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

这项调查验证了一种假设，即军事占领特定的二氧化硅和其他无机物暴露 粉尘与类风湿性关节炎(RA)和其他风湿性疾病的未来发展有关 自身免疫性疾病。对平民人口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研究过。这个 主要的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 使用已建立的OEF/OIF/OND名册，与军队暴露于无机粉尘有关 有过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)的军事任务与为本研究开发的工作暴露矩阵联系起来。这个 感兴趣的疾病结果将通过为RA、系统性红斑狼疮编码的VAHCS来访来定义 (SLE)和选定的其他风湿性自身免疫性疾病(如系统性硬化症， 皮肌炎和血管炎)。进一步的诊断改进将由血清学数据和 基于自然语言的算法。我们将分析每个目标情况的初始诊断前的时间 (比例危害建模)以估计与军事职业相关的疾病风险 曝光。我们将根据关键的协变量进行调整，包括性别、年龄、吸烟、服务年限和 服务。我们将把学习资格限制在完全现役军事人员(预备役和国民警卫队) 成员不会被包括在内，以更好地对暴露进行分类)。在额外的排除之后，我们预计 对600,000人、每年约240万人的VAHCS患者就诊进行队列分析。的 队列中，25%的人有较高的职业任务；18%的人有中等程度的职业任务；57%的人的职业任务可以忽略不计 暴露的可能性。在使用RA作为队列的子集的初步Logistic回归分析中 结果，我们观察到与暴露相关的患病几率增加了38%(OR 1.38；95%CI 1.05-1.80)。基座 根据这些数据，我们保守地估计我们将有足够的学习能力(阿尔法0.05；贝塔0.20) 检测暴露相关的增加风险，RA的风险低至1.3，SLE的风险低于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是公认的 这是发病的重要来源。现在公认，吸入无机粉尘是一个始终如一的因素。 这与平民人口患此类疾病的风险增加有关。然而这两个独立的和 重要的现象从来没有考虑过彼此之间的关系。简而言之，这个问题并没有 有人问，服兵役本身会不会是此类疾病的诱因？这个问题的答案是至关重要的 到减少风险、病例识别、有效治疗以及潜在和初级预防。

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.