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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

10
Morbidity Results

OVERVIEW: SURVEY RESPONSE

The data in this section of the report come from mail questionnaires and telephone interviews, as described in Chapter 7. The total number of subjects is 12,499, which excludes a total of 159 Army, Air Force, and Coast Guard participants and controls. As explained in Chapter 5, the primary reason for excluding the non-Navy, non-Marine subjects was their small number and our inability to assemble reasonable control groups. A total of 5,106 respondents is included in the analyses in this chapter.

Table 10-1 shows the total numbers of subjects and response rates for mail questionnaires and telephone interviews by analysis group. Response rates were calculated based on number of subjects presumed alive through 2005, and in all groups, participants have substantially higher response rates within each analysis group. Except for group B controls, participant response rates are all over 60 percent, while control response rates are 45–53 percent. In addition, mail questionnaire response rates were usually higher than telephone interview response rates. Overall, the response rate was 53.1 percent.

PRIMARY OUTCOME VARIABLE: SF-36

Unadjusted SF-36 Summary Scores by Analysis Group

Table 10-2 shows the two primary morbidity outcome measures from the SF-36, the physical component summary (PCS) and mental component summary (MCS) scores, by analysis group and participation status. Participants show uniformly lower scores (worse health) than controls in total as well as across all four analysis groups, with most of the differences in SF-36 scores being relatively small, in the range of 1 to 2 points. The exception is MCS scores in groups B and D, which show differences of around 5 points, considered moderate in size. Moreover, all differences between participant and control PCS and MCS scores were statistically significant, except for MCS and PCS scores in analysis group C, which contained the subjects potentially exposed to active agents. PCS and MCS scores in our survey were generally lower than comparable national norms for males aged 55–64 and 65–74: national PCS scores were 48.16 and 45.13, respectively; national MCS scores were 52.53 and 53.66, respectively.

It is important, especially when sample sizes are large, to interpret the clinical importance of these differences as well. According to the customary rule of thumb, based on Cohen’s criteria, differences of 0.2 to 0.49 standard

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

TABLE 10-1 Availability of Mail Questionnaire and Telephone Interview Data by Analysis Group and Participation Status

Analysis Group and Participation Status*

Mail Questionnaire Only

Telephone Interview Only

Any Response (includes both)

Total Subjects Presumed Alive

Group A, participants

834

(33.4%)

637

(25.5%)

1,545

(62.0%)

2,494

(100%)

Group A, controls

725

(26.8%)

552

(20.4%)

1,325

(48.9%)

2,710

(100%)

Group B, participants

192

(27.4%)

175

(24.9%)

380

(54.1%)

702

(100%)

Group B, controls

85

(11.5%)

137

(18.6%)

230

(31.2%)

738

(100%)

Group C, participants

174

(31.9%)

130

(23.6%)

339

(61.5%)

551

(100%)

Group C, controls

209

(25.2%)

159

(19.2%)

377

(45.5%)

829

(100%)

Group D, participants

218

(33.2%)

178

(27.1%)

412

(62.8%)

656

(100%)

Group D, controls

261

(27.7%)

225

(23.9%)

498

(54.7%)

942

(100%)

Total number of responding subjects

2,700

(28.1%)

2,193

(22.8%)

5,106

(53.1%)

9,622

(100%)

*Group A = participants potentially exposed only to BG or MAA; group B = participants potentially exposed only to TOF; group C = participants potentially exposed to any active chemical or biological agent; group D = participants potentially exposed only to simulants and not in groups A or B.

TABLE 10-2 Mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores, by Analysis Group and Participation Status (Sample Sizes in Parentheses), with Results of t-Test Comparisons

Analysis Groupa

PCS Participant (sample size)

PCS Control (sample size)

t-Testb

MCS Participant (sample size)

MCS Control (sample size)

t-Test

Group A

42.36

(N = 1,438)

44.20

(N = 1,220)

4.09

2,656 df

P < .0001

49.32

(N = 1,438)

51.22

(N = 1,220)

3.92

2,656 df

P < .0001

Group B

42.64

(N = 357)

44.93

(N = 220)

2.41

575 df

P = .0163

44.54

(N = 357)

49.78

(N = 220)

4.21

575 df

P < .0001

Group C

42.14

(N = 315)

42.82

(N = 345)

0.75

658 df

P = .4558

48.83

(N = 315)

50.06

(N = 345)

1.24

658 df

P = .2158

Group D

42.80

(N = 388)

44.59

(N = 460)

2.22

846 df

P = .0269

47.90

(N = 388)

52.31

(N = 460)

5.30

846 df

P < .0001

All Subjects

42.44

(N = 2,498)

44.14

(N = 2,245)

5.06

4,741 df

P < .0001

48.74

(N = 2,498)

51.48

(N = 245)

7.40

4,741 df

P < .0001

National norms for males

age 55–64

 

48.16

 

 

52.53

 

age 65–74

 

45.13

 

 

53.66

 

NOTE: Statistically significant items are in bold.

aGroup A = participants potentially exposed only to BG or MAA; group B = participants potentially exposed only to TOF; group C = participants potentially exposed to any active chemical or biological agent; group D = participants potentially exposed only to simulants and not in groups A or B.

bt-test value based on pooled variance estimate.

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

deviations are considered “small,” differences of 0.5 to 0.79 standard deviations are considered “moderate,” and differences greater than 0.8 standard deviations are considered “large.” Because our normed scores all have a mean of 50 and a standard deviation of 10, this means that differences in mean SF-36 scores of 2 to 4.9 points are interpreted as “small,” 5 to 7.9 points as “moderate,” and 8 or more points as “large.”

Figures 10-1 and 10-2 show bar graphs of the PCS and MCS scores by analysis group and participation status. Most of the differences in the PCS scores were considered small, around 2 points, with a smaller difference of less than 1 point in group C. For MCS scores, groups A and C showed small, 2-point differences, while the group B and D differences were moderate.

The next step was to examine the data for the SF-36 subscales, shown in Table 10-3. Overall, there were no striking differences in the SF-36 subscales. Group A showed small but consistent differences in all the SF-36 subscales, while group B differences were moderate in size, ranging up to 5 points; in all subscales, participants showed smaller values than controls. Group D differences were similar, but slightly smaller, than those of group B. Virtually all the SF-36 subscale differences in groups A, B, and D were statistically significant. In contrast, group C differences were relatively small, and none of them were statistically significant.

SF-36 Summary Scales by Potential Confounding Variables

Table 10-4 shows adjusted mean SF-36 summary scale values by analysis group for various potential confounding factors, with branch included only for group B, where there were sufficient numbers of Marines. Age was significantly associated with PCS and MCS scores in the majority of analysis groups, while race differences

FIGURE 10-1 Average SF-36 physical component scores (PCS) by study group and participation status.

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

FIGURE 10-2 Average SF-36 mental component scores (MCS) by study group and participation status.

were statistically significant only for group A’s PCS and MCS scores and group B’s PCS score. Pay grade differences were all statistically significant except for group B; some of the differences by pay grade in Table 10-4 are moderate to large in size. Smoking, drinking, and body mass index (BMI) all had statistically significant effects on PCS and MCS in more than one analysis group, although BMI was not statistically associated with MCS in any group. In summary, age, race, pay grade, branch, smoking, drinking, and BMI were all significantly associated with either PCS or MCS scores in at least one of the analysis groups. Therefore, further general linear model analyses will compare SF-36 summary scores within analysis groups, having adjusted for age, race, pay grade, branch, smoking, drinking, and BMI. Because statistical adjustment for source of data (mail questionnaire versus telephone interview) and for age-squared did not result in any meaningful change in estimates, we did not adjust for either of these covariates, in the interests of parsimony.

Analysis of Adjusted SF-36 Summary Scores by Analysis Group

Having established that age, race, pay grade, and branch are all potential confounding variables, our general linear model analyses compared SF-36 summary scores adjusted for all these variables simultaneously. Table 10-5 shows the results of our general linear models comparisons.

Although participants have uniformly smaller adjusted mean SF-36 summary scores than controls, there were differences between PCS and MCS scores. Adjusted mean PCS scores all showed small differences between participants and controls, roughly two points, with the group C difference not reaching statistical significance.

