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Occupational and environmental medicine
Research
The mortality and cancer experience of New Zealand Vietnam war veterans: a cohort study
  1. David McBride1,2,
  2. Brian Cox3,
  3. John Broughton4,
  4. Darryl Tong5
  1. 1Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
  2. 2Centre for Military and Veterans Health, University of Queensland, Herston, Queensland, Australia
  3. 3Hugh Adam Cancer Epidemiology Unit, University of Otago, Dunedin, New Zealand
  4. 4Ngai Tahu Māori Health Research Unit, University of Otago, Dunedin, New Zealand
  5. 5Department of Oral Diagnostic and Surgical Sciences, University of Otago, Dunedin, New Zealand
  1. Correspondence to Dr David McBride; david.mcbride{at}otago.ac.nz

Abstract

Objectives The aim was to observe the patterns of mortality and cancer incidence in New Zealand Vietnam veterans. The objectives were to assess whether the patterns of disease observed were consistent with those associated with military service in Vietnam, and similar to the patterns identified in other groups of Vietnam veterans.

Design A historical cohort study.

Setting Veterans, identified from service records, with Vietnam service between 1964 and 1972.

Participants Of the 3322 survivors of Vietnam service, we followed up 2783 (84%).

Outcome measures Standardised mortality and incidence ratios (SMRs and SIRs, respectively) were calculated based on the number of deaths and cancer registrations observed, those expected being based on New Zealand national rates.

Results All cause mortality was significantly reduced (SMR 0.85, 95% CI 0.77 to 0.94) and cancer incidence non-significantly increased (SIR 1.06, 95% CI 0.97 to 1.16). The risk of mortality from cancers of the head and neck (SMR 2.20, 95% CI 1.09 to 3.93); oral cavity pharynx and larynx (SMR 2.13, 95% CI 1.06 to 3.81) and the incidence of chronic lymphatic leukaemia (CLL) (SIR 1.91, 95% CI 1.04 to 3.20) were, however, significantly increased. Other lymphohaematopoietic disorders, specifically multiple myeloma and Hodgkin disease, showed non-significant mortality excesses, reflected by a similar increase in incidence.

Conclusions Service in the Vietnam war was associated with defoliant herbicide exposure, including 2,4,5-trichlorophenoxyacetic acid, 2,4-dichlorophenoxyacetic acid, picloram and cacodylic acid. Subsequent reviews of mechanistic, animal and epidemiological evidence led to certain conditions being deemed compensable. The pattern of mortality and cancer incidence is not at odds with the list of compensable conditions and consistent with that found in Australian veterans serving in the same area of Vietnam, but also consistent with smoking and the healthy soldier effect. In common with the Australian experience, this is the only veterans group to show a significant excess of CLL.

  • EPIDEMIOLOGY
  • Leukaemia < ONCOLOGY
  • OCCUPATIONAL & INDUSTRIAL MEDICINE

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/bmjopen-2013-003379

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