B
Air Force Health Study Data
Section 602(c) of Pub. L. 108-183 called for this committee to evaluate “[t]he scientific merit of retaining and maintaining the medical records, other study data, and laboratory specimens collected in the course of the Air Force Health Study after its currently scheduled termination date in 2006” and to determine “[w]hether or not any obstacles exist to retaining and maintaining the medical records, other study data, and laboratory specimens.”
Pursuant to this charge, the committee reviewed data and specimen collection as reported in the original study protocol (AFHS, 1982), official AFHS morbidity cycle reports (AFHS, 1984, 1987, 1990, 1995, 2000, 2005), the Serum Dioxin Analysis of 1987 Examination Results (AFHS, 1991), AFHS mortality (AFHS, 1983, 1984, 1985, 1986, 1989, 1991, 1993, 1994, 1996) and reproductive outcomes reports (AFHS, 1992, 1998), as well as various AFHS analyses reported in scientific journals as cited in preceding chapters. AFHS data dictionaries and clinical collection and laboratory processing protocols were also reviewed where available.
The purpose of this appendix is to provide a sense of the scope and magnitude of the data collected and analyzed throughout the course of the AFHS. The following tables are not intended to serve as an exhaustive accounting of data collected or archived. Data collected in the mortality arm of the study are not represented in this appendix. The information contained in Tables B-1 through B-13 was derived primarily from analyses reported in AFHS morbidity cycle reports (cited above). Hence, they generally represent those outcomes included in morbidity analyses for a particular cycle and not necessarily all outcomes re-
corded or measured in AFHS clinical and laboratory evaluations or those obtained from private medical and dental records or military records.
The myriad laboratory tests performed (by the Kelsey-Seybold Clinic for Cycle 1 and Scripps Clinic for Cycles 2–6) on subject blood, urine, and semen were provided by AFHS investigators by committee request and are listed in Table B-14. Dioxin assays are not included in this list as they were performed separately at the Centers for Disease Control and Prevention.
A summary of covariates used in various analyses throughout the AFHS is provided in Table B-15 to further characterize available subject data.
Table B-16 provides a brief overview of the types of data gathered through questionnaire administration as well as the major changes made to questionnaire (baseline and interval) content over time.
Additional details relating AFHS data resources and analyses are can be found in Chapters 2–4.
TABLE B-1 General Health Assessment
TABLE B-2 Neurological Assessment
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Analyzed Endpoints |
|
|||||
Inflammatory diseases (MVR) |
X |
X |
X |
X |
X |
X |
Hereditary and degenerative diseases (MRV) |
X |
X |
X |
X |
X |
X |
Peripheral disorders (MRV) |
X |
X |
X |
X |
X |
X |
Disorders of eye (MRV) |
X |
X |
X |
|
||
Disorders of ear (MRV) |
X |
X |
X |
|
||
Other neurological disorders (MRV) |
|
X |
X |
X |
X |
X |
Smell (PE) |
X |
X |
X |
X |
X |
X |
Visual fields (PE) |
X |
X |
X |
X |
X |
X |
Light reaction (PE) |
X |
X |
X |
X |
X |
X |
Ocular movement (PE) |
X |
X |
X |
X |
X |
X |
Facial sensation (PE) |
X |
X |
X |
X |
X |
X |
Corneal reflex (PE) |
X |
X |
X |
X |
X |
X |
Jaw clench (PE) |
X |
X |
X |
X |
X |
X |
Smile (PE) |
X |
X |
X |
X |
X |
X |
Palpebral fissure (PE) |
X |
X |
X |
X |
X |
X |
Balance/Romberg sign (PE) |
X |
X |
X |
X |
X |
X |
Gag reflex (PE) |
X |
X |
X |
X |
X |
X |
Speech (PE) |
X |
X |
X |
X |
X |
X |
Tongue position relative to midline (PE) |
X |
X |
X |
X |
X |
X |
Palate and uvula movement (PE) |
X |
X |
X |
X |
X |
X |
Shoulder shrug (PE) |
|
X |
||||
Cranial nerve index without range of motion (PE) |
|
X |
X |
X |
|
|
Cranial nerve index (PE) |
|
X |
X |
X |
X |
X |
TABLE B-3 Psychology Assessment
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Analyzed Endpoints |
|
|||||
Psychoses (MRV) |
X |
X |
X |
X |
X |
X |
Alcohol dependence (MRV) |
X |
X |
X |
X |
X |
X |
Drug dependence (MRV) |
|
