Mortality of Veteran Participants in the CROSSROADS Nuclear Test (1996)
Chapter: Front Matter
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.
This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.
Support for this project was provided by the U.S. Department of Veterans Affairs contract nos.V101(93)P1431 and V101(93)P1165), cofunded by the Defense Special Weapons Agency (formerly, Defense Nuclear Agency). This support does not constitute an endorsement of the views expressed in this report.
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COMMITTEE ON THE CROSSROADS NUCLEAR TEST
RICHARD B. SETLOW, Chair, Associate Director for Life Sciences and Senior Biophysicist,
Biology Department, Brookhaven National Laboratory, Upton, New York
GILBERT W. BEEBE, Statistician,
Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland
RICHARD L. BOYLAN, Senior Military Reference Archivist,
National Archives and Records Administration, College Park, Maryland
DANIEL H. FREEMAN, JR., Professor,
Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas
ETHEL S. GILBERT, Senior Staff Scientist and Statistician,
Pacific Northwest Division, Battelle Memorial Institute, Richland, Washington
DENNIS F. HOEFFLER, Medical Director,
General Electric Lighting, Cleveland, Ohio
BARBARA S. HULKA, Professor,
Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
KEITH J. SCHIAGER, Director Emeritus,
Radiological Health Department, University of Utah, Salt Lake City, Utah
SEYMOUR JABLON,
Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland (through 1/93)
Study Staff
J. CHRISTOPHER JOHNSON, Study Director
HARRIET CRAWFORD, Operations Team Leader
WILLIAM F. PAGE, Biostatistician
PAMELA C. RAMEY-McCRAY, Project Assistant
SUSAN THAUL, Epidemiologist
DENNIS ROBINETTE (through 12/91)
YOUN SHIM (6/94–1/95)
BOARD OF THE MEDICAL FOLLOW-UP AGENCY
NORMAN BRESLOW, Chair, Professor of Biostatistics,
University of Washington, Seattle
JOHN C. BAILAR, III, Professor,
Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
DAN G. BLAZER, J.P. Gibbons Professor of Psychiatry, Dean of Medical Education,
Duke University Medical Center, Durham, North Carolina
DONALD L. CUSTIS, Senior Medical Advisor,
Paralyzed Veterans of America
DAVID G. HOEL, Chairman,
Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston
MICHEL M. IBRAHIM, Dean,
School of Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill
BERNARD T. MITTEMEYER, Executive Vice President and Provost,
Texas Tech University Health Sciences Center, Lubbock
H. ELDON SUTTON, Professor of Zoology, Director,
The Genetics Institute, The University of Texas at Austin
MARIE G. SWANSON, Professor,
Cancer Center at Michigan State University, East Lansing
MYRNA M. WEISSMAN, Professor of Psychiatry and Epidemiology,
Columbia University, College of Physicians and Surgeons, New York
Staff
RICHARD N. MILLER, Director,
Medical Follow-up Agency
CARLISS PARKER-SMITH, Administrative Assistant
NANCY DIENER, Financial Associate
Operations Team
HARRIET CRAWFORD, Operations Team Leader and Senior Programmer/Analyst
CHIQUITA BENSON, Programmer/Analyst
JIHAD DAGHMASH, Programmer/Analyst
NOAH DROPKIN, Coder/Abstractor
MARY JUMAN, Senior Program Assistant
SYLVIA MCKINNIS, Manager,
St. Louis Office
NICK FINDLAY, Records Assistant (7/95–6/96)
ALEXANDER SAENGER, Programmer/Analyst (9/93–7/95)
Preface
In November of 1983 the Congress of the United States passed Public Law 98–160 that directed the Veterans Administration (VA) to provide for the conduct of epidemiological studies of the long-term adverse health effects of exposure to ionizing radiation from detonation of nuclear devices. In response, the Medical Follow-up Agency (MFUA), then in the Commission on Life Sciences, National Academy of Sciences (NAS), proposed to compare the mortality experience of veteran participants in the CROSSROADS nuclear test to a similar group of nonparticipants. Operation CROSSROADS involved approximately 40,000 military personnel, mostly Navy, and occurred in July of 1946 at the Bikini Atoll in the Marshall Islands.
The VA convened an ad hoc scientific committee to review the NAS proposal which they recommended should be funded to "enlarge the growing body of information relating to the effects of low levels of radiation on human populations." The study was begun in September of 1986 and in 1988, a committee of the Institute of Medicine was organized to provide guidance and advice to the MFUA staff on the conduct of the study. The study was interrupted by the untimely death of the principal investigator, Dr. Dennis Robinette, in 1992. Both the Committee and MFUA staff wish to acknowledge their debt of gratitude