Agent Orange Exposure and Risk of Idiopathic Pulmonary Fibrosis Among U.S. Veterans

Details

• Personal Author:
  Blanc PD ; Collard HR ; Glidden DV ; Kaul B ; Lee JS ; Whooley MA ; Zhang N
• Description:
  Rationale: There is limited literature exploring the relationship between military exposures and idiopathic pulmonary fibrosis (IPF). Objectives: To evaluate whether exposure to Agent Orange is associated with an increased risk of IPF among veterans. Methods: We used Veterans Health Administration data to identify patients diagnosed with IPF between 2010 and 2019. We restricted the cohort to male Vietnam veterans and performed multivariate logistic regression to examine the association between presumptive Agent Orange exposure and IPF. We conducted sensitivity analyses restricting the cohort to army veterans (highest theoretical burden of exposure, surrogate for dose response) and a more specific case definition of IPF. Fine-Gray competing risk models were used to evaluate age to IPF diagnosis. Measurements and Main Results: Among 3.6 million male Vietnam veterans, 948,103 (26%) had presumptive Agent Orange exposure. IPF occurred in 2.2% of veterans with Agent Orange exposure versus 1.9% without exposure (odds ratio, 1.14; 95% confidence interval [CI], 1.12-1.16; P < 0.001). The relationship persisted after adjusting for known IPF risk factors (odds ratio, 1.08; 95% CI, 1.06-1.10; P < 0.001). The attributable risk among exposed veterans was 7% (95% CI, 5.3-8.7%; P < 0.001). Numerically greater risk was observed when restricting the cohort to 1) Vietnam veterans who served in the army and 2) a more specific definition of IPF. After accounting for the competing risk of death, veterans with Agent Orange exposure were still more likely to develop IPF. Conclusions: Presumptive Agent Orange exposure is associated with greater risk of IPF. Future research should validate this association and investigate the biological mechanisms involved. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Epidemiology Lung Lung Diseases Occupational Exposure Occupational Health Respiratory System Respiratory Tract Diseases Safety
• Keywords:
  Author Keywords: Interstitial Lung Disease Chemical Warfare Agents Cohort Studies Lung Disease Lung Fibrosis Military Personnel Occupational Exposure Veterans Health
• ISSN:
  1073-449X
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; Colorado ; OSHA Region 8 ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  206
• Issue:
  6
• NIOSHTIC Number:
  nn:20067244
• Citation:
  Am J Respir Crit Care Med 2022 Sep; 206(6):750-757
• Contact Point Address:
  Bhavika Kaul, M.D., Assistant Professor, University of California San Francisco, 513 Parnassus Avenue, HSE 1314, San Francisco, CA 94143
• Email:
  Bhavika.Kaul@ucsf.edu
• Federal Fiscal Year:
  2022
• Performing Organization:
  University of California, Berkeley
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:180f0c532e746215c0c0a1372021ac8ba2c0f8e4bb2742a1cec5409b128351573c7c09589cccaee33a0f957eaf38f5e9d34aefeac481f3dc044f499c86fa00a0
• Download URL:
  https://stacks.cdc.gov/view/cdc/231363/cdc_231363_DS1.pdf
• File Type:
  [PDF - 1.32 MB ]