X |
X |
X |
X |
|
Anxiety (MRV) |
X |
X |
X |
X |
X |
X |
Other neuroses (MRV) |
X |
X |
X |
X |
X |
X |
Fatigue (Q) |
X |
|
||||
Depression (Q) |
X |
|||||
Anxiety (Q) |
X |
|||||
Erosion of skills (Q) |
X |
|||||
Social isolation (Q) |
X |
|||||
Aggressive or impulsive behavior (Q) |
X |
|||||
Trouble falling asleep (Q) |
|
X |
|
|||
Waking up during the night (Q) |
X |
|||||
Waking up too early and can’t go back to sleep (Q) |
X |
|||||
Waking up unrefreshed (Q) |
X |
|||||
Involuntarily falling asleep during the day (Q) |
X |
|||||
Great disabling fatigue during the day (Q) |
X |
|||||
Frightening dreams (Q) |
X |
|||||
Talking in sleep (Q) |
X |
|||||
Sleepwalking (Q) |
X |
|||||
Abnormal movement/activity during the night (Q) |
X |
|||||
Sleep problems requiring medication (Q) |
X |
|||||
Snore loudly in all sleeping positions (Q) |
X |
TABLE B-4 Gastrointestinal Assessment
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Analyzed Endpoints |
|
|||||
Uncharacterized hepatitis (Q/MRV) |
X |
X |
Xa |
X |
X |
X |
Jaundice (unspecified) (Q/MRV) |
X |
X |
X |
X |
X |
X |
Acute and subacute necrosis of the liver (Q/MRV) |
|
X |
X |
X |
X |
|
Chronic liver disease and cirrhosis (alcohol related) (Q/MRV) |
X |
X |
X |
X |
X |
X |
Chronic liver disease and cirrhosis (nonalcohol related) (Q/MRV) |
X |
X |
X |
X |
X |
X |
Liver abscess and sequelae of chronic liver disease (Q/MRV) |
|
X |
X |
X |
X |
|
Enlarged liver (hepatomegaly) (Q/MRV) |
|
X |
X |
X |
X |
X |
Skin bruises, patches, or sensitivity (Q/MRV) |
X |
X |
X |
|
||
Reported/verified ulcer (Q/MRV) |
|
X |
X |
|
||
Other disorders of the liver (Q/MRV) |
Xb |
X |
X |
X |
X |
X |
Liver disease (lifetime history) (Q/MRV) |
|
X |
|
|||
Current hepatomegaly (PE) |
X |
X |
X |
X |
X |
X |
AST (U/L) (LAB) |
X |
X |
X |
X |
X |
X |
ALT (U/L) (LAB) |
X |
X |
X |
X |
X |
X |
GGT (U/L) (LAB) |
X |
X |
X |
X |
X |
X |
Alkaline phosphatase (U/L) (LAB) |
X |
X |
X |
X |
X |
X |
Total bilirubin (mg/dl) (LAB) |
X |
X |
X |
X |
X |
X |
Direct bilirubin (mg/dl) (LAB) |
X |
X |
X |
X |
X |
X |
LDH (U/L) (LAB) |
X |
X |
X |
X |
X |
X |
Cholesterol (mg/dl) (LAB) |
X |
X |
X |
X |
X |
X |
HDL cholesterol (mg/dl) (LAB) |
|
X |
X |
X |
X |
|
Cholesterol-HDL ratio (LAB) |
|
X |
X |
X |
X |
|
Triglycerides (mg/dl) (LAB) |
X |
X |
X |
X |
X |
X |
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Creatine phosphokinase (U/L) (LAB) |
|
X |
X |
X |
X |
|
Serum amylase (U/L) (LAB) |
|
X |
X |
X |
||
Evidence of prior hepatitis A (LAB) |
X |
X |
X |
|||
Evidence of prior hepatitis B (LAB) |
X |
X |
X |
|||
Current hepatitis B (LAB) |
X |
X |
|
|||
Evidence of prior hepatitis C (LAB) |
X |
X |
X |
|||
Evidence of prior hepatitis D (LAB) |
|
X |
|
|||
Stool occult blood test (LAB) |
X |
X |
X |
|||
Protein profile: prealbumin (mg/dl) (LAB) |
X |
X |
X |
|||
Protein profile: albumin (mg/dl) (LAB) |
X |
X |
X |
|||
Protein profile: α-1-acid glycoprotein (mg/dl) (LAB) |
X |
X |
X |
|||
Protein profile: α-1-antitrypsin (mg/dl) (LAB) |
X |
X |
X |
|||
Protein profile: α-2-macroglobulin (mg/dl) (LAB) |
X |
X |
X |
|||
Protein profile: apolipoprotein B (mg/dl) (LAB) |
X |
X |
X |
|||
Protein profile: C3 complement (mg/dl) (LAB) |
X |
X |
X |
|||
Protein profile: C4 complement (mg/dl) (LAB) |
X |
X |
X |
|||
Protein profile: haptoglobin (mg/dl) (LAB) |
X |
X |
X |
|||
Protein profile: transferrin (mg/dl) (LAB) |
X |
X |
X |
|||
Prothrombin time (seconds) (LAB) |
|
X |
||||
Fasting glucose (LAB) |
|
X |
|
|||
Uroporphyrin (LAB) |
X |
X |
|
TABLE B-5 Dermatological Assessment
Cycle |
1 |
2 |
3 |
4 |
5a |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Analyzed Endpoints |
|
|||||
Acne (lifetime) (Q/MRV) |
X |
X |
X |
X |
|
X |
Post-SEA acne (Q/MRV/MIL) |
X |
X |
X |
X |
X |
|
Post-SEA acne (no pre-SEA acne) (Q/MRV/MIL) |
X |
X |
X |
X |
X |
|
Post-SEA acne (with pre-SEA acne) (Q/MRV/MIL) |
X |
X |
X |
X |
X |
|
Location of post-SEA acne (pre-SEA acne cases excluded) (Q/MRV) |
|
X |
X |
X |
X |
|
Location of post-SEA acne (all post-SEA occurrences) (Q/MRV) |
X |
X |
X |
X |
X |
|
Duration of post-SEA acne (pre-SEA acne cases excluded) (months) (Q) |
X |
X |
X |
|
X |
|
