Military exposures and ALS in a large veteran population

项目总结/摘要 我们建议研究军事分支、职业、部署与脑外伤的关系 损伤，以及他汀类药物的使用，肌萎缩侧索硬化症（ALS）的发病率和生存率，使用新的 连接国防部和退伍军人管理局的超大型数据库 在ALS发病前收集的数据。我们还将探讨使用他汀类药物是否可以防止任何 与其他军事接触的不良关联。我们将在关节内进行病例对照研究 DOD-VA DaVINCI数据库包含超过400万美国退伍军人。我们预计超过14,000例ALS病例， 将每个人的年龄和性别与随机选择的10个对照组相匹配。军事数据包括军事 服务，如服务的分支、军事占领、部署，以及人口统计信息和健康 数据特别是，它包括创伤性脑损伤的数据-在战区（即在冲突中）捕获 环境）和其他地方。VA数据捕获那些获得医疗保健的服务成员的病史 在退伍军人事务部的驻地这些数据使我们能够识别ALS的病例以及药物的使用， 使用Statins。通过在大型联合DOD-VA数据库中嵌套这项研究，我们有一个独特的设置， 这使我们能够首次以前所未有的方式评估关键军事暴露与ALS之间的关系。 路上了我们的假设是，在军队服役的人中， 是由特定的风险所驱动的，这些风险不是随机分布在服务成员中，而是很可能是 从事某些工作的人或被部署的人有选择地经历（可能因部署地点而异）。 我们的研究将有助于我们更好地理解这些因素可能是什么。

Project Summary/Abstract We propose to study the relation between military branch, occupation, deployment, and traumatic brain injury, as well as use of statins, and amyotrophic lateral sclerosis (ALS) incidence and survival using a new extremely large database that has linked both Department of Defense (DOD) and Veterans Administration (VA) data collected well before the onset of ALS. We will also explore whether use of statins protects against any adverse association with other military exposures. We will conduct a case-control study nested within the joint DOD-VA DaVINCI database of over 4 million US military veterans. We anticipate over 14,000 ALS cases and will match each on age and sex to 10 randomly selected controls. Military data includes aspects of military service like branch of service, military occupation, deployment, as well as demographic information and health data. In particular, it includes data on traumatic brain injury—captured both in theater (i.e. in the conflict environment) and elsewhere. VA data captures medical history of those service members who get health care at VA sites after their service. These data allow us to identify cases of ALS as well as use of medications such as use of statins. By nesting this study within large joint DOD-VA database, we have a unique setting that will allow us for the first time to assess the relation between key military exposures and ALS in an unprecedented way. Our hypothesis is that the increased risk of ALS frequently seen among those who served in the military is driven by specific exposures that are not randomly distributed among service members, but rather likely are selectively experienced by those in certain jobs or who are deployed (possibly varying by deployment location). Our study will help refine our understanding of what those factors could be.