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

TABLE 10-3 Mean SF-36 Subscale Scores, by Analysis Group and Participation Status, with Results of t-Test Comparisons

Analysis Groupa and SF-36 Subscaleb

Participant

Control

t-Testc

Group A

PF

42.30

43.78

3.14, 2,794 df, P = .0017

RP

43.79

45.74

4.17, 2,842 df, P < .0001

BP

45.88

47.59

4.05, 2,845 df, P < .0001

GH

42.73

45.40

5.79, 2,840 df, P < .0001

VT

48.56

50.97

5.34, 2,811 df, P < .0001

SF

46.25

48.09

3.99, 2,831 df, P < .0001

RE

46.41

48.63

4.72, 2,850 df, P < .0001

MH

48.95

51.07

4.67, 2,814 df, P < .0001

Group B

PF

42.48

45.32

2.80, 597 df, P = .0053

RP

42.99

46.56

3.37, 601 df, P = .0008

BP

43.70

46.81

3.20, 603 df, P = .0015

GH

40.49

44.50

3.72, 605 df, P = .0002

VT

46.05

50.04

3.83, 601 df, P = .0001

SF

42.05

46.89

4.24, 605 df, P < .0001

RE

42.72

47.72

4.14, 602 df, P < .0001

MH

44.31

49.33

4.28, 598 df, P < .0001

Group C

PF

42.30

42.32

0.03, 698 df, P = .9764

RP

43.48

44.06

0.61, 702 df, P = .5423

BP

45.53

45.86

0.39, 705 df, P = .6935

GH

41.92

43.36

1.61, 701 df, P = .1071

VT

47.40

48.73

1.44, 703 df, P = .1492

SF

45.93

45.48

-0.47, 706 df, P = .6378

RE

45.78

46.34

0.56, 702 df, P = .5781

MH

48.49

49.47

1.04, 706 df, P = .2999

Group D

PF

42.69

44.29

1.91, 884 df, P = .0565

RP

43.87

46.35

3.02, 899 df, P = .0026

BP

45.12

47.90

3.77, 901 df, P = .0002

GH

42.20

45.09

3.52, 901 df, P = .0004

VT

47.41

50.73

4.07, 890 df, P < .0001

SF

44.90

48.36

4.29, 895 df, P < .0001

RE

45.45

49.36

4.80, 901 df, P < .0001

MH

47.18

50.64

4.17, 893 df, P < .0001

aGroup A = participants potentially exposed only to BG or MAA; group B = participants potentially exposed only to TOF; group C = participants potentially exposed to any active chemical or biological agent; group D = participants potentially exposed only to simulants and not in groups A or B.

bPF = physical functioning; RP = role physical; BP = bodily pain; GH = general health; VT = vitality; SF = social functioning; RE = role emotional; and MH = mental health.

ct-test value based on pooled variance estimate.

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

TABLE 10-4 Mean SF-36 Summary Scores, by Analysis Group and Various Other Factors, with Results of F-Test Comparisons

Analysis Group and Factor*

Mean Value PCS

F-Test

Mean Value MCS

F-Test

Group A

Age

28.70, 1 df

12.05, 1 df

 

 

P < 0.0001

 

P = 0.0005

Race

 

 

 

 

White

45.40

7.64, 1 df

50.33

3.75, 1 df

Nonwhite

43.00

P = 0.0078

48.46

P = 0.0529

Pay grade

 

 

 

 

E1–E3

41.58

13.13, 2 df

47.71

5.74, 2 df

E4–E8

42.65

P < 0.0001

49.05

P = 0.0032

Officer

48.36

 

51.43

 

Branch

 

 

 

 

Marine

48.06

2.58, 1 df

47.29

3.43, 1 df

Navy

44.72

P = 0.1080

51.51

P = 0.0643

Smoking

 

 

 

 

Yes

44.67

36.81, 1 df

48.61

6.38, 1 df

No

48.11

P < 0.0001

50.18

P = 0.0116

Drinking

 

 

 

 

Yes

47.98

51.12, 1 df

50.54

21.97, 1 df

No

44.80

P < 0.0001

48.25

P < 0.0001

Body Mass Index

78.73, 1 df

1.30, 1 df

 

 

P < 0.0001

 

P = 0.2540

Group B

Age

0.20, 1 df

2.64, 1 df

 

 

P = 0.6510

 

P = 0.1048

Race

 

 

 

 

White

44.38

4.01, 1 df

47.28

1.93, 1 df

Nonwhite

41.55

P = 0.0457

44.70

P = 0.1652

Pay grade

 

 

 

 

E1–E3

43.51

2.98, 2 df

46.00

0.56, 2 df

E4–E8

44.57

P = 0.0514

46.96

P = 0.5721

Officer

40.82

 

45.01

 

Branch

 

 

 

 

Marines

42.53

0.77, 1 df

42.74

24.96, 1 df

Navy

43.40

P = 0.3809

49.24

P < 0.0001

Smoking

 

 

 

 

Yes

40.94

14.51, 1 df

45.25

1.14, 1 df

No

44.99

P = 0.0002

46.73

P = 0.2866

Drinking

 

 

 

 

Yes

45.11

22.12, 1 df

47.08

3.29, 1 df

No

40.82

P < 0.0001

44.90

P = 0.0702

Body Mass Index

11.25, 1 df

0.14, 1 df

 

 

P = 0.0008

 

P = 0.7120

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

Analysis Group and Factor*

Mean Value PCS

F-Test

Mean Value MCS

F-Test

Group C

Age

6.05, 1 df

0.03, 1 df

 

 

P = 0.0142

 

P = 0.8725

Race

 

 

 

 

White

48.63

0.42, 1 df

53.87

0.02, 1 df

Nonwhite

47.67

P = 0.5185

54.10

P = 0.8888

Pay grade

 

 

 

 

E1–E3

46.10

4.07, 2 df

51.48

3.01, 2 df

E4–E8

46.25

P = 0.0176

53.39

P = 0.0501

Officer

52.11

 

57.07

 

Branch

 

 

 

 

Marine

51.79

0.84, 1 df

56.41

0.29, 1 df

Navy

44.52

P = 0.8597

51.55

P = 0.5894

Smoking

 

 

 

 

Yes

46.67

6.76, 1 df

52.71

3.91, 1 df

No

49.63

P = 0.0095

55.26

P = 0.0486

Drinking

 

 

 

 

Yes

50.10

17.16, 1 df

55.27

6.28, 1 df

No

46.28

P < 0.0001

52.70

P = 0.0125

Body Mass Index

27.28, 1 df

0.74, 1 df

 

 

P < 0.0001

 

P = 0.3914

Group D

Age

7.47, 1 df

8.38, 1 df

 

 

P = 0.0064

 

P = 0.0039

Race

 

 

 

 

White

45.98

0.35, 1 df

51.95

2.32, 1 df

Nonwhite

47.17

P = 0.5519

48.72

P = 0.1282

Pay grade

 

 

 

 

E1–E3

45.04

4.25, 2 df

48.67

2.17, 2 df

E4–E8

44.45

P = 0.0146

49.06

P = 0.1146

Officer

50.24

 

53.28

 

Branch

 

 

Marine

 

 

Navy

 

 

 

 

Smoking

 

 

 

 

Yes

44.63

16.92, 1 df

48.93

7.75, 1 df

No

48.52

P < 0.0001

51.73

P = 0.0055

Drinking

 

 

 

 

Yes

48.37

17.94, 1 df

52.01

15.12, 1 df

No

44.78

P < 0.0001

48.66

P < 0.0001

Body Mass Index

40.37, 1 df

0.12, 1 df

P < 0.0001

P = 0.7244

NOTE: Statistically significant items are in bold.

*Group A = participants potentially exposed only to BG or MAA; group B = participants potentially exposed only to TOF; group C = participants potentially exposed to any active chemical or biological agent; group D = participants potentially exposed only to simulants and not in groups A or B.