Duration of post-SEA acne (all post-SEA occurrences) (months) (Q) |
X |
X |
X |
X |
||
Acneiform lesions (PE) |
X |
X |
X |
X |
||
Acneiform scars (PE) |
X |
X |
X |
X |
||
Comedones (PE) |
X |
X |
X |
X |
||
Depigmentation (PE) |
|
X |
X |
X |
||
Hyperpigmentation (PE) |
X |
X |
X |
X |
||
Inclusion cysts (PE) |
X |
X |
X |
X |
||
Dermatology index (PE)b |
X |
X |
X |
X |
X |
|
Other abnormalities (PE)c |
X |
X |
X |
X |
|
|
NOTES: Data sources: (Q) questionnaires; (PE) physical examination; (LAB) laboratory tests; (MRV) medical records verified; (MIL) military records. Areas in gray indicate that either an endpoint was not analyzed for a particular cycle or that it was unclear from the cycle report if an endpoint was analyzed. Gray areas do not indicate that an endpoint was not measured or recorded for a particular cycle. Shaded boxes with an X indicate that the endpoint was measured but not included in section analyses. aDermatologic assessment not reported in the Cycle 5 follow-up examination results. bThe dermatology index comprised counts for comedones, acneiform lesions, acneiform scars, and inclusion cysts (AFHS, 1990). cConditions comprising the other abnormalities category were jaundice, spider angiomata, palmar erythema, suspected melanoma, palmar keratoses, petechiae, ecchymoses, conjunctival abnormality, oral mucosal abnormality, fingernail abnormality, toenail abnormality, dermatographia, cutis rhomboidalis, suspected basal cell carcinoma, suspected squamous cell carcinoma, nevus, or other abnormalities (AFHS, 1990). Vitiligo was added to the list in Cycle 5 (AFHS, 1997). |
TABLE B-6 Cardiovascular Assessment
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Analyzed Endpoints |
|
|||||
Essential hypertension (Q/MRV/PE) |
|
X |
X |
X |
X |
X |
Heart disease (excluding essential hypertension) (Q/MRV/PE) |
X |
X |
X |
X |
X |
X |
Myocardial infarction (Q/MRV/PE) |
X |
X |
X |
X |
X |
X |
Stroke or transient ischemic attack (MRV) |
|
X |
X |
|||
Systolic blood pressure (mm Hg) (PE) |
X |
X |
X |
X |
X |
X |
Diastolic blood pressure (mm Hg) (PE) |
X |
X |
X |
X |
X |
X |
Heart sounds (PE) |
X |
X |
X |
X |
X |
X |
Overall ECG (PE) |
X |
X |
X |
X |
X |
X |
ECG: RBBB (PE) |
|
X |
X |
X |
X |
X |
ECG: LBBB (PE) |
X |
X |
X |
X |
X |
|
ECG: nonspecific ST- and T-wave changes (PE) |
X |
X |
X |
X |
X |
|
ECG: bradycardia (PE) |
X |
X |
X |
X |
X |
|
ECG: tachycardia (PE) |
X |
X |
X |
X |
X |
|
ECG: arrhythmia (PE) |
X |
X |
X |
X |
X |
|
ECG: evidence of prior myocardial infarction (PE) |
|
X |
X |
X |
||
ECG: other diagnoses (PE) |
X |
X |
X |
X |
X |
|
Funduscopic examination (PE) |
X |
X |
X |
X |
X |
X |
Carotid bruits (PE) |
X |
X |
X |
X |
X |
X |
Radial pulses (PE) |
X |
X |
X |
X |
X |
X |
Femoral pulses (PE) |
X |
X |
X |
X |
X |
X |
Popliteal pulses (PE) |
X |
X |
X |
X |
X |
X |
Dorsalis pedis pulses (PE) |
X |
X |
X |
X |
X |
X |
Posterior tibial pulses (PE) |
X |
X |
X |
X |
X |
X |
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Leg pulses (PE) |
X |
X |
X |
X |
X |
X |
Peripheral pulses (PE) |
X |
X |
X |
X |
X |
X |
All pulses (PE) |
X |
X |
X |
|
||
Resting pressure index (PE) |
|
X |
||||
Hyperemic pressure index (1 minute postexercise) (PE) |
X |
|||||
Hyperemic pressure index (2 minutes postexercise) (PE) |
X |
|||||
Intermittent claudication and vascular insufficiency index (Q) |
|
X |
X |
X |
||
Kidney, urethra, and bladder (KUB) X ray excluding kidney stones (PE) |
|
X |
|
|||
Questionnaire-physical exam associations* (PE) |
|
X |
|
|||
NOTES: Data sources: (Q) questionnaires; (PE) physical examination; (LAB) laboratory tests; (MRV) medical records verified; (MIL) military records. Areas in gray indicate that either an endpoint was not analyzed for a particular cycle or that it was unclear from the cycle report if an endpoint was analyzed. Gray areas do not indicate that an endpoint was not measured or recorded for a particular cycle. *Measure was determined by analysis of central and peripheral PE findings and verified CVD endpoints to determine strength of correlation between PE findings and medical history (AFHS, 1990). |
TABLE B-7 Hematological Assessment
TABLE B-8 Renal Assessment
