Deployment to bases with open burn pits and mortality of US military Veterans
Abstract: Introduction: Five million US Veterans had possible exposure to open burn pits used for waste disposal through service in Iraq (2003-2011) and Afghanistan (2001-2014). Burn pits generate toxic exposures that may be associated with adverse health outcomes. We examined all-cause and cause-specific mortality in relation to deployment to bases with open burn pits. Methods: We analysed a cohort of 474 634 Veterans who received some healthcare from the Veterans Health Administration, linked to Department of Defense deployment records to identify assignments to bases with burn pits. In multivariable logistic regression models, we assessed the association between duration of deployment to bases with burn pits and all-cause mortality and cause-specific mortality from the six most common causes among this population of Veterans. Results: Duration of deployment to bases with burn pits was modestly related to all-cause mortality, with adjusted ORs of 1.07 (95% CI 0.99 to 1.15), 1.08 (95% CI 1.00 to 1.16) and 1.16 (95% CI 1.06 to 1.27) across tertiles, but not associated with mortality due to cancer, heart disease or chronic liver disease/cirrhosis. Positive associations were also found for unintentional injuries, suicide and stroke. Discussion: These data are suggestive of an association between duration of deployment to bases with burn pits and overall mortality, but not from cancer or heart disease. Unexpected associations with injury and suicide call for a more detailed evaluation. Conclusions are restricted by the broad aggregations of causes of death, a limited number of deaths in this relatively young cohort and the lack of more detailed information on exposure to burn pits.