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

TABLE 10-5 Adjusted Mean SF-36 Summary Scores, by Analysis Group, with Results of F-Test Comparisons

Analysis Group and Factor*

Adjusted Mean PCS Score

F-Test

Adjusted Mean MCS Score

F-Test

Group A

Participants

45.32

23.54, 1 df, P < .0001

48.36

18.50, 1 df, P < .0001

Controls

47.45

 

50.43

 

Age

28.70, 1 df, P < .0001

12.05, 1 df, P = .0005

Race

7.64, 1 df, P = .0058

3.75, 1 df, P = 0.0529

Pay grade

13.13, 2 df, P < .0001

5.74, 2 df, P = .0032

Branch

2.58, 1 df, P = .1080

3.43, 1 df, P = .0643

Smoking

36.81, 1 df, P < 0.0001

6.38, 1 df, P = 0.0116

Drinking

51.12, 1 df, P < 0.0001

21.97, 1 df, P < 0.0001

Body mass index

78.73, 1 df, P < 0.0001

1.30, 1 df, p = 0.2540

Group B

Participants

42.12

3.06, 1 df, P = .0808

43.92

10.73, 1 df, P = .0011

Controls

43.81

 

48.07

 

Age

0.20, 1 df, P = .6510

2.64, 1 df, P = .1048

Race

4.01, 1 df, P = .0457

1.93, 1 df, P = .1652

Pay grade

2.98, 2 df, P = .0514

0.56, 2 df, P = .5721

Branch

0.77, 1 df, P = .3809

24.96, 1 df, P < .0001

Smoking

14.51, 1 df, P = 0.0002

1.14, 1 df, P = 0.2866

Drinking

22.12, 1 df, P < 0.0001

3.29, 1 df, P = 0.0702

Body mass index

11.25, 1 df, P = 0.0008

0.14, 1 df, P = 0.7120

Group C

Participants

47.51

2.06, 1 df, P = .1517

53.03

3.59, 1 df, P = .0587

Controls

48.79

 

54.94

 

Age

6.05, 1 df, P = .0142

0.03, 1 df, P = .8725

Race

0.42, 1 df, P = .5185

0.02, 1 df, P = .8888

Pay grade

4.07, 2 df, P = .0176

3.01, 2 df, P = 0.0501

Branch

0.84, 1 df, P = .8597

0.29, 1 df, P = .5894

Smoking

6.76, 1 df, P = 0.0095

3.91, 1 df, P = 0.0486

Drinking

17.16, 1 df, P < 0.0001

6.28, 1 df, P = 0.0125

Body mass index

27.28, 1 df, P < 0.0001

0.74, 1 df, P = 0.3914

Group D

 

 

 

 

Participants

45.50

 

47.70

40.26, 1 df, P < .0001

Controls

47.88

7.56, 1 df, P = .0061

52.97

 

Age

7.47, 1 df, P = .0064

8.38, 1 df, P = 0.0039

Race

0.35, 1 df, P = .3519

2.32, 1 df, P = 0.1282

Pay grade

4.25, 2 df, P = .0146

2.17, 2 df, P = 0.1146

Branch

Smoking

16.92, 1 df, P < 0.0001

7.75, 1 df, P = 0.0055

Drinking

17.94, 1 df, P < 0.0001

15.12, 1 df, P < 0.0001

Body mass index

40.37, 1 df, P < 0.0001

0.12, 1 df, P = 0.7244

NOTE: Mean SF-36 summary scores adjusted for age, race, pay grade, branch, smoking, drinking, and body mass index. Statistically significant items are in bold.

*Group A = participants potentially exposed only to BG or MAA; group B = participants potentially exposed only to TOF; group C = participants potentially exposed to any active chemical or biological agent; group D = participants potentially exposed only to simulants and not in groups A or B.

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

Differences between participants and controls for adjusted mean MCS scores were small in groups A and C (group A’s difference was statistically significant), whereas groups B and D showed larger differences (both statistically significant). The statistical significance of age, race, pay grade, and branch varied by group and by summary score, especially the effect of branch in group B’s MCS score. We note that although group C participants were the only subjects potentially exposed to active agents, neither adjusted mean PCS or MCS scores differed from those of group C controls.

Analysis of Group A “Factorial Design”

The subjects in group A were exposed only to Bacillus globigii (BG) simulant agent or methylacetoacetate (MAA), which allows a natural factorial design that allows for independent estimates of the effects of BG and MAA. Table 10-6 shows the results of a general linear model analysis of PCS and MCS mean scores, based on 2,661 subjects. The first analysis is a main effects model with separate effects for BG and MAA exposure, adjusted for age at participation, race, pay grade, branch, smoking, drinking, and body mass index. The second analysis was identical to the first, except that an additional adjustment was made for number of tests, a categorical variable with level 0 for controls and levels 1, 2, or 3 for participants.

In model 1, without adjustment for number of tests, potential exposure to BG or to MAA resulted in a statistically significant lowering of the PCS scores of around one point. MCS scores in model 1 were not statistically significantly different for BG exposure, but they were for MAA exposure, the difference being around 2.5 points. We also fit the same model with an interaction term added, which was not statistically significant (data not shown). In model 2, the effects of possible BG and MAA exposure were all attenuated and none were statistically significant. In model 2, the number of tests is a statistically significant factor for PCS and for MCS. For neither PCS nor MCS score is there a monotone decline in score with an increasing number of tests; that is, there is not a clear dose-response effect with number of tests.

Models 1 and 2 looked at the effects of simple BG or MAA exposure as either a yes or no. In Table 10-7 we report an analysis that attempts to assign “doses” of BG and MAA. Specifically, in this model, we defined the dose for BG and MAA as the number of tests at which a particular subject might have been exposed to these agents. For example, participation in Autumn Gold yields a BG dose of 1 and an MAA dose of 0, since only BG was used in that test. Eager Belle I, Eager Belle II, and Scarlet Sage also used only BG. Tests High Low and Purple Sage used only MAA, but DTC test 69-31 used both BG and MAA. The range of observed dose for BG ranged from 0 (controls) to 3, while the range of observed dose for MAA ranged from 0 to 2.

General linear model analyses of PCS and MCS scores were run using BG and MAA dose data as independent variables, adjusted for age, race, pay grade, and branch. Table 10-7 shows that both PCS and MCS scores have a statistically significant difference by BG and MAA dose, although neither exposure relationship shows a clear gradient. The maximum effect size is around 3–4 points for BG and MAA dose effects.

However, it is mostly the highest exposure group for both PCS and MCS that is not strictly monotone, and this is the group whose effect estimates have the largest standard error. Thus, we did analyses for linear trends. We found statistically significant coefficients for linear trend for both BG and MAA for both PCS and MCS scores, evidence that PCS and MCS scores were statistically significantly lower with each additional test in which there was potential exposure to either BG or MAA.

Analysis of Individual Exposure Data from DTC Test 69-10

As explained in detail in Chapter 8, during Project SHAD (Shipboard Hazard and Defense) test DTC 69-10, Marine troops were subjected to a simulated chemical weapons assault with the purpose of determining the “operational effects of a persistent, toxic, chemical agent spray attack on U.S. amphibious forces.” During this test, sampling was conducted on exposed personnel and their clothing to determine the extent of exposure to the simulant agent, trioctyl phosphate (TOF). DTC test 69-10 was conducted at Vieques island, east of Puerto Rico, on May 3, 4, 5, and 7, 1969. Using material from a redacted version of the DTC test 69-10 final report, we assigned individual exposure levels based on individual estimates of magnitude of contamination on an ordinal

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

TABLE 10-6 Mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores for Subjects in Group A (Standard Errors in Parentheses), by Agent, with Adjustment for Age, Race, Branch, Pay Grade, Smoking, Drinking, and Body Mass Index (Model 1) or These Factors Plus Number of Tests (Model 2)

Model Factor and Level

Adjusted Mean PCS Value

F-Test Value and Probability

Adjusted Mean MCS Value

F-Test Value and Probability

Model 1

BG

 

 

 

 

No

45.84 (1.25)

10.38, 1 df, P = .0013

48.80 (1.37)

2.77, 1 df, P = .0964

Yes

44.37 (1.21)

 