TABLE B-9 Endocrine Assessment
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Analyzed Endpoints |
|
|||||
Past thyroid disease (MRV) |
|
X |
X |
X |
X |
X |
Current thyroid function (Q) |
|
X |
X |
|
||
Composite diabetes indicator (MRV/LAB) |
|
X |
X |
X |
|
|
Composite diabetes indicator (2002 AFHS diabetes definition) (MRV/LAB) |
|
X |
||||
Composite diabetes indicator (pre-2002 AFHS diabetes definition)(MRV/LAB) |
|
X |
X |
|||
Diabetic severity (MRV) |
|
X |
|
|||
Diabetic control (MRV/LAB) |
|
X |
X |
X |
||
Time to diabetes onset (years) (MRV/LAB/MIL) |
|
X |
X |
X |
||
Thyroid gland (PE) |
|
X |
X |
X |
X |
X |
Testicular examination (PE) |
|
X |
X |
|
X |
X |
Testicular volume (PE) |
|
X |
|
|||
TSH (µIU/ml) (LAB) |
|
X |
X |
X |
X |
X |
Free thyroxine index (µg/dl) (LAB) |
X |
|
||||
Free T4 (ng/dl) (LAB) |
|
X |
||||
T4 (µg/dl (LAB) |
X |
|
X |
X |
|
|
T3 % uptake (LAB) |
X |
X |
X |
|
||
Antithyroid antibodies (LAB) |
|
X |
X |
X |
||
Fasting glucose (mg/dl) (LAB) |
|
X |
X |
X |
||
2-hour postprandial glucose (mg/dl) (LAB) |
X |
X |
X |
X |
X |
X |
Fasting urinary glucose (LAB) |
|
X |
X |
|
||
2-hour postprandial urinary glucose (LAB) |
|
X |
X |
X |
X |
|
Insulin (µIU/ml) (LAB) |
|
X |
X |
X |
||
2-hour postprandial insulin (µIU/ml) (LAB) |
|
X |
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Serum glucagon (pg/ml) (LAB) |
|
X |
|
|||
Hemoglobin A1c (percent) (LAB) |
X |
X |
X |
|||
C-peptide (ng/ml) (LAB) |
X |
|
X |
|||
Proinsulin (pmol/l) (LAB) |
X |
|
X |
|||
GADA (LAB) |
|
X |
||||
Total testosterone (ng/dl) (LAB) |
X |
X |
X |
X |
X |
X |
Free testosterone (pg/ml) (LAB) |
|
X |
X |
X |
||
Estradiol (pg/ml) (LAB) |
X |
X |
X |
|||
LH (mIU/ml) (LAB) |
X |
X |
X |
|||
FSH (mIU/ml) (LAB) |
|
X |
X |
X |
X |
|
Retinopathy results (diabetics only) (PE) |
|
X |
|
|||
Neuropathy results (diabetics only) (PE) |
X |
|||||
Radial pulses (diabetics only) (PE) |
X |
|||||
Femoral pulses (diabetics only) (PE) |
X |
|||||
Popliteal pulses (diabetics only) (PE) |
X |
|||||
Dorsalis pedis pulses (diabetics only) (PE) |
X |
|||||
Posterior tibial pulses (diabetics only) (PE) |
X |
|||||
Leg pulses (diabetics only) (PE) |
X |
|||||
Peripheral pulses (diabetics only) (PE) |
X |
|||||
Urine protein (diabetics only) (PE) |
X |
|||||
Sex hormone-binding globulin (SHBG) (nmol/l) (LAB) |
X |
TABLE B-10 Immunology Assessment
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Analyzed Endpoints |
|
|||||
Composite skin test (PE) |
|
X |
X |
X |
|
|
CD2+ cells (total T cells) (cells/mm3) (LAB) |
X |
X |
X |
|
||
CD3 cells (total T cells) (cells/mm3) (LAB) |
X |
|
X |
X |
X |
|
CD4 cells (helper T cells) (cells/mm3) (LAB) |
X |
X |
X |
X |
X |
X |
CD5 cells (cells/mm3) (LAB) |
|
X |
|
|||
CD8 cells (suppressor cells) (cells/mm3) (LAB) |
X |
X |
X |
X |
X |
X |
CD14 cells (monocytes) (cells/mm3) (LAB) |
|
X |
X |
X |
|
|
CD16+56 cells (natural killer cells) (cells/mm3) (LAB) |
|
X |
X |
X |
||
CD20 cells (B cells) (cells/mm3) (LAB) |
X |
X |
X |
X |
X |
X |
CD25 cells (cells/mm3) (LAB) |
|
X |
X |
|
||
CD4-CD8 ratio (LAB) |
X |
X |
X |
X |
|
|
HLA-DR cells (cells/mm3) (LAB) |
|
X |
X |
|
||
CD3 with CD25 (cells/mm3) (LAB) |
|
X |
|
|||
CD5 with CD20 (cells/mm3) (LAB) |
X |
|||||
CD4 with CD8 (cells/mm3) (LAB) |
X |
|||||
CD3 with CD16+56 (cells/mm3) (LAB) |
X |
|||||
CD3+CD4 cells (helper T cells) (cells/mm3) (LAB) |
|
X |
X |
|||
Absolute lymphocytes (cells/mm3) (LAB) |
X |
|
X |
X |
X |
X |
IgA (mg/dl) (LAB) |
|
X |
X |
X |
X |
|
IgG (mg/dl) (LAB) |
X |
X |
X |
X |
||
IgM (mg/dl) (LAB) |
X |
X |
X |
X |
||
Lupus panel: ANA test (LAB) |
|
X |
X |
X |
||
Lupus panel: thyroid microsomal antibody (LAB) |
|
X |
X |
X |
TABLE B-11 Pulmonary Assessment
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Analyzed Endpoints |
|
|||||
Asthma (MRV*/Q) |
|
X |
X |
X |
X |
X |
Bronchitis (MRV*/Q) |
X |
X |
X |
X |
X |
|
Pneumonia (MRV*/Q) |
X |
X |
X |
X |
X |
|
Pleurisy (Q) |
X |
X |
|
|||
Tuberculosis (Q) |
X |
X |
X |
|
||
Neoplasia (Q) |
X |
|
||||
Chronic sinusitis and other upper respiratory disease (Q) |
X |
|||||
Thorax and lung abnormality (PE) |
|
X |
X |
X |
X |
X |
X ray interpretation (LAB) |
X |
