Epidemiological Studies of the Porton Down Veterans: a ten-year update on mortality and cancer incidence, 2005-2014

从1941年4月1日到1989年12月31日，在波顿唐恩参加化学战剂（CWA）研究的“人类志愿者计划”的英国军人，最初聚集波顿唐恩退伍军人群体是为了看看是否对他们的健康有任何延迟影响。我们发现，18276名波顿唐氏退伍军人与17600名没有访问波顿唐氏的退伍军人相比，癌症总体上没有增加，随访到2004年12月31日。虽然所有原因加起来造成的死亡人数略多（6%），但这不能直接归因于cwa。队列研究之前没有更新，我们现在建议随访至2014年12月31日。额外的十年将大大提高统计能力，因为我们估计它将使死亡人数增加近8 000人，并使癌症登记人数按比例增加。这将使我们能够研究自第一次研究以来出现的新问题。这一队列在今天仍然具有相关性，因为由于流氓国家和恐怖分子使用cwa，其长期危害的可能性仍然是热门话题。波顿唐研究中使用的暴露量非常低，但也是世界上记录最充分的CWA暴露量，因此继续提供有关暴露在频谱低端的影响的信息。一些在化学武器袭击中幸存下来的人可能接触的剂量很低。这些新的研究问题包括探索，例如：脑癌与神经毒剂的关系；与CS气体有关的食管癌；与接触氯氟烃有关的自杀。由于军事人员档案检索已实现电脑化，我们还计划评估吸烟和饮酒数据的可用性。如果这些信息能够被检索出来，它将极大地加强我们的统计分析，因为我们将能够在我们的分析中控制这些生活方式因素的混淆。最后，我们将探讨将这些队列与只有在第一次研究完成后才可供研究人员使用的数据集（如医院事件统计数据）联系起来的可行性。如果联系是可行的，这将导致未来的研究经费申请，如研究老年退伍军人的心理健康。进行这项新分析所需的大部分工作都是在第一次研究期间完成的，因此该提案是对公共资金的谨慎和有效利用。对暴露于CWAs或其治疗的担忧可能会持续很长时间，更新这一队列使我们能够检查这些担忧，并为政策制定者和服务提供者提供可靠的证据。社会有责任照顾其退伍军人，更新的队列也可以帮助回答有关老年退伍军人健康的新问题，因为这些问题将来会出现，这是国防部和英国皇家军团当前的一个重要问题。

The Porton Down Veterans cohort was originally assembled to see if there were any delayed effects on the health of UK servicemen who took part in the 'human volunteer programme' of chemical warfare agent (CWA) research at Porton Down from 01/04/1941 to 31/12/1989. We showed that the 18,276 Porton Down veterans had no overall excess of cancer compared to 17,600 veterans who did not visit Porton Down, taking follow-up until 31/12/2004. While they had a small (6%) excess of deaths from all causes combined, this could not be directly attributed to CWAs.The cohort study has not previously been updated and we now propose to take follow-up to 31/12/2014. The additional ten years will greatly increase statistical power because we estimate it will add almost 8,000 further deaths and a proportionate number of additional cancer registrations. This will allow us to study new questions that have arisen since the first study. The cohort remains relevant today because the potential for long-term harm from CWAs continues to be topical because of their use by rogue states and terrorists. The exposures used in the research at Porton Down were very low but were also the best documented CWA exposures in the world and therefore continue to be informative about the effects of exposures at the low end of the spectrum. Some of the survivors of a CWA attack would be expected to have had low exposures.These new research questions include exploring, for example: brain cancer in relation to nerve agents; oesophageal cancer in relation to CS gas; suicide in relation to CWA exposure. We also plan to assess the availability of data on smoking and alcohol consumption now that military personnel record retrieval has been computerised. If this information can be retrieved, it would greatly strengthen our statistical analyses because we would be able to control in our analyses for confounding by these lifestyle factors. Finally, we will explore the feasibility of linking these cohorts to datasets which only became available to researchers after the first study was completed, such as Hospital Episode Statistics data. If linkage is feasible, this will lead on to future research funding applications, such to study the mental health of older-aged military veterans.Most of the work required to do this new analysis was done during the first study, so the proposal represents a prudent and efficient use of public funds. Concerns about exposure to CWAs or their treatments are likely to remain long into the future and updating this cohort allows us to examine these concerns and provide reliable evidence for policymakers and service providers. Society has a duty of care to its veterans and the updated cohort can also help to answer new questions about the health of older veterans, as they arise in the future, an important current issue for both the Ministry of Defence and also the Royal British Legion.