Military exposures and ALS in a large veteran population

项目摘要/摘要 我们建议研究军事部门、职业、部署和创伤性脑之间的关系 损伤，以及他汀类药物的使用，以及肌萎缩侧索硬化症(ALS)的发病率和生存率使用新的 连接国防部(DOD)和退伍军人管理局(VA)的超大型数据库 在肌萎缩侧索硬化症发病前收集的数据。我们还将探讨他汀类药物的使用是否能预防 与其他军事接触的不利联系。我们将进行一项嵌套在联合内的病例对照研究 DOD-VA达芬奇数据库，包含超过400万名美国退伍军人。我们预计将有超过14,000例肌萎缩侧索硬化症病例 将在年龄和性别上将每个人与随机选择的10个对照组进行匹配。军事数据包括军事的各个方面 军种、军事占领、部署以及人口信息和健康等服务 数据。特别是，它包括关于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人员的病史 在退伍军人事务部服役后。这些数据使我们能够识别肌萎缩侧索硬化的病例以及使用 作为他汀类药物的使用。通过将这项研究嵌套在大型联合国防部-退伍军人事务部数据库中，我们拥有了一个独特的环境，将 让我们第一次以前所未有的方式评估主要军事接触与ALS之间的关系 道路。我们的假设是，肌萎缩侧索硬化症的风险增加通常见于那些在军队服役的人 是由特定的暴露驱动的，这些暴露不是在服务成员之间随机分布的，而是很可能是 特定工作人员或已部署人员有选择地体验(可能因部署位置而异)。 我们的研究将有助于完善我们对这些因素可能是什么的理解。

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.