47.97 (1.33)

 

MAA

 

 

 

 

No

45.92 (1.20)

11.38, 1 df, P = .0008

49.58 (1.32)

20.11, 1 df, P < .0001

Yes

44.28 (1.26)

 

47.19 (1.39)

 

Age

29.06, 1 df, P < .0001

6.62, 1 df, P = .0101

Race

7.89, 1 df, P = .0050

3.76, 1 df, P = .0526

Pay grade

12.88, 2 df, P < .0001

6.66, 2 df, P = .0013

Branch

1.02, 1 df, P = .3123

4.38, 1 df, P = .0364

Smoking

35.53, 1 df, P < .0001

5.86, 1 df, P = .0155

Drinking

51.54, 1 df, P < .0001

21.61, 1 df, P < .0001

BMI*

76.35, 1 df, P < .0001

1.47, 1 df, P = .2251

Model 2

BG

 

 

 

 

No

44.45 (1.40)

0.85, 1 df, P = .3565

47.78 (1.54)

1.23, 1 df, P = .2666

Yes

45.33 (1.35)

 

48.94 (1.48)

 

MAA

 

 

 

 

No

45.36 (1.30)

1.37, 1 df, P = .2422

49.17 (1.43)

3.35, 1 df, P = .0674

Yes

44.42 (1.40)

 

47.55 (1.54)

 

Age

32.52, 1 df, P < .0001

5.52, 1 df, P = .0189

Race

7.69, 1 df, P = .0056

3.58, 1 df, P = .0584

Pay grade

14.78, 2 df, P < .0001

7.63, 2 df, P = .0005

Branch

0.54, 1 df, P = .4605

4.87, 1 df, P = .0274

Smoking

34.91, 1 df, P < .0001

5.77, 1 df, P = .0164

Drinking

49.80, 1 df, P < .0001

20.67, 1 df, P < .0001

BMI*

77.63, 1 df, P < .0001

1.60, 1 df, P = .2067

Number of tests

0

46.59 (1.53)

5.57, 3 df, P = .0008

49.86 (1.68)

2.74, 3 df, P = .0419

1

45.38 (1.21)

 

48.54 (1.33)

 

2

42.56 (1.37)

 

46.51 (1.50)

 

3

45.03 (2.10)

 

48.53 (2.31)

 

NOTE: Statistically significant items are in bold.

*BMI = body mass index.

scale: VH (very heavy), H (heavy), M (medium), L (light), VL (very light), T (trace) and N (negligible). When multiple exposures were taken into account, there were 428 individuals who had ordinal contamination data from one or more trials. Because we were unable to obtain quantitative data regarding the contamination levels, we analyzed the TOF exposure data by arbitrarily assigning the following exposure values: T (trace) and N (negligible) = 0.5; VL (very light) = 1.0; L (light) = 2.0; M (medium) = 3.0; H (heavy) = 4.0; and VH (very heavy) = 5.0. We further assigned a dose of zero to Marine controls in DTC test 69-10.

A total of 260 Marine subjects in group B provided data for an analysis of SF-36 summary outcomes. After adjusting for age, race, and pay grade, SF-36 PCS did not differ significantly by assigned TOF exposure levels (F statistic = 0.01, 1 df, P = .9309) nor did mental component scores (F statistic = 0.44, 1 df, P = .5094). When we dichotomized exposure into two groups, with “high” defined as 4.0 or more and “low” defined as less than 4.0, we

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

TABLE 10-7 Mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores (Standard Errors in Parentheses) for Subjects in Group A, by “Dose” of Agent, with Adjustment for Age, Race, Pay Grade, and Branch

Model Factor and Dosea

Adjusted Mean PCS Value

F-Test Value and Probability

Adjusted Mean MCS Value

F-Test Value and Probability

BG

 

 

 

 

0

46.30 (1.46)

6.93, 3 df, P = .0001

48.58 (1.61)

4.12, 3 df, P = .0063

1

45.77 (1.43)

 

48.75 (1.57)

 

2

43.30 (1.47)

 

46.15 (1.62)

 

3

45.25 (2.93)

 

49.87 (3.22)

 

MAA

 

 

 

 

0

45.27 (1.36)

9.24, 2 df, P < .0001

49.48 (1.49)

12.91, 2 df, P < .0001

1

43.11 (1.45)

 

46.62 (1.59)

 

2

47.08 (2.61)

 

48.91 (2.87)

 

Age

31.59, 1 df, P < .0001

5.35, 1 df, P = .0208

Race

7.70, 1 df, P = .0056

3.60, 1 df, P = .0579

Pay grade

14.42, 2 df, P < .0001

7.82, 2 df, P = .0004

Branch

0.29, 1 df, P = .5907

6.28, 1 df, P = .0123

Smoking

35.42, 1 df, P < .0001

5.73, 1 df, P = .0167

Drinking

48.88, 1 df, P < .0001

19.96, 1 df, P < .0001

BMIb

76.61, 1 df, P < .0001

1.45, 1 df, P = .2286

NOTE: Statistically significant items are in bold.

aDose is the number of tests in which a subject was potentially exposed to an agent.

bBMI = body mass index.

found similar results. The SF-36 summary scores did not differ statistically significantly for either PCS (F statistic = 0.00, 1 df, P = .9937) or MCS (F statistic = 0.40, 1 df, P = .5278).

SF-36 Summary

In summary, we detected many statistically significant differences in SF-36 scores, although relatively few were of even moderate size. In most cases, differences in adjusted SF-36 summary scores are all around two points, with age and pay grade generally the most important covariates, although group C differences were smaller and not statistically significant. In comparison to national norms, both participants and controls had lower PCS and MCS scores (worse health), but controls had PCS and MCS scores that were nearer the national norms. In comparison, veterans aged 50–64 in the Veterans Health Study, who were receiving outpatient care from the Department of Veterans Affairs (VA), had an average PCS score of 37.2 and an average MCS score of 47.0 (Payne et al., 2005), both of which are substantially lower than the participant or control scores in our study.

An analysis of the independent effects of BG and MAA exposure in group A found that neither agent was associated with a large change in SF-36 summary score, although both agents had a statistically significant effect on both PCS and MCS adjusted mean scores. We did not see a clear dose-response relationship between the number of tests in group A and either PCS or MCS, but there was a statistically significant linear trend. An analysis of the only individual exposure data available, from DTC test 69-10, showed no statistically significant association of recorded exposure level, either on an ordinal scale or dichotomized, with either PCS or MCS.

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

OTHER SCALED DATA

Somatization Scale

Twelve items, taken from the Structured Clinical Interview for DSM-IV (SCID) somatization scale, were included in the Project SHAD health survey questionnaire. The number of “yes” responses was totaled to produce a score ranging from 0 to 12. If 3 or more items were missing, the score was considered missing. Table 10-8 shows unadjusted and adjusted (for age, race, pay grade, branch, smoking, drinking, and BMI) somatization scores for participants and controls by analysis group; all mean differences were statistically significant. Somatization scores were uniformly higher for participants, with differences typically less than one point.

Memory and Attention Subscales of the Neuropsychological Scale

The subscales on memory and attention problems, taken from the Neuropsychological Impairment Scale (O’Donnell et al., 1993), were included in the Project SHAD health survey questionnaire. Each questionnaire item (e.g., “I have a hard time remembering people’s names”) is scored from 1 to 5 (“not at all” to “extremely”) and the individual items scores are summed. The responses on the memory subscale range from 0 to 32, and the attention subscale responses range from 0 to 36. We also analyzed data based on a dichotomous outcome, with a score of 14 or more on either scale considered as “high.”

Table 10-9 shows unadjusted and adjusted (for age, race, pay grade, branch, smoking, drinking, and BMI) memory and attention scores for participants and controls by analysis group. Except for group C, all mean differences were statistically significant; in group C only the adjusted memory scale scores were significantly different. Both memory and attention scores were uniformly higher for participants (indicating greater problems), with differences in unadjusted mean scores ranging from one to almost four points. The largest differences were found in group B.