X |
X |
X |
X |
|
Asymmetric expansion (PE) |
X |
X |
|
|||
Hyperresonance (PE) |
X |
X |
||||
Wheezes (PE) |
X |
X |
||||
Rales (PE) |
X |
X |
||||
Dullness (PE) |
X |
X |
||||
FVC (percent of predicted) (LAB) |
X |
|
X |
X |
X |
X |
FEV1 (percent of predicted) (LAB) |
X |
|
X |
X |
X |
X |
FEV2 (LAB) |
|
X |
|
|||
FEV3 (LAB) |
X |
|||||
FEV MAX (LAB) |
X |
|||||
Ratio of observed FEV1 to observed FVC (LAB) |
X |
|
X |
X |
X |
X |
TABLE B-12 Neoplasia Assessment
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Analyzed Endpoints |
|
|||||
Skin neoplasms (MRV/PE) |
|
|||||
Behavior (All Sites Combined) |
|
|||||
All |
|
X |
X |
X |
X |
X |
Malignant |
|
X |
X |
X |
X |
X |
Benign |
|
X |
X |
X |
X |
X |
Uncertain behavior or unspecified nature |
|
X |
X |
X |
X |
X |
Cell Type-Specific Analysesa |
|
|||||
Basal cell carcinoma |
X |
X |
X |
X |
X |
X |
Squamous cell carcinoma |
X |
X |
X |
X |
X |
X |
Fibrosarcoma |
X |
|
||||
Nonmelanoma |
|
X |
X |
X |
||
Melanoma |
X |
X |
Xb |
X |
X |
X |
Sun exposure-related malignancies |
|
X |
X |
|
||
Systemic neoplasms (MRV/PE) |
|
|||||
Behavior (All Sites Combined) |
|
|||||
All |
|
X |
X |
X |
X |
X |
Malignant |
|
X |
X |
X |
X |
X |
Benign |
|
X |
X |
X |
X |
X |
Uncertain behavior or unspecified nature |
|
X |
X |
X |
X |
X |
Site-Specific Analyses |
|
|||||
Malignant |
|
|||||
Eye, ear, face, head, and neck |
|
X |
X |
X |
X |
X |
Oral cavity, pharynx, and larynx |
X |
X |
X |
X |
X |
X |
Brain |
|
X |
X |
X |
X |
|
Digestive organs, peritoneum, and esophagus |
Xc |
X |
|
X |
X |
Xd |
Thymus, heart, and mediastinum |
|
X |
X |
X |
X |
|
Thyroid gland |
X |
X |
X |
X |
X |
X |
Bronchus and lung (includes trachea and pleura) |
X |
X |
X |
X |
X |
X |
Liver |
|
X |
|
X |
X |
|
Colon and rectum (includes anus) |
X |
X |
X |
X |
X |
X |
Urinary system |
Xe |
Xf |
Xf |
Xf |
X |
X |
Kidney and ureter |
Xe |
Xf |
Xf |
Xf |
|
X |
Prostate |
Xe |
X |
X |
X |
X |
X |
Penis and other male genital organs |
Xe |
X |
X |
X |
X |
X |
Testicles |
Xe |
X |
X |
X |
X |
X |
Bone and articular cartilage |
X |
|
X |
|||
Extrahepatic bile duct |
|
X |
X |
|||
Ill-defined sites |
|
X |
X |
X |
|
|
Connective and other soft tissues |
X |
X |
|
X |
X |
X |
Hodgkin’s disease |
X |
X |
X |
X |
X |
X |
Non-Hodgkin’s lymphoma |
X |
X |
|
X |
X |
|
Leukemia |
X |
X |
X |
X |
|
X |
Other malignant systemic neoplasms of lymphoid and histiocytic tissue |
X |
|
X |
X |
X |
X |
Lymphoreticular sarcoma |
|
X |
||||
Multiple myeloma |
|
X |
|
X |
||
Soft-tissue sarcoma |
|
X |
|
|||
Premalignant |
|
|||||
Carcinoma in situ (breast, digestive organs, respiratory, prostate, penis and other male genitals, bladder and other, and nonspecified urinary) |
X |
|
Xg |
X |
Xh |
X |
Premalignant and Malignant |
|
|||||
Stomach (All) |
|
X |
||||
Other and unspecified sites |
X |
|
TABLE B-13 Reproductive Assessment
Year of Report |
1984a |
1992b |
1998 |
Analyzed Endpoints |
|
||
Number of marriages (Q) |
X |
|
X |
Duration of marital and nonmarital relationships (Q) |
X |
X |
|
Number of couples with the desired number of children (Q) |
X |
X |
|
Sperm count (LAB) |
X |
X |
|
Sperm morphology (LAB) |
X |
X |
|
Number of conceptions (Q) |
X |
X |
X |
Conception outcomes: miscarriage (Q/MRV) |
X |
X |
X |
Conception outcomes: induced abortion (Q/MRV) |
X |
X |
X |
Conception outcomes: tubal pregnancy (QMRV) |
|
X |
|
Conception outcomes: stillbirth (Q/MRV) |
X |
X |
X |
Conception outcomes: live birth (Q/MRV) |
X |
X |
X |
Live birth outcomes: learning disabilities (Q/MRV) |
X |
|
X |
Live birth outcomes: physical handicaps (Q/MRV) |
X |
X |
|
Live birth outcomes: neonatal mortality (Q/MRV) |
X |
X |
|
Live birth outcomes: infant mortality (Q/MRV) |
X |
X |
|
Live birth outcomes: birth defectsc (ICD 9 coded) (Q/MRV) |
X |
X |
X |
CDC birth defect category: total congenital anomalies (Q/MRV) |
|
X |
|
CDC birth defect category: nervous system anomalies (Q/MRV) |
X |
||
CDC birth defect category: eye anomalies (Q/MRV) |
X |
||
CDC birth defect category: ear, face, and neck anomalies (Q/MRV) |
X |
||
CDC birth defect category: circulatory system and heart anomalies (Q/MRV) |
X |
||
