Hodgkin's disease and Vietnam service
ABSTRACT Earlier studies that showed an association between exposure to phenoxy herbicides and the risk of malignant lymphomas have sparked concerns among Vietnam veterans over Agent Orange exposure. The Department of Veterans Affairs (VA) undertook a hospital-based case-control study to examine the association between military service in Vietnam and several histologic types of malignant lymphomas. This is a report of 283 Vietnam-era veteran patients who were treated in one of 172 VA hospitals from 1969 to 1985 with a diagnosis of Hodgkin's Disease (HD). Four hundred and four Vietnam-era veteran patients with a diagnosis other than malignant lymphoma sewed as a comparison group. Military service information was obtained from a review of the veteran's military personnel records. Service in Vietnam was not associated with any significant increase in the risk of HD (adjusted odds ratio = 1.28; 95% confidence interval = 0.94, 1.76). Surrogate measures of potential Agent Orange exposure such as service in a specific military branch, in a certain region within Vietnam, in a combat role, or extended Vietnam service time were not associated with any significant increased risk of HD.
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ABSTRACT: To systematically review published studies for algorithms that identified lymphoma as a health outcome of interest in administrative or claims data and examined the validity of the algorithm to identify lymphoma cases. A systematic literature search was executed using PubMed and the Iowa Drug Information Service database. Two investigators reviewed search results to identify studies using administrative or claims databases from the USA or Canada that both reported and validated an algorithm to identify lymphoma. The search identified 713 unique citations with 402 eliminated by an initial screen of the article abstract. The remaining 311 resulted in one study that identified and validated an algorithm. Ten other studies reported algorithms but were not validated. The validated study reported four possible algorithms that had a specificity (> 99%), but the algorithm using two diagnostic codes recorded within 2 months had the best positive predictive value (PPV = 62.83%) and a sensitivity (79.81%). The most comprehensive algorithm required multiple diagnostic codes 2 months apart or diagnostic, and procedure codes on the same day had the greatest sensitivity (88.31%) and a PPV = 56.69%. The algorithm that required only a single diagnostic or procedure code had the worst PPV (34.72%). The International Classification of Disease, Ninth Revision diagnostic, clinical procedure, and complication codes for lymphoma can identify incident hematologic malignancies and solid tumors with high specificity but with relatively low to moderate sensitivity and PPVs. When diagnostic and procedure codes were required on the same visit or multiple codes between visits, then PPV was increased. Relying on a single registry to confirm true positive cases is also not sufficient.Pharmacoepidemiology and Drug Safety 01/2012; 21 Suppl 1:203-12. DOI:10.1002/pds.2315 · 3.17 Impact Factor
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ABSTRACT: This research examined the risk of disease-related mortality of the Army Chemical Corps (ACC) veterans who handled/sprayed herbicides in Vietnam in comparison with their non-Vietnam veteran peers or U.S. men. Vital status was determined through December 31, 2005. All-cause mortality and cause-specific mortality were compared for individuals who served in Vietnam (n = 2872) versus those who did not (n = 2737). Similar analyses were completed on a subset of the original Vietnam cohort that consisted of individuals who either reported spraying herbicide (n = 662) or not (n = 811). The observed deaths for each of the two base cohorts were also compared with expected deaths for U.S. men. Statistically significant excess mortality was found for ACC Vietnam veterans for chronic obstructive pulmonary disease (adjusted relative risk [ARR], 4.82; 95% confidence interval [95% CI], 1.10-21.18). When examining patterns for veterans in the Vietnam veteran subset, we found nonsignificant elevated ARRs among herbicide sprayers for all-cause, respiratory system disease, and respiratory system cancer mortality. Compared with U.S. men, the Vietnam veteran cohort had significant excess mortality for all-causes (standardized mortality ratio [SMR], 1.13; 95% CI, 1.04-1.23), respiratory system cancer (SMR, 1.35; 95% CI, 1.03-1.73), nonmalignant respiratory system disease (SMR, 1.58; 95% CI, 1.08-2.23), and miscellaneous malignant cancers (SMR, 1.77; 95% CI, 1.03-2.84). The risk of mortality from respiratory disease (malignant or nonmalignant) was significantly greater for ACC Vietnam veterans in comparison with their non-Vietnam veteran peers and U.S. men. Herbicide exposure could be contributing to the patterns observed. Because of the unique nature of their military duties and study limitations, findings may not be generalizeable to Vietnam veterans as a whole.Annals of epidemiology 05/2010; 20(5):339-46. DOI:10.1016/j.annepidem.2010.02.003 · 2.15 Impact Factor
Annals of Epidemiology 10/1995; 5(5):414-6. DOI:10.1016/1047-2797(95)00071-E · 2.15 Impact Factor