of non-Vietnam veterans. No formal analysis of the difference in malformations between the veteran groups was conducted, because negative responses (i.e., children without a reported malformation) were not verified and the participation rates differed between groups (7.8 percent of Vietnam veterans and 22.1 percent of non-Vietnam veterans refused to participate).

The VES did find suggestive associations for birth defects. It is interesting to note that some potential associations were found for birth defects considered by the investigators to be "relatively common, easily diagnosed, and observable at birth" (CDC, 1989). These include hydrocephalus (OR = 5.1, CI 1.1-23.1) and hypospadias (OR = 3.1, CI 0.9-11.3). The GBDS did not replicate these findings, but this sample had limited power for the analysis of specific defects. Although associations were not found for all conditions, there was clearly a general pattern of a greater prevalence of birth defects in the offspring of Vietnam veterans, according to self-reports. The authors properly note the potential for recall bias as an explanation for the pattern of excess risk. As an attempt to evaluate recall bias, two record validation studies of birth defects were conducted. Overall, the GBDS did not find any association with an increased risk of birth defects among offspring of Vietnam veterans. However, this validation study had limited power to detect an increased risk for specific birth defects. The second validation substudy, the CSM review, was flawed by the differentially poor response rate among the non-Vietnam veteran group. This result and the fact that negative responses were not pursued discouraged the investigators from estimating the relative risk for cerebrospinal malformations.

Another important study of Vietnam veterans was the CDC Birth Defects Study (Erickson et al., 1984a,b). In this study, children with birth defects among 428 fathers who were reported to have been Vietnam veterans were compared to children with birth defects among 268 control fathers who were non-Vietnam veterans. The odds ratio for Vietnam veteran status in relation to any major birth defect among offspring was 1.0 (CI 0.8-1.1). Analysis of the Agent Orange exposure opportunity index (EOI; see VAO Chapter 6 for details) based on both military records and self-reports did not indicate a statistically significant trend of increasing risk of all types of birth defects (combined) with increasing levels of Agent Orange exposure. No association was noted between Vietnam veteran status or self-reported Agent Orange exposure and risk of fathering a child with multiple birth defects (OR = 1.1, CI 0.7-1.7). The odds ratios for Vietnam veteran status, self-reported Agent Orange exposure, and logistic regression coefficients for EOI based on self-report and military records for most of the 95 birth defect groups were not significantly elevated. Although the odds ratio for spina bifida was not elevated with Vietnam veteran status (OR = 1.1), the EOI indices showed a pattern of increasing risk. For example, the odds ratios for the EOI based on information obtained during the interview for low to high levels of exposure (levels 1 to 5) were 1.2 (CI 1.0-1.4), 1.5 (CI 1.1-2.1), 1.8 (CI 1.1-3.0), 2.2 (CI 1.2-4.3), 2.7 (CI 1.2-6.2). A similar pattern was found for cleft lip with/without



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