OTHER MEDICAL DATA

Medical Conditions

Table 10-10 shows self-reported medical conditions by analysis group. The original 45 medical conditions (including open-ended items such as “Any other heart condition [please specify]”) have been grouped into 11 broader categories for analysis. Adjusted (for age, race, pay grade, smoking, drinking, and BMI) odds ratios (OR) are shown, with statistically significant odds ratios shown in bold.

TABLE 10-8 Mean Somatization Scores, Unadjusted and Adjusted, for Participants and Controls, by Analysis Group

 

Unadjusted

Adjusteda

Participants

Controls

Participants

Controls

Group Ac

2.83b

2.15

2.38b

1.63

Group Bc

3.49b

2.59

3.62b

2.90

Group Cc

3.02b

2.59

2.18b

1.62

Group Dc

2.90b

2.27

2.76b

1.98

aAdjusted for age, race, pay grade, branch, smoking, drinking, and body mass index.

bStatistically significant difference.

cGroup A = participants potentially exposed only to BG or MAA; group B = participants potentially exposed only to TOF; group C = participants potentially exposed to any active chemical or biological agent; group D = participants potentially exposed only to simulants and not in groups A or B.

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

TABLE 10-9 Mean Memory and Attention Scores, Unadjusted and Adjusted, for Participants and Controls, by Analysis Groupa

 

Unadjusted

Adjustedc

Participants

Controls

Participants

Controls

Group A

Memory

8.33b

6.83

8.27b

6.64

Attention

9.09b

7.10

9.30b

7.17

Group B

Memory

10.08b

7.56

10.12b

8.32

Attention

11.66b

7.93

11.41b

8.25

Group C

Memory

8.46

7.59

5.74b

4.56

Attention

9.23

8.37

5.52

4.35

Group D

Memory

8.53b

6.89

8.30b

6.51

Attention

9.62b

7.38

9.69b

7.23

aGroup A = participants potentially exposed only to BG or MAA; group B = participants potentially exposed only to TOF; group C = participants potentially exposed to any active chemical or biological agent; group D = participants potentially exposed only to simulants and not in groups A or B.

bStatistically significant difference.

cAdjusted for age, race, pay grade, branch, smoking, drinking, and body mass index.

TABLE 10-10 Number of Medical Conditions for Participants and Controls, with Adjusted Odds Ratios (ORs) and 95% Confidence Intervals (CIs), by Analysis Group

 

Participants

Controls

Adjusted OR*

95% CI

Group A

N = 1,548

N = 1,326

 

 

Cardiovascular

1,106

892

1.31

1.05–1.62

Visual

541

418

1.21

0.98–1.50

Respiratory

648

460

1.49

1.22–1.83

Renal

245

158

1.49

1.09–1.96

Endocrine

556

421

1.26

1.01–1.56

Liver

124

89

1.11

0.76–1.62

Autoimmune

323

253

1.09

0.85–1.40

Gastrointestinal

256

179

1.28

0.97–1.68

Neurological

468

567

1.54

1.26–1.88

Psychological

375

259

1.59

1.25–2.04

Cancer

263

185

1.43

1.08–1.89

Group B

N = 384

N = 230

 

 

Cardiovascular

278

154

1.47

0.83–2.60

Visual

115

55

1.02

0.57–1.84

Respiratory

177

81

1.57

0.90–2.74

Renal

63

20

1.74

0.79–3.80

Endocrine

112

68

0.96

0.53–1.76

Liver

38

20

0.66

0.24–1.81

Autoimmune

102

43

2.14

1.05–4.35

Gastrointestinal

74

28

1.75

0.82–3.74

Neurological

214

87

2.01

1.16–3.47

Psychological

161

63

2.84

1.50–5.37

Cancer

56

24

1.27

0.52–3.09

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

 

Participants

Controls

Adjusted OR*

95% CI

Group C

N = 337

N = 376

 

 

Cardiovascular

251

264

1.16

0.73–1.86

Visual

120

118

1.43

0.93–2.20

Respiratory

159

139

1.27

0.85–1.92

Renal

59

52

1.17

0.68–2.00

Endocrine

128

133

0.78

0.50–1.20

Liver

16

32

0.47

0.20–1.07

Autoimmune

68

73

1.23

0.75–2.01

Gastrointestinal

72

66

1.97

1.17–3.32

Neurological

175

166

1.16

0.77–1.75

Psychological

90

89

1.12

0.70–1.79

Cancer

69

60

1.35

0.79–2.32

Group D

N = 411

N = 498

 

 

Cardiovascular

286

333

1.06

0.71–1.59

Visual

131

144

1.18

0.80–1.74

Respiratory

169

178

1.30

0.90–1.88

Renal

63

56

1.65

0.98–2.72

Endocrine

131

157

1.08

0.73–1.62

Liver

28

38

1.09

0.57–2.06

Autoimmune

83

98

0.97

0.61–1.54

Gastrointestinal

59

68

1.07

0.65–1.75

Neurological

184

221

1.04

0.72–1.50

Psychological

121

94

2.04

1.34–3.09

Cancer

71

59

1.40

0.86–2.28

NOTE: Cardiovascular: hypertension, coronary heart disease, heart attack, angina, other heart condition, stroke; Visual: cataract/lens problems, conjunctivitis; Respiratory: sinusitis, chronic bronchitis, emphysema, asthma; Renal: kidney failure, bladder infection; Endocrine: pancreatitis, diabetes, gallstones, thyroid condition; Liver: hepatitis B, hepatitis C, any other hepatitis, cirrhosis; Autoimmune: rheumatoid arthritis, lupus, multiple sclerosis; Gastrointestinal: Crohn’s disease, stomach/peptic ulcer, ulcerative colitis; Neurologic: neuropathy, seizures, Parkinson’s, amyotrophic lateral sclerosis, other neurodegenerative disease, migraines, hearing loss; Psychologic: depression, schizophrenia/ psychosis, manic depressive disorder, post-traumatic stress disorder. Sleep apnea, anemia, chronic fatigue syndrome, and dermatitis/eczema/ psoriasis did not fit into any categories. Statistically significant odds ratios in bold.

*Adjusted for age, race, pay grade, smoking, drinking, and body mass index.

Based on adjusted OR estimates, in group A there were significantly more cardiovascular, respiratory, renal, endocrine, gastrointestinal, neurological, and psychological medical conditions reported by participants than controls; in group B, significantly more respiratory, renal, autoimmune, gastrointestinal, neurological, and psychological conditions reported by participants; for group C, significantly more respiratory and neurological conditions; and in group D, significantly more psychological conditions. Most adjusted ORs were under 2.0. Respiratory conditions were reported at significantly higher rates among participants in all analysis groups but group D, and psychological conditions in all but group C.

Table 10-11 shows a distribution of self-reported cancer by type. Skin cancer and prostate cancer are generally reported with the highest prevalences.

Table 10-12 shows adjusted ORs for medical conditions as they appeared in the questionnaire, rather than grouped into broader categories. The sparser data make for larger confidence intervals (CIs) and some slightly higher ORs. All groups reported higher rates of neurodegenerative conditions, with relatively large and statistically significant ORs in groups A, B, and C. Table 10-13 shows a breakdown of these self-reported neurodegenerative

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

TABLE 10-11 Summary of Cancer Types by Group and Participant Status

 

Participant

Control

Group A

(N = 263)

(N = 185)

Skin

15.2% (40)

12.4% (23)

Prostate

12.5% (33)

19.5% (36)

Colon

4.2% (11)

2.7% (5)

Lung

2.3% (6)

3.8% (7)

Other

6.1% (16)

(includes 3 kidney, 4 leukemia, 2 bladder, 2 multiple myeloma, 2 NHL, 1 liver, 2 testicular)

7.0% (13)

(includes 1 esophageal, 3 kidney, 2 leukemia, 2 NHL, 2 bone, 1 bladder, 1 lip, 1 throat)

Unspecified

59.6% (157)

66.1% (101)

Group B

(N = 56)

(N = 24)

Skin

17.9% (10)

37.5% (9)

Prostate

8.9% (5)

4.2% (1)

Colon

3.6% (2)

8.3% (2)

Lung

5.4% (1)

8.3% (2)