CDC birth defect category: respiratory anomalies (Q/MRV) |
X |
||
CDC birth defect category: digestive system anomalies (Q/MRV) |
X |
||
CDC birth defect category: genital anomalies (Q/MRV) |
X |
||
Birth defects: urinary system anomalies (Q/MRV) |
X |
||
CDC birth defect category: musculoskeletal deformities (Q/MRV) |
X |
||
CDC birth defect category: anomalies of the skin (Q/MRV) |
X |
||
CDC birth defect category: chromosomal anomalies (Q/MRV) |
X |
||
CDC birth defect category: other and unspecified anomalies (Q/MRV) |
X |
||
Birth defect severity (Q/MRV) |
X |
X |
X |
Birth weight (MRV) |
|
X |
|
NOTES: Data sources: (Q) questionnaires; (PE) physical examination; (LAB) laboratory tests; (MRV) medical records verified. Analyzed endpoints in 1992 study were chosen for ease of comparison with the results from the 1989 CDC Vietnam Experience Study reproductive outcome results. Many of the outcomes in the 1992 report were included under broader variables analyzed for the 1984 and 1998 reports. Areas in gray indicate that either an endpoint was not analyzed for a particular cycle or that it was unclear from the cycle report if an endpoint was analyzed. Gray areas do not indicate that an endpoint was not measured or recorded for a particular cycle. aData collected at Cycle 1 (1982). No outcomes verified. bData collected in 1982, 1985, and 1987. cBirth defect had to match description on predetermined list to be included in analyses at the baseline. |
TABLE B-14 Laboratory Analyses
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Hematology |
|
|||||
Cell Count/Indices |
X |
X |
X |
X |
X |
X |
WBC |
X |
X |
X |
X |
X |
X |
RBC |
X |
X |
X |
X |
X |
X |
RDW |
X |
X |
X |
X |
|
|
HGB |
X |
X |
X |
X |
X |
X |
Hematocrit |
X |
X |
X |
X |
X |
X |
MCV |
X |
X |
X |
X |
X |
X |
MCH |
X |
X |
X |
X |
X |
X |
MCHC |
X |
X |
X |
X |
X |
X |
PLT |
X |
X |
X |
X |
X |
X |
Differential |
X |
X |
X |
X |
X |
X |
Neutrophils |
X |
X |
X |
X |
X |
X |
LYMPH |
X |
X |
X |
X |
X |
X |
MONO |
X |
X |
X |
X |
X |
X |
EOS |
X |
X |
X |
X |
X |
X |
BANDS |
X |
X |
X |
X |
X |
X |
BASO |
X |
X |
X |
X |
X |
X |
BLAST |
X |
X |
X |
X |
X |
X |
RBC morphology |
|
X |
X |
X |
X |
X |
Platelet observation |
|
X |
X |
X |
X |
X |
Cells counted |
X |
X |
X |
X |
X |
X |
Absolute differential |
|
|||||
ABS SEGS |
|
X |
X |
X |
X |
X |
ABS BANDS |
X |
X |
X |
X |
X |
|
ABS LYMPHS |
X |
X |
X |
X |
X |
|
ABS MONOS |
X |
X |
X |
X |
X |
|
ABS EOS |
X |
X |
X |
X |
X |
|
ABS BASOS |
X |
X |
X |
X |
X |
|
RPR/VDRL/FTA |
X |
X |
X |
X |
X |
X |
ESR |
X |
X |
X |
X |
X |
X |
Glucose, 2HR PP |
X |
X |
X |
X |
X |
X |
Prothrombin time |
X |
X |
X |
X |
X |
X |
Chemistry Routine |
|
|||||
BUN |
X |
X |
X |
X |
X |
X |
Glucose fasting |
X |
X |
X |
X |
X |
X |
Cholesterol |
X |
X |
X |
X |
X |
X |
HDL cholesterol |
X |
X |
X |
X |
X |
X |
Triglycerides |
X |
X |
X |
X |
X |
X |
SGOT/AST |
X |
X |
X |
X |
X |
X |
SGPT/ALT |
X |
X |
X |
X |
X |
X |
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Gamma GT |
X |
X |
X |
X |
X |
X |
Alkaline phosphatase |
X |
X |
X |
X |
X |
X |
Total LDH |
X |
X |
X |
X |
X |
X |
Creatinine serum |
X |
|
X |
X |
X |
|
Creatine kinase |
X |
X |
X |
X |
X |
X |
Amylase |
|
X |
X |
X |
X |
X |
Total bilirubin |
X |
X |
X |
X |
X |
X |
Direct bilirubin |
X |
X |
X |
X |
X |
X |
Chemistry Miscellaneous |
|
|||||
FSH |
X |
X |
X |
X |
X |
X |
LH |
X |
X |
X |
X |
X |
X |
Testosterone, free |
|
X |
X |
X |
||
Testosterone, total |
X |
X |
X |
X |
X |
X |
Sex hormone binding globulin |
|
X |
|
|||
Estradiol |
|
X |
X |
X |
||
T4, free |
|
X |
||||
T4, RIA |
X |
X |
X |
X |
X |
|
T3, free |
|
X |
||||
T3, uptake |
X |
X |
X |
|
||
TSH |
X |
X |
X |
X |
X |
X |
FTI |
X |
|
||||
PSA |
|
X |
X |
X |
||
Insulin, fasting |
|
X |
||||
Glucagon @ 2 hr |
|
X |
|
X |
||
Insulin, serum @ 2 hr |
|
X |
X |
X |
||
Glycated hemoglobin |
|
X |
X |
X |
||
C Peptide, serum |
|
X |
|
X |
||
ACTH, serum |
|
X |
|
|||
Uric acid |
|
X |
||||
Urinalysis Routine |
|
|||||
Color |
X |
X |
X |
X |
X |
X |
Character |
X |
X |
X |
X |
X |
X |
Glucose |
X |
X |
X |
X |
X |
X |
pH |
X |
X |
X |
X |
X |
X |
Ketone |
X |
X |
X |
X |
X |
X |
Protein |
X |
X |
X |
X |
X |
X |
