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Disposition of the Air Force Health Study Michael A. Stoto, PhD Institute of Medicine

Disposition of the Air Force Health Study Michael A. Stoto, PhD Institute of Medicine April 14, 2005. Disclaimers. I chair the official advisory committee in my personal capacity Not a RAND project Some information from AFHS

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Disposition of the Air Force Health Study Michael A. Stoto, PhD Institute of Medicine

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  1. Disposition of the Air Force Health Study Michael A. Stoto, PhD Institute of Medicine April 14, 2005

  2. Disclaimers • I chair the official advisory committee in my personal capacity • Not a RAND project • Some information from AFHS • Opinions are my own, based on following the study closely for a decade • Not Air Force, RHAC, RAND, or NAS/IOM

  3. Outline • AFHS as a national resource to study • Agent Orange and Vietnam herbicides • Dioxin • Veterans’ and occupational health issues • Aging • Chronic disease risks • Other environmental health issues • Disposition options and issues

  4. AFHS Purpose • Congressional and Presidential mandate • To conduct a 20-year prospective epidemiological study of herbicide exposure and health, mortality, and reproductive outcomes in veterans of Operation Ranch Hand

  5. Study Design • Index group: Ranch Hand veterans (N=1,208) • Control population: Air Force veterans of Southeast Asia (N=19,080) • Examined controls matched on age, race, military occupation (N=1,668)

  6. Study Design (Continued) • Multiple endpoints • Mortality, morbidity, reproductive outcomes • Repeated physical examinations,interviews and mortality assessments, plus • Biological samples • Medical records • Military and civilian employment history • Herbicide and dioxin exposure based on military records, military occupation, serum dioxin measurement

  7. General Health Cancer Neurological Psychological Gastrointestinal Dermatological Endocrinological Immunological Pulmonary Cardiovascular Renal Morbidity Endpoints

  8. Study Schedule 1960 1970 1980 1990 2000 2010 Exposure period Protocol Development Physical Examination

  9. Ground troop veterans in AOVS Controls Low Medium High Ranch Hand veterans Controls Officers - non-flying Officers - flying (navigators) Officers - flying (pilots) Enlisted men - flying Enlisted men - non-flying Occupational exposures NIOSH workers - quintile 1 quintile 2 quintile 3 quintile 4 quintile 5 German plant workers New Zealand sprayers Seveso, Italy population Without chloracne With chloracne Median serum dioxin levels in selected populations 157 355 4540 16,600 0 20 40 60 80 100 1000 10,000 Serum dioxin (ppt)

  10. Numbers of Veterans Physically Examined

  11. Item Number Biological specimens X rays Physical examinations Questionnaires Death records Viable conceptions Nonviable conceptions 74,577 19,594 13,177 20,645 2,819 6,801 1,490 Study Materials

  12. Knowledgeable Staff

  13. Research Results

  14. Study Disposition • Veterans Benefits Act of 2003 (PL108-183): NAS study to address (among others) • Potential value of extending the study • Scientific merit of retaining and maintaining medical records, specimens, other data • Obstacles to retaining materials • Advisability and cost of making specimens available to independent researchers

  15. Extending the Study • Due to age and number of remaining participants, value of extending the study to do more physical examinations is not clear • Consider • Value of completing research in progress • Monitoring mortality

  16. Retaining and Maintaining Materials • Not the original goal, but the result is a • Longitudinal study of males with very detailed information on a variety of occupational and other health risks and outcomes • Clear value of retaining and maintaining materials to study • Health effects of herbicides/dioxin in veterans • Other aspects of military health and environmental and occupational exposures • Chronic disease risks • Normal aging

  17. Consent to Use Records and Materials

  18. Making Data and Materials Available to Researchers • Separately consider • A. Logistics and costs of maintenance of materials • B. Costs of further research using these materials • If data and material were available to researchers, NIH and other research funders could support research using it through established programs

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