Other

7.5% (3)

(includes 1 kidney, 1 bladder, 1 testicular)

25.0% (6)

(includes 3 bladder, 1 liver, 1 throat, 1 testicular)

Unspecified

62.5% (35)

16.7% (4)

Group C

(N = 69)

(N = 60)

Skin

34.7% (24)

13.3% (8)

Prostate

7.2% (5)

16.7% (10)

Colon

1.4% (1)

3.3% (2)

Lung

0% (0)

3.3% (2)

Other

7.2% (5)

(includes 2 bladder, 1 NHL, 1 kidney, 1 thyroid)

11.7% (7)

(includes 3 bladder, 2 throat, 1 lymphoma, 1 leukemia)

Unspecified

49.3% (34)

51.7% (31)

Group D

(N = 71)

(N = 59)

Skin

16.9% (12)

13.6% (8)

Prostate

14.1% (10)

8.5% (5)

Colon

0% (0)

5.1% (3)

Lung

2.8% (2)

3.4% (2)

Other

2.8% (2)

(includes 1 NHL, 1 bladder)

8.5% (5)

(includes 2 throat, 1 kidney, 1 leukemia, 1 testicular)

Unspecified

63.4% (45)

61.0% (36)

NOTE: NHL = non-Hodgkin’s lymphoma.

conditions. Most of the entries were unspecified, some overlap the categories in Table 10-12 (e.g., neuropathy), and the inclusion of conditions such as arthritis calls into doubt the utility of these data for further analyses.

Table 10-14 shows self-reported symptoms, rather than medical conditions, for participants and controls, along with adjusted ORs. In contrast to the data on medical conditions, nearly every symptom is reported at higher prevalence among participants than nonparticipants, even though not all differences are statistically significant. Among these is included “earlobe pain,” an item without a clear medical basis, included to obtain data on possible overreporting of medical problems.

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

TABLE 10-12 Ungrouped Medical Conditions by Analysis Group, Comparing Participants to Controls (Navy and Marine Only)

Analysis Group and Medical Condition

Participants (N = 1,548)

Controls (N = 1,326)

Adjusted OR for Age, Race, Pay Grade, Smoking, Drinking, and BMI

95% CI

Group A

N

N

 

 

Hypertension

949

766

1.24

1.00–1.53

Coronary heart disease

338

242

1.30

1.01–1.68

Heart attack

265

186

1.23

0.93–1.62

Angina

374

261

1.31

1.02–1.67

Other heart condition

157

112

1.59

0.61–4.13

Cataracts/eye lens

497

397

1.14

0.92–1.42

Conjunctivitis

85

36

2.85

1.54–5.25

Sinusitis

455

290

1.63

1.30–2.04

Chronic bronchitis

230

156

1.56

1.15–2.12

Emphysema

106

139

1.28

0.89–1.83

Asthma

157

115

1.20

0.85–1.69

Kidney failure

16

13

0.78

0.22–2.75

Bladder infection

235

148

1.48

1.09–1.99

Pancreatitis

33

28

1.17

0.59–2.31

Diabetes

363

279

1.24

0.96–1.59

Gallstones

163

110

1.15

0.82–1.61

Hepatitis B

37

25

0.88

0.41–1.86

Hepatitis C

26

23

0.91

0.42–1.97

Any other hepatitis

46

37

0.85

0.50–1.47

Cirrhosis

33

23

1.54

0.73–3.26

Rheumatoid arthritis

303

244

1.06

0.82–1.37

Lupus

14

10

0.96

0.32–2.88

Multiple sclerosis

5

4

0.91

0.06–14.63

Crohn’s disease

13

9

1.43

0.46–4.1

Stomach/peptic ulcer

214

154

1.24

0.92–1.67

Ulcerative colitis

51

44

0.94

0.53–1.66

Hearing loss

567

405

1.31

1.06–1.61

Migraines

171

112

1.86

1.28–2.71

Stroke

107

71

1.27

0.82–1.96

Neuropathy

320

203

1.69

1.30–2.20

Seizures

32

34

1.05

0.53–2.09

Sleep apnea

319

222

1.31

1.00–1.70

Anemia

75

52

1.29

0.79–2.11

Thyroid condition

98

82

1.12

0.76–1.66

Cancer

263

185

1.43

1.08–1.89

Chronic fatigue syndrome

100

41

2.55

1.51–4.30

Depression

350

234

1.68

1.30–2.16

Schizophrenia

19

11

4.34

0.95–19.89

Manic depressive disorder

42

29

1.42

0.70–2.88

PTSD

105

88

0.99

0.65–1.50

Dermatitis, eczema, psoriasis

269

135

1.83

1.36–2.45

Parkinson’s

9

5

2.39

0.48–12.02

ALS

2

1

1.70

0.15–18.89

Other neurodegenerative disease

61

18

3.77

1.81–7.84

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

Analysis Group and Medical Condition

Participants (N = 384)

Controls (N = 230)

Adjusted OR for Age, Race, Pay Grade, Smoking, Drinking, and BMI

95% CI

Group B

N

N

 

 

Hypertension

241

138

1.12

0.64–1.96

Coronary heart disease

74

37

1.28

0.59–2.79

Heart attack

57

25

1.29

0.56–2.97

Angina

108

48

2.12

1.06–4.16

Other heart condition

42

29

2.07

0.06–72.76

Cataracts/eye lens

101

46

1.01

0.55–1.87

Conjunctivitis

23

10

1.64

0.49–5.50

Sinusitis

121

53

1.86

1.00–3.44

Chronic bronchitis

68

32

1.68

0.70–4.04

Emphysema

41

14

1.21

0.43–3.42

Asthma

46

22

0.98

0.45–2.14

Kidney failure

6

0

 

Bladder infection

61

20

1.66

0.78–3.65

Pancreatitis

12

3

3.43

0.35–34.09

Diabetes

88

50

0.87

0.45–11.66

Gallstones

27

20

1.22

0.43–3.72

Hepatitis B

15

4

1.77

0.19–16.33

Hepatitis C

14

8

0.62

0.17–2.34

Any other hepatitis

11

5

0.86

0.15–5.06

Cirrhosis

5

6

0.66

0.05–8.16

Rheumatoid arthritis

99

41

2.28

1.09–4.74

Lupus

4

1

 

Multiple sclerosis

2

0

 

Crohn’s disease

2

1

0.92

0.08–11.04

Stomach/peptic ulcer

62

25

1.93

0.81–4.56

Ulcerative colitis

17

2

2.63

0.53–13.03

Hearing loss

154

55

2.08

1.14–3.79

Migraines

70

25

3.15

1.16–8.58

Stroke

23

12

1.05

0.30–3.67

Neuropathy

88

34

1.46

0.70–3.3

Seizures

18

6

1.14

0.28–4.69

Sleep apnea

91

52

0.98

0.51–1.86

Anemia

20

12

2.83

0.56–14.26

Thyroid condition

19

9

2.55

0.55–11.87

Cancer

56

24

1.27

0.52–3.09

Chronic fatigue syndrome

31

12

9.27

1.12–76.80

Depression

136

56

2.55

1.33–4.91

Schizophrenia

12

4

1.68

0.33–8.66

Manic depressive disorder

24

8

3.20

0.67–15.41

PTSD

91

28

5.87

1.99–17.33

Dermatitis, eczema, psoriasis

52

28

1.85

0.71–4.82

Parkinson’s

6

0

 

ALS

1

0

 

Other neurodegenerative disease

18

4

2.85

0.31–25.93

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

Analysis Group and Medical Condition

Participants (N = 337)

Controls (N = 376)

Adjusted OR for Age, Race, Pay Grade, Smoking, Drinking, and BMI

95% CI

Group C

N

N

 

 