Bile |
X |
X |
X |
X |
X |
X |
Occult blood |
X |
|
X |
|||
Urobilinogen |
X |
X |
X |
X |
X |
X |
Specific gravity |
X |
X |
X |
X |
X |
X |
Epithelial cells |
X |
X |
X |
X |
X |
X |
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Urinalysis Routine |
|
|||||
Bacteria |
X |
X |
X |
X |
X |
X |
Mucus |
X |
X |
X |
X |
X |
X |
WBC/HPF |
X |
X |
X |
X |
X |
X |
Casts |
|
X |
X |
X |
X |
X |
Crystals |
X |
X |
X |
X |
X |
|
RBC |
X |
X |
X |
X |
X |
|
Nitrites |
X |
X |
X |
X |
X |
|
Leukocyte esterase |
|
X |
X |
|||
Other |
|
X |
X |
X |
||
Comments |
X |
X |
X |
X |
X |
X |
Glucose, urine 2 hr |
X |
X |
X |
X |
X |
X |
Urine 24 hr |
|
|||||
Coproporphyrin |
X |
X |
|
|||
Uroporphyrin |
X |
X |
||||
Porphobilinogen |
X |
X |
||||
Heptacarboxyporphyrins |
|
X |
||||
Hexacarboxyporphyrins |
X |
|||||
Pentacarboxyporphyrins |
X |
|||||
Creatinine |
X |
|
||||
Aminolevulinic Acid |
X |
|||||
Comments |
X |
X |
||||
Cortisol Differential |
|
|||||
Cortisol 1 |
X |
X |
|
|||
Cortisol 2 |
X |
X |
||||
Protein Electrophoresis |
|
|||||
Total protein |
X |
X |
X |
|
||
Prealbumin |
|
X |
X |
X |
||
Albumin |
X |
X |
X |
X |
X |
X |
Alpha 1 globulin |
X |
X |
X |
X |
X |
X |
Alpha 2 globulin |
X |
X |
X |
X |
X |
X |
Beta globulin |
X |
X |
X |
X |
X |
X |
Gamma globulin |
X |
X |
X |
X |
X |
X |
IGA |
X |
X |
X |
X |
X |
X |
IGG |
X |
X |
X |
X |
X |
X |
IGM |
X |
X |
X |
X |
X |
X |
Protein Profile |
|
|||||
Alpha 1 acid glycoprotein |
|
X |
X |
X |
X |
|
Alpha 1 antitrypsin |
X |
X |
X |
X |
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Alpha 2 macroglobulin |
|
X |
X |
X |
X |
|
Apolipoprotein B |
X |
X |
X |
X |
||
C3 complement |
X |
X |
X |
X |
||
C4 complement |
X |
X |
X |
X |
||
Haptoglobin |
X |
X |
X |
X |
||
Transferrin |
X |
X |
X |
X |
||
HI-RES Electrophoresis |
|
|||||
High-resolution bands |
|
|||||
IGG-Kappa |
|
X |
|
|||
IGG-Lambda |
X |
|||||
IGG-No light chain |
X |
|||||
IGA-Kappa |
X |
|||||
IGA-Lambda |
X |
|||||
IGA-No light chain |
X |
|||||
IGM-Kappa |
X |
|||||
IGM-Lambda |
X |
|||||
IGM-No light chain |
X |
|||||
KAPPA-No heavy chain |
X |
|||||
LAMBDA-No heavy chain |
X |
|||||
Hepatitis Panel |
|
|||||
HA Antibody |
X |
|
X |
X |
X |
X |
HBs Antigen |
X |
X |
X |
X |
X |
X |
HBc Antibody |
X |
|
X |
X |
X |
X |
HBs Antibody |
X |
X |
X |
X |
X |
X |
HC Antibody |
|
X |
X |
X |
||
HD Antibody |
|
X |
X |
|||
HIV-1 ELISA Screen |
|
X |
X |
X |
X |
|
Semen Analysis |
|
|||||
Total count |
X |
|
||||
Volume |
X |
|||||
Abnormal forms |
X |
|||||
Immunology |
|
|||||
Mixed lymphocyte RX |
|
X |
X |
|
||
Cell surface markers |
X |
X |
||||
Killer cell no interferon |
X |
X |
||||
Killer cell interferon |
X |
X |
||||
Mitogen PHA stimulate |
X |
X |
||||
Mitogen pokweed stimulation |
X |
X |
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Lymphocyte Phenotyping Panel |
|
|||||
WBC count |
|
X |
X |
X |
||
% Lymphocytes |
X |
X |
X |
|||
Absolute lymphocytes |
X |
X |
X |
|||
C45 total lymph (CD14–) |
X |
X |
X |
|||
CD14 monocytes |
X |
X |
X |
|||
Absolute CD14 |
X |
|
||||
CD20 B cells |
X |
|||||
Absolute CD20 |
X |
X |
X |
|||
CD5 T cells |
X |
X |
X |
|||
Absolute CD5 |
X |
|
||||
Absolute CD20 and CD5+ |
X |
|||||
CD4 helper T cells |
X |
|||||
Absolute CD4 |
X |
X |
X |
|||
CD4+CD3 |
X |
X |
X |
|||
Absolute CD4+CD3 |
|
X |
X |
|||
CD8 suppressor T cells |
X |
X |
||||
Absolute CD8 |
X |
X |
X |
|||
CD4+ & CD8+ |
X |
X |
X |
|||
Absolute CD4+ & CD8+ |
X |
|
||||
Ratio CD4/CD8 |
X |
|||||
CD8+CD3 |
X |
|||||
Absolute CD8+CD3 |
|
X |
X |
|||
CD3 T cells |
|
X |
X |
|||
Absolute CD3 |
X |
X |
X |
|||
CD16/56 NK cells |
X |
X |
X |
|||
Absolute CD16/56 |
X |
X |
X |
|||
CD3+ & CD16/56+NK-like T cells |
X |
X |
X |
|||
Absolute CD3+ & CD16/56+ |
X |
|
||||
CD25 IL-2 receptor cells |
X |
|||||
Absolute CD25 |
X |
|||||
CD25+ & CD3+ activated T cells |
X |
|||||
Absolute CD25+ & CD3+ |
X |
|||||
(CD4 + CD8)/CD3 |
X |
|||||
(CD3 + CD20 + CD16)/CD45 |
X |
|||||
Occult Blood Panel—Fecal |
|
|||||
Occult blood 1 |
|
X |
|
|||
Occult blood 2 |
X |
|||||
Occult blood 3 |
X |
Cycle |
1 |
2 |
3 |
4 |
5 |
6 |
Examination Year |
1982 |
1985 |
1987 |
1992 |
1997 |
2002 |
