More Cases of Asthma, COPD, Hypertension After Military Burn Pit Exposure

Prolonged deployment to military bases with open burn pits was associated with increased risks for certain respiratory and cardiovascular diseases, according to a retrospective cohort study using Veterans Health Administration (VHA) records.

In adjusted analyses, every 100 days of deployment to bases with burn pit exposure was associated with small increases in the odds of having asthma (adjusted OR 1.01, 95% CI 1.00-1.02), chronic obstructive pulmonary disease (COPD; aOR 1.04, 95% CI 1.02-1.06), and hypertension (aOR 1.02, 95% CI 1.01-1.03), reported David A. Savitz, PhD, of Brown University School of Public Health in Providence, Rhode Island, and co-authors.

Veterans in the highest tertile of burn pit exposure (340 days or more) had a 10% higher odds of asthma, a 22% higher odds of COPD, and a 10% higher odds of hypertension when compared with those with no exposure.

While a signal for an increased risk of ischemic stroke was observed, it was not statistically significant (aOR 1.05, 95% CI 0.97-1.14), Savitz and team noted in JAMA Network Open.

The U.S. military used open burn pits on some military bases to dispose of solid, medical, and hazardous materials during Operation Enduring Freedom (OEF) in Afghanistan (2001-2014) and Operation Iraqi Freedom (OIF) in Iraq (2003-2011), the authors explained. In 2009, the Department of Defense restricted the materials allowed to be disposed in burn pits, they added, but the U.S. military continued to use burn pits until other methods of disposal, including incineration, recycling, waste segregation, and landfills, were put into practice.

"Research on the long-term health consequences of exposure to open burn pits has been limited, despite widespread concern among veterans and the general public," Savitz and colleagues noted.

Three previous studies attempted to look at the association between burn pit exposures and health outcomes. Two found no association between burn pit exposure or deployment to bases with burn pits and respiratory symptoms/diagnoses or respiratory disease outcomes, and the third identified some positive associations, but Savitz's group noted that the registry used was "of limited value due to the highly self-selected population."

Deployment during OEF and OIF has been associated with a higher risk of respiratory disease, but the authors said that this may be attributed to other exposures. Furthermore, "comprehensive exposure assessment has not been feasible due to the lack of systematic monitoring or detailed records on burn pit use," they added.

"The findings of this cohort study suggest that healthcare for veterans of OEF and OIF should consider the potential health outcomes associated with exposure to emissions from open burn pits, with implications for access to care and benefits," Savitz and team concluded. "Potential long-term health outcomes associated with open burn pit exposure call for continued efforts to evaluate whether there are measurable increases in disease risk."

In an invited commentary, John R. Balmes, MD, of the University of California San Francisco, stressed the need for physicians to discuss the health risks of deployment with their veteran patients.

"When encountering patients with respiratory concerns who are veterans deployed in the Gulf War, [OEF], or OIF, it is incumbent to ask about whether they were deployed to bases where open burn pits were in operation and for how long," he wrote. "If a history of substantial exposure to burn pit emissions is elicited, referral to a VHA facility for an Environmental Health Registry Evaluation may be warranted."

This observational study used VHA medical records and declassified deployment records from the Department of Defense to assess Army and Air Force veterans who were deployed between 2001 and 2011, with follow-up through December 2020.

Savitz and colleagues included 459,381 OEF and OIF veterans in the study. Mean age was 31.6, 87% were men, 66.6% were white, and 16.4% were Black. Of these veterans, 43.4% reported at least some cigarette smoking.

Most of the cohort (85.6%) had been deployed to bases with burn pits at some time. Overall median exposure was 244 days. Median follow-up from end of deployment was 10.9 years.

The researchers found that odds of interstitial lung disease, myocardial infarction, congestive heart failure, or hemorrhagic stroke were not increased.

They noted that a limitation of the study was its inability to assess burn pit characteristics at each base that could have affected the probability of exposure to specific toxicants among those serving at the base.

Balmes emphasized that patients who might have been impacted by this exposure may be able to get disability compensation if they believe they are experiencing negative health effects from being deployed to a base with a burn pit.

"Congress recently passed the Promise to Address Comprehensive Toxics Act that provides disability compensation for multiple burn pit and other toxic exposure presumptive conditions, including asthma, COPD, constrictive or obliterative bronchiolitis, and several interstitial lung diseases," he wrote.

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