Hypertension

211

232

1.06

0.69–1.65

Coronary heart disease

67

82

0.91

0.55–1.50

Heart attack

50

66

0.85

0.49–1.46

Angina

71

90

0.93

0.58–1.51

Other heart condition

36

38

0.64

0.06–6.61

Cataracts/eye lens

106

104

1.20

0.77–1.86

Conjunctivitis

23

19

2.52

0.98–6.47

Sinusitis

115

86

1.46

0.93–2.28

Chronic bronchitis

57

45

1.18

0.62–2.24

Emphysema

35

36

1.21

0.61–2.38

Asthma

42

32

1.44

0.74–2.82

Kidney failure

5

3

1.59

0.09–27.74

Bladder infection

56

50

1.14

0.66–1.97

Pancreatitis

13

8

1.81

0.49–6.69

Diabetes

80

90

0.68

0.41–1.13

Gallstones

41

39

0.82

0.43–1.55

Hepatitis B

5

11

0.33

0.08–1.36

Hepatitis C

4

10

0.40

0.08–2.05

Any other hepatitis

6

9

0.97

0.29–3.29

Cirrhosis

4

6

0.28

0.03–2.61

Rheumatoid arthritis

66

69

1.30

0.78–2.15

Lupus

1

4

0.35

0.04–3.45

Multiple sclerosis

0

0

 

Crohn’s disease

4

3

1.68

0.28–10.26

Stomach/peptic ulcer

57

60

1.79

1.04–3.08

Ulcerative colitis

19

7

4.99

1.29–19.30

Hearing loss

119

121

0.99

0.64–1.53

Migraines

45

41

1.21

0.66–2.24

Stroke

18

21

1.46

0.60–3.53

Neuropathy

70

62

1.31

0.79–2.19

Seizures

14

9

2.02

0.57–7.15

Sleep apnea

74

73

0.97

0.57–1.65

Anemia

28

21

1.69

0.76–3.77

Thyroid condition

25

23

1.17

0.52–2.65

Cancer

69

60

1.35

0.79–2.32

Chronic fatigue syndrome

26

25

1.65

0.78–3.60

Depression

86

84

1.19

0.74–1.91

Schizophrenia

2

9

0.16

0.02–1.77

Manic depressive disorder

8

9

0.72

0.14–3.58

PTSD

17

27

0.54

0.20–1.48

Dermatitis, eczema, psoriasis

66

49

1.71

0.96–3.03

Parkinson’s

6

8

0.79

0.23–2.72

ALS

0

1

 

Other neurodegenerative disease

17

6

3.25

0.84–12.59

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

Analysis Group and Medical Condition

Participants (N = 411)

Controls (N = 498)

Adjusted OR for Age, Race, Pay Grade, Smoking, Drinking, and BMI

95% CI

Group D

N

N

 

 

Hypertension

254

290

0.92

0.62–1.35

Coronary heart disease

80

86

1.21

0.73–2.01

Heart attack

61

63

1.34

0.78–2.31

Angina

91

94

1.45

0.92–2.27

Other heart condition

48

41

0.95

0.12–7.86

Cataracts/eye lens

118

135

1.16

0.78–1.72

Conjunctivitis

22

22

0.96

0.42–2.22

Sinusitis

114

119

1.02

0.68–1.52

Chronic bronchitis

66

54

1.91

1.08–3.38

Emphysema

42

42

1.21

0.65–2.26

Asthma

41

52

1.33

0.75–2.37

Kidney failure

3

2

1.77

0.29–10.83

Bladder infection

61

54

1.68

0.99–2.87

Pancreatitis

6

20

0.28

0.07–1.02

Diabetes

85

108

1.17

0.75–1.83

Gallstones

27

35

0.79

0.39–1.61

Hepatitis B

9

19

0.73

0.27–1.96

Hepatitis C

5

9

1.00

0.26–3.86

Any other hepatitis

8

10

1.48

0.44–4.44

Cirrhosis

8

5

1.85

0.48–7.08

Rheumatoid arthritis

80

92

0.99

0.62–1.58

Lupus

4

2

4.14

0.42–41.20

Multiple sclerosis

4

5

1.67

0.36–7.70

Crohn’s disease

3

1

2.25

0.20–25.20

Stomach/peptic ulcer

51

59

1.00

0.59–1.71

Ulcerative colitis

16

14

1.81

0.71–4.63

Hearing loss

122

147

1.01

0.68–1.51

Migraines

59

53

1.70

0.98–2.94

Stroke

24

32

0.67

0.28–1.58

Neuropathy

81

80

1.25

0.79–1.98

Seizures

10

11

2.05

0.59–7.18

Sleep apnea

101

92

1.43

0.91–2.24

Anemia

26

30

0.83

0.41–1.69

Thyroid condition

40

31

1.84

0.95–3.53

Cancer

71

59

1.40

0.86–2.28

Chronic fatigue syndrome

29

21

2.46

1.19–5.10

Depression

115

88

1.91

1.25–2.93

Schizophrenia

8

2

8.04

0.95–68.01

Manic depressive disorder

18

10

2.49

0.81–7.64

PTSD

32

30

2.06

1.04–3.09

Dermatitis, eczema, psoriasis

79

70

1.52

0.93–2.47

Parkinson’s

2

2

 

ALS

0

0

 

Other neurodegenerative disease

17

14

2.74

1.00–7.53

NOTE: PTSD = post-traumatic stress disorder; ALS = amyotrophic lateral sclerosis (Lou Gehrig disease). Statistically significant odds ratios in bold.

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

TABLE 10-13 Reports of Other Neurodegenerative Diseases by Participant and Group Status

 

Participant

Control

Group A

(N = 61)

46 unspecified, 8 spinal problems/degenerative discs, 1 meningitis, 1 myasthenia gravis, 1 dementia, 1 erectile dysfunction, 1 diverticulitis, 1 gout, 1 polio

(N = 18)

13 unspecified, 2 spinal/degenerative discs, 1 arthritis, 1 dementia, 1 neuropathy

Group B

(N = 18)

8 unspecified, 7 spinal problems/degenerative discs, 2 arthritis, 1 diverticulitis

(N = 4)

1 unspecified, 2 osteoporosis, 1 anxiety

Group C

(N = 17)

12 unspecified, 3 tremors, 1 hearing loss, 1 attention deficit disorder

(N = 6)

4 unspecified, 1 dementia, 1 neuropathy

Group D

(N = 17)

15 unspecified, 1 arthritis, 1 anxiety

(N = 14)

8 unspecified, 2 neuropathy, 1 myasthenia gravis, 1 Guillan-Barre syndrome, 1 brain tumor, 1 spinal problem

Hospitalizations Since Discharge from Active Duty

Table 10-15 shows self-reported data on hospitalizations since discharge from active duty. Roughly two-thirds of participants and controls reported a hospitalization, across all analysis groups; there were no statistically significant differences. Data on the mean number of hospitalizations (those not reporting a hospitalization were assigned zero number of hospitalizations) showed nearly equal rates between participants and controls across analysis groups, with no statistically significant differences.

Birth Defects

Table 10-16 shows data on self-reported birth defects. To calculate these rates, we divided the number of subjects who reported children with birth defects by the number of “eligible fathers.” Eligible fathers are defined as men who answered “yes” to the following question, “Have you ever been the biological father of any pregnancy, regardless of whether there was a live birth outcome from that pregnancy?” and also answered one or more to the following question, “How many of the pregnancies ended in live births, even if the infant died shortly after birth?”

Table 10-16 shows that roughly 10–16 percent of participants reported birth defects among their children born live. The corresponding rate among participant subjects was larger in group D, while the mean number of children born with birth defects showed no statistically significant differences.

REFERENCES

O’Donnell, W. E., C. B. DeSoto, and J. L. DeSoto. 1993. Validity and reliability of the revised Neuropsychological Impairment Scale (NIS). Journal of Clinical Psychology 49:372-382.

Payne, S. M., A. Lee, J. A. Clark, W. H. Rogers, D. R. Miller, K. M. Skinner, X. S. Ren, and L. E. Kazis. 2005. Utilization of medical services by Veterans Health Study (VHS) respondents. Journal of Ambulatory Care Management 28:125-140.

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

TABLE 10-14 Numbers of Symptoms by Group Comparing Participants to Controls, with Adjusted Odds Ratios (ORs)

 

Participants

Controls

Adjusted OR*

95% CI

Group A

(N = 1,548)

(N = 1,326)

 

 

Severe headache

201

115

1.73

1.25–2.38

Diarrhea

284

143

1.90

1.43–2.52

Rash/skin ulcer

282

137

2.00

1.51–2.63

Sore throat

309

168

1.58

1.21–2.06

Frequent bladder infections

61

32

1.55

0.84–2.85

Cough

511

323

1.62

1.30–2.01

Fever

150

90

1.42

1.00–2.01

Unexplained hair loss

71

32

1.77

1.00–3.15

Earlobe pain

53

35

1.15

0.65–2.01

Sleepy all the time

321

207

1.52

1.16–1.98

Night sweats

373

253

1.34

1.05–1.70

Chest pain

325

191

1.79

1.38–2.34

Unusual muscle pains

483

286

1.77

1.41–2.21

Shortness of breath

592

414

1.53

1.24–1.89

Trouble sleeping

625

416

1.50

1.22–1.84

Unusual fatigue

444

309

1.42

1.13–1.78

Forgetfulness

561

399

1.71

1.38–2.12

Confusion

214

130

1.71

1.25–2.35

Group B

(N = 384)

(N = 230)

 

 

Severe headache

88

27

1.63

0.77–3.44

Diarrhea

91

28

2.41

1.10–5.28

Rash/skin ulcer

74

33

1.35

0.67–2.69

Sore throat

85

39

1.36

0.70–2.62

Frequent bladder infections

3

20

3.06

0.36–26.05

Cough

132

58

1.50

0.85–2.64

Fever

51

19

2.76

0.99–7.73

Unexplained hair loss

27

12

3.40

0.69–16.80

Earlobe pain

17

13

1.01

0.32–3.17

Sleepy all the time

124

37

3.73

1.71–8.41

Night sweats

149

52

3.10

1.58–6.07

Chest pain

106

46

1.59

0.83–3.06

Unusual muscle pains

160

61

1.35

0.77–2.37

Shortness of breath

154

73

1.65

0.94–2.91

Trouble sleeping

199

89

1.86

1.08–3..18

Unusual fatigue

164

52

2.87

1.55–5.30

Forgetfulness

176

71

2.45

1.34–4.74

Confusion

96

31

3.79

1.61–8.94

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

 

Participants

Controls

Adjusted OR*

95% CI

Group C

(N = 337)

(N = 376)

 

 

Severe headache

46

49

1.14

0.63–2.07

Diarrhea

68

66

1.28

0.76–2.15

Rash/skin ulcer

73

48

2.20

1.29–3.76

Sore throat

76

64

1.32

0.79–2.20

Frequent bladder infections

15

20

0.75

0.29–1.95

Cough

115

105

1.24

0.80–1.92

Fever

29

27

1.77

0.82–3.82

Unexplained hair loss

13

15

1.97

0.62–6.26

Earlobe pain

11

11

0.90

0.77–3.03

Sleepy all the time

81

78

1.07

0.66–1.76

Night sweats

74

87

1.07

0.66–1.72

Chest pain

71

79

1.02

0.62–1.68

Unusual muscle pains

132

90

2.51

1.62–3.90

Shortness of breath

135

143

1.15

0.76–1.75

Trouble sleeping

152

141

1.48

0.98–2.22

Unusual fatigue

119

102

1.88

1.21–2.92

Forgetfulness

136

123

1.73

1.13–2.64

Confusion

53

56

1.35

0.73–2.50

Group D

(N = 411)

(N = 498)

 

 

Severe headache

63

50

1.81

1.07–3.07

Diarrhea

63

78

1.10

0.69–1.77

Rash/skin ulcer

84

58

2.16

1.37–3.42

Sore throat

74

58

1.70

1.05–2.78

Frequent bladder infections

16

14

1.74

0.67–4.47

Cough

133

132

1.51

1.03–2.22

Fever

36

34

1.28

0.71–2.34

Unexplained hair loss

15

11

3.89

1.22–12.38

Earlobe pain

14

13

1.48

0.57–3.87

Sleepy all the time

98

73

2.03

1.28–3.23

Night sweats

95

95

1.36

0.89–2.08

Chest pain

82

74

1.61

1.01–2.55

Unusual muscle pains

133

110

1.85

1.25–2.75

Shortness of breath

169

143

1.81

1.23–2.66

Trouble sleeping

172

164

1.70

1.16–2.48

Unusual fatigue

135

116

1.72

1.16–2.54

Forgetfulness

148

143

1.68

1.15–2.46

Confusion

68

50

2.10

1.23–3.56

Note: Statistically significant odds ratios in bold.

*Adjusted for age, race, and pay grade.

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

TABLE 10-15 Proportion of Subjects Hospitalized Since Discharge from Active Duty Comparing Participants to Controls, with Adjusted Odds Ratios (ORs)

 

Participants

Controls

Adjusted OR*

95% CI

Group A

68.0% (484)

66.0% (396)

1.10

0.87–1.39

Group B

65.3% (124)

62.5% (91)

1.04

0.64–1.69

Group C

71.2% (116)

67.9% (114)

1.20

0.74–1.95

Group D

69.3% (133)

64.4% (152)

1.19

0.78–1.81

Mean # of Hospitalizations

Participants

Controls

Adjusted Means (95% CI) Participants

Adjusted Means (95% CI) Controls

Group A

3.18

3.23

2.82 (2.17–3.47)

2.86 (2.17–3.55)

Group B

3.69

3.23

3.17 (2.24–4.10)

3.45 (2.30–4.59)

Group C

3.69

3.61

3.95 (2.40–5.49)

4.12 (2.47–5.77)

Group D

2.81

3.40

2.97 (1.62–4.35)

2.35 (0.86–3.84)

NOTE: Percentages are based on those who answered question—not total number.

*Adjusted for age, race, and pay grade.

TABLE 10-16 Birth Defects Among Those Who Fathered a Child Comparing Participants to Controls, with Adjusted Odds Ratios (ORs)

 

Participants

Controls

Adjusted OR*

95% CI

Group A

10.8% (59)

13.0% (61)

0.82

0.56–1.21

Group B

14.8% (19)

16.5% (19)

1.11

0.55–2.27

Group C

16.1% (20)

9.3 (12)

1.02

0.96–1.09

Group D

13.3% (20)

5.6% (10)

2.42

1.07–5.48

Mean # of Birth Defects

Participants

Controls

Adjusted Means (95% CI) Participants

Adjusted Means (95% CI) Controls

Group A

0.14

0.15

0.10 (0.03–0.18)

0.12 (0.04–0.200

Group B

0.19

0.25

0.19 (0.06–0.31)

0.21 (0.05–0.37)

Group C

0.18

0.14

0.19 (0.04–0.35)

0.16 (-0.01–0.32)

Group D

0.18

0.08

0.28 (0.10–0.45)

0.18 (-0.01–0.37)

NOTE: Percentages and means are based on those who answered and had fathered a child. Statistically significant odds ratios in bold.

*Adjusted for age, race, and pay grade.

Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×
Page 45
Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×
Page 46
Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×
Page 47
Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×
Page 48
Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×
Page 49
Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×
Page 50
Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×
Page 51
Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×
Page 52
Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"10 Morbidity Results." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) Get This Book
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More than 5,800 military personnel, mostly Navy personnel and Marines, participated in a series of tests of U.S. warship vulnerability to biological and chemical warfare agents, Project SHAD (Shipboard Hazard and Defense), in the period 1962-1973. Only some of the involved military personnel were aware of these tests at the time. Many of these tests used simulants, substances with the physical properties of a chemical or biological warfare agent, thought at the time to have been harmless. The existence of these tests did not come to light until many decades later.

In September 2002, the Institute of Medicine (IOM) agreed to undertake a scientific study, funded by the Veterans' Affairs, of potential long-term health effects of participation in Project SHAD. In general, there was no difference in all-cause mortality between Project SHAD participants and nonparticipant controls, although participants statistically had a significantly higher risk of death due to heart disease, had higher levels of neurodegenerative medical conditions and higher rates of symptoms with no medical basis.

Long-Term Health Effects of Participation in Project SHAD focuses on the potential health effects of participation in Project SHAD. It is a useful resource for government defense agencies, scientists and health professionals.

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