Mouse Stomach/Kidney Lupus Panel |
|
|||||
Antinuclear AB |
|
X |
X |
|||
Antimitochondrial AB |
|
X |
X |
X |
||
Antismooth Muscle AB |
X |
X |
X |
|||
Antiparietal Cell AB |
X |
X |
X |
|||
MSK other |
X |
|
||||
Thyroid microsomal AB |
X |
X |
X |
|||
Rheumatoid factor latex |
X |
X |
X |
|||
ANA on HEP-2 Cells |
|
|||||
Hep-2 cells |
|
X |
|
|||
Speckled |
X |
|||||
Homogenous |
X |
|||||
Nucleolar |
X |
|||||
Centromere |
X |
|||||
ANA Hep-2 other |
X |
|||||
DNA antibodies (IFA) |
X |
|||||
Anti Sm |
X |
|||||
Anti RNP |
X |
|||||
SSA antibody |
X |
|||||
SSB antibody |
X |
|||||
Lymphocyte phenotyping panel |
X |
X |
X |
|||
Islet cell antibody |
X |
X |
X |
|||
T-Cell clone |
|
X |
||||
Anti-thyroid antibody |
X |
|
X |
|||
Fibrinogen |
|
X |
X |
|||
Microalbumin |
|
|||||
Microalbumin screen |
|
X |
||||
Urine creatinine |
X |
|||||
Microalbumin quantity |
X |
|||||
Ratio |
X |
|||||
Diabetes Panel |
|
|||||
Hemoglobin A1c |
|
X |
||||
Islet Cell AB |
X |
|||||
GAD Ab |
X |
|||||
C-Peptide |
X |
|||||
Proinsulin |
X |
TABLE B-15 Covariate Data Collected (Nonexhaustive List)
TABLE B-16 AFHS Questionnaire Data
Cycle |
Subject Areas |
1 |
Subject Demographic Employment history Marital/reproductive history Medical history Substance abuse history Psychological history Exposure to toxic substances Income Spouse Demographic Reproductive history Substance abuse history Next of Kin (Proxy) Demographic Employment history Marital/reproductive history Medical history Substance abuse history Leisure activities Mortality data |
Additions to Interval Questionnaires |
|
2 |
Subject Skin cancer Personality type Birth marks Smoking habits Drinking habits |
3 |
Subject |
4 |
Subject Occupational exposures (heavy metals and vibrating power tools) Family health history (with particular reference to diabetes, heart trouble, and heart disease) Diabetes history (type, treatment received, and medications taken) Hepatitis B vaccination history Intermittent claudication and vascular insufficiency history Normal physical activity level Dietary surveyb |
5 |
Subject Percentage of herbicide spraying missions flown Intentional herbicide ingestion |
6 |
Subject Drinking history 2 weeks prior to physical exam Current personal relationships Employment history 1 week prior to physical exam Children under 18 living at home (including children, grandchildren, stepchildren, foster or adopted children) History of mission volunteerism in SEA |
aThis section was added to the baseline questionnaire. bThe dietary survey was developed by Walter Willett at Harvard University and administered at the Cycle 4 follow-up only. |
REFERENCES
AFHS. 1984. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. Baseline Morbidity Study Results. Brooks AFB, TX: USAF School of Aerospace Medicine. NTIS AD-A-138-340.
AFHS. 1987. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. First Follow-up Examination Results. 2 vols. Brooks AFB, TX: USAF School of Aerospace Medicine. USAFSAM-TR-87-27.
AFHS. 1990. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. 2 vols. Brooks AFB, TX: USAF School of Aerospace Medicine. USAFSAM-TR-90-2.
AFHS. 1992. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. Reproductive Outcomes. Brooks AFB, TX: Armstrong Laboratory. AL-TR-1992-0090.
AFHS. 1993. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. Mortality Update: 1993. Brooks AFB, TX: Armstrong Laboratory. AL/ AO-TR-1993-0161.
AFHS. 1995. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. 1992 Followup Examination Results. Brooks AFB, TX: Epidemiologic Research Division. Armstrong Laboratory. AL-TR-920107.
AFHS. 1998. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. Reproductive Outcome Update. Brooks AFB, TX: Epidemiologic Research Division. Armstrong Laboratory. AFRL-HE-BR-TR-1998-0073.
AFHS. 2000. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. 1997 Follow-up Examination Results. Brooks AFB, TX: Human Systems Program Office. Armstrong Laboratory. AFRL-HE-BR-TR-2000-02.
AFHS. 2005. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. 2002 Followup Examination Results. Brooks AFB, TX: Epidemiologic Research Division. Armstrong Laboratory. AFRL-HE-BR-SR-2005-0003.