Military Service, Occupational Exposure, and Rheumatoid Arthritis Risk in Veterans

这项调查测试的假设，军事职业的具体暴露于二氧化硅和其他无机 粉尘与类风湿性关节炎（RA）和其他风湿性关节炎（RA）的潜在发展有关。 自身免疫性疾病对受辐射平民的研究充分支持了这一假设。 二氧化硅和其他无机粉尘，但这从来没有在军事职业背景下进行过研究。的 总体研究目的是评估类风湿性关节炎（RA）和其他风湿性疾病的风险 使用OEF/OIF/OND的既定名册， 曾与退伍军人管理局医疗保健系统（VAHCS）联系的退伍军人。我们将定义 通过将分类（编码）的军事职责与为本研究开发的工作暴露矩阵联系起来，分析了职业暴露。的 关注的疾病结局将通过编码为RA、系统性红斑狼疮的VAHCS访视定义 (SLE)和选择的其它风湿性自身免疫病症（如系统性硬化症， 皮肌炎和血管炎）。进一步的诊断完善将通过血清学数据进行补充， 自然语言算法我们将分析每个目标条件的初始诊断时间 （比例风险模型），以估计与军事职业相关的疾病风险 exposure.我们将对关键协变量进行调整，包括性别、年龄、吸烟、服务时间和分支 的服务.我们将研究资格限制为现役军人（预备役和国民警卫队 将不包括成员，以便更好地对暴露进行分类）。在额外的排除之后，我们预计 队列分析60万人，约240万人年的VAHCS患者就诊。的 25%的人有较高的职业分配; 18%，中等; 57%，可以忽略不计 暴露的可能性在使用RA作为队列的一个子集的初步逻辑回归分析中， 结果，我们观察到38%的增加与疾病的风险（OR 1.38; 95%CI 1.05 - 1.80）。基于 根据这些数据，我们保守估计，我们将有足够的研究能力（α 0.05; β 0.20）， 检测到RA的风险增加低至1.3，SLE低于1.5。RA、SLE和其他 在VAHCS服务的人群中，自身免疫性风湿性疾病被公认为是一种 发病率的重要来源。现在已经很好地确定，无机粉尘吸入是一个因素， 与平民人口中此类疾病的风险增加有关。这两个独立的， 重要的现象从来没有被认为是相互关联的。简而言之，这个问题并没有 有人问，服兵役本身是否也会导致这些疾病？这个问题的答案至关重要 风险降低、病例识别、有效治疗和潜在的初级预防。

This investigation tests the hypothesis that military occupation-specific exposures to silica and other inorganic dusts are associated with the prospective development of rheumatoid arthritis (RA) and other rheumatic autoimmune diseases. There is ample support for this hypothesis from studies of civilian populations exposed to silica and other inorganic dusts, but this has never been studied in the military occupational context. The overarching Study Aim is to estimate the risk of rheumatoid arthritis (RA) and other rheumatic diseases associated with military service exposure to inorganic dust using an established roster of OEF/OIF/OND veterans who have had any Veterans Administration Health Care System (VAHCS) contact. We will define exposure by linking categorized (coded) military duties to a job exposure matrix developed for this study. The disease outcomes of interest will be defined by VAHCS visits coded for RA, systemic lupus erythematosus (SLE) and selected additional rheumatologic autoimmune conditions (such as systemic sclerosis, dermatomyositis, and vasculitis). Further diagnosis refinement will be supplemented by serologic data and natural language-based algorithms. We will analyze time until initial diagnosis for each target condition (Proportionate Hazards modeling) to estimate the risk of disease associated with military occupational exposure. We will adjust for key covariates, including sex, age, smoking, duration of service, and branch of service. We will limit study eligibility to full active duty military personnel (Reserve duty and National Guard members will not be included to better categorize exposure). After additional exclusions, we anticipate a cohort for analysis of 600,000 persons with approximately 2.4 million person years of VAHCS patient visits. Of the cohort, 25% will have had occupational assignments of higher; 18%, intermediate; and 57%, negligible exposure likelihood. In a preliminary logistic regression analysis in a subset of the cohort using RA as the outcome, we observed a 38% increased exposure-associated odds of disease (OR 1.38; 95% CI 1.05-1.80). Based on these data, we conservatively estimate that we will have sufficient study power (alpha 0.05; beta 0.20) to detect exposure-related increase risk as low as 1.3 for RA and below 1.5 for SLE. RA, SLE, and other autoimmune rheumatic diseases within the population served by the VAHCS are well recognized as an important source of morbidity. It is now well established that inorganic dust inhalation is a factor consistently associated with increased risk of such diseases among civilian populations. Yet these two independent and important phenomena never have been considered in relation to one another. In short, the question has not been asked, can military service itself be a contributor to such diseases? The answer to this question is critical to risk reduction, case identification, effective treatment, and potentially, and primary prevention.