increase was not statistically significant. The study
results were published in the American Journal of Epidemiology in November
1991. This study was updated by extending the follow-up period of vital
status to December 31, 1991. The results, which are consistent with
the earlier findings, were published in the Journal of Occupational
Medicine in March 1995.
Hodgkin's Disease and Vietnam Service - This hospital-based case-control
study examined the association between mi1itary service in Vietnam and
several histologic types of malignant lymphomas. Earlier studies that
showed an association between exposure to phenoxy herbicides and the
risk of malignant lymphomas sparked concerns among Vietnam veterans
about Agent Orange exposure. This is a report of 283 Vietnam-era veteran
patients with a diagnosis of Hodgkin's disease who were treated in one
of the 172 VA hospitals from 1969 to 1985 with a diagnosis of Hodgkin's
disease. The controls consisted of 405 Vietnam-era veterans with a diagnosis
other than malignant lymphoma.
Military service information was obtained from a review the veterans'
military personnel records. Cases and controls were compared with respect
to service in Vietnam and surrogate measures of potential Agent Orange
exposure. Investigators found that service in Vietnam was not associated
with any significant increase in the risk of Hodgkin's disease. Furthermore,
surrogate measures of potential Agent Orange exposure, such as service
in a specific military branch, in a certain region within Vietnam, in
a combat role, or extended Vietnam service time, were not associated
with any significant increased risk of Hodgkin's disease. The results
were published in the Annals of Epidemiology in September 1995.
Military Service in Vietnam and the Risk of Death from Trauma and
Selected Cancers - This study compared the postservice mortality
of 10,716 U.S. Marine veterans who served in Vietnam with that of 9,346
Marine veterans who did not serve in Vietnam. There was a significant
excess of death for Vietnam Marines from all causes (combined) and all
external causes (combined). After adjustments for age and rank in military,
overall mortality continued to be statistically significant for Vietnam
Marines compared to non-Vietnam Marines. The excess overall mortality
was mainly due to excess deaths from external causes.
The risks for several site-specific cancers were elevated but not statistically
significant. Investigators suggested that follow-up of this Marine cohort
continue to determine whether there are statistically significant differences
in the mortality patterns of Marine Vietnam and non-Vietnam veterans,
especially for cancers. The results were published in the Annuals of
Epidemiology in September 1995.
A Review of NVVRS Data for Women Vietnam Veterans - VA, by means
of a contract with the Research Triangle Institute (RTI), completed
the National Vietnam Veterans Readjustment Study (NVVRS). The 3,106
study subjects included 950 women (431 Vietnam veterans, 304 non-Vietnam
veterans, and 215 civilians). In addition to a 3-5 hour interview, some
Vietnam and non-Vietnam veterans underwent a follow-up clinical interview
with an expert mental health clinician. There were 86 women Vietnam
veterans and 35 women non-Vietnam veterans in the group that received
the follow-up interview. There is already an extensive report on the
study design, statistical methods, and results by the RTI.
This follow-up analysis is focusing on women veterans. They are being
evaluated by military service characteristics, such as occupation (nurse
vs. non-nurse), length of service, branch, rank, and career status.
Other characteristics, including age, race, substance abuse, and family
history of violence are being considered and adjusted for in the analysis.
All the data files, analysis files, and documentation necessary for
the project have been obtained from the RTI. Investigators expect publication
of the study results in early 1997.
Mortality Patterns among Vietnam Veterans -- A 24-Year Retrospective
Analysis - This project is the second update of the Vietnam
Veterans Mortality Study. The mortality experience of 33,833 U.S. Army
and Marine Corps Vietnam veterans who died during 1965-1988 was compared
with that of 36,797 deceased non-Vietnam veterans using proportionate
mortality ratios (PMP). Military service information was abstracted
from military personnel records and cause of death information recorded
from death certificates.
Army Vietnam veterans had statistically significant excesses of deaths
from laryngeal cancer and lung cancer. There was an excess of external
causes, including motor vehicle accidents and accidental poisonings.
In contrast to Army veterans, the results for Marine Vietnam
veterans varied according to the referent population used. When compared
with non-Vietnam veterans, Marine Vietnam veterans had significantly
elevated PMRs for lung cancer and skin cancer. There was also a significant
excess of external causes of death, accidental poisonings and homicides
compared with all non-Vietnam veterans. The results were published in
the Journal of Occupational Medicine in March 1996.
Army Chemical Corps Vietnam Veterans Study Update - This study
is an update of an investigation pub1ished in the American Journal of
Industrial Medicine in December 1990. The original mortality study was
expanded to include Army Vietnam-era veterans who were identified by
the Defense Manpower Data Center with a chemical primary military occupational
specialty or MOS code and by class rosters (1965-72) obtained from the
Army Chemical School of Ft.�McClellan.
These additional study subjects will increase the size of the original
Vietnam chemical cohort and will provide a comparison group of Army
Chemical Corps veterans who never served in Vietnam. The study results
have been submitted for publication. VA will conduct an expanded study
of these veterans in a manner similar to the Air Force Ranch Hand Study.
Agent Orange Registry Review for Testicular Cancer - All men
who had their initial Agent Orange Registry examination between 1983
and 1987, and who had a confirmed diagnosis of testicular cancer were
potential candidates for this project. Controls were selected from the
Agent Orange Registry group matched to the case group by age, year of
initial examination, and race. Military records were sought for all
cases and controls and abstracted to obtain information on dates of
military service, dates served in Vietnam unit addresses, and military
occupations in Vietnam.
Case-control analyses examined the relationship between specific Vietnam
service characteristics and testicular cancer. This study results are
not consistent with the hypothesis that Agent Orange may be a risk factor
for testicular cancer among Vietnam veterans. The study results were
published in the Annals of Epidemiology in January 1994.
The Risk of Suicide among Wounded Vietnam Veterans - This study
was undertaken to determine whether an association exists between combat
trauma and risk of postservice suicide among Vietnam veterans. The risk
of suicide for 34,534 veterans who were wounded in Vietnam was evaluated
for severity of wound and the number of times wounded. Investigators
found that there was a trend of increasing risk of suicide with increased
occurrence of combat trauma. The highest relative risk was observed
for those veterans who were wounded more than once and hospitalized
for a wound.
In comparison with the U.S. male general population, veterans hospitalized
because of a combat wound or wounded more than once had a significantly
increased risk of suicide. Those wounded more than once and hospitalized
had the highest increased risk of suicide. The study results were published
in the American Journal of Public Health in May 1996.
A Case-Control Study of Lung Cancer among Vietnam Veterans --
This case control study examined lung cancer among Vietnam veterans.
The study results have been submitted for publication.
Posttraumatic Stress Disorder and the Risk of Traumatic Deaths Among
Vietnam Veterans -- This study evaluated whether an association
exists between posttraumatic stress disorder (PTSD) and traumatic deaths
among Vietnam veterans. Mortality risk of 4,247 Vietnam veterans from
the VA Agent Orange Registry (AOR) with a diagnosis of PTSD relative
to that of 12,010 Vietnam veterans from the AOR with no diagnosis of
PTSD was calculated. Mortality experience of both groups was also compared
with U.S. males.
The veterans with PTSD were more likely than non-PTSD veterans to die
from suicide and from accidental poisoning. Among Vietnam veterans on
the AOR, PTSD is associated with a significant increase risk for suicide
and accidental poisoning. The study results were published in the Journal
of Nervous and Mental Disease in November 1994.
Women Vietnam Veterans Reproductive Health Study - Studies of
reproductive outcomes among male veterans have been mostly negative
in that service in Vietnam was not associated with the risk of fathering
a child with birth defects. Although the results of male Vietnam veterans
health studies are useful in assessing the general health of women Vietnam
veterans, further investigation may be necessary in the areas of gender
specific health outcomes of women and of the birth outcomes of
their children. It is generally accepted that maternal exposures are
more commonly associated with adverse reproductive outcomes than paternal
exposures.
This research will compare the reproductive health outcomes of all women
Vietnam veterans with those of an equal number of women veterans who
did not serve in Vietnam. Information on exposure will be collected
from telephone interviews and will be supplemented with and validated
by military personnel records. Data on the birth outcomes will also
be collected from telephone interviews and validated by reviews of medical
and hospital records.
The Phase I feasibility study was successfully concluded, and Phase
II (full study) began in May 1996. Investigators anticipate that study
results will be available in 1998.
Where can a veteran obtain additional information on VA Agent Orange
research and studies on related matters?
Information on these subjects can be obtained at the VA medical
center libraries, from the Registry Physicians or Agent Orange Coordinator
at every VA medical center, or from the Environmental Agents Service
(131), Department of Veterans Affairs, 810 Vermont Avenue, N.W., Washington,
DC 20420.
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DioxinKills!
Agent
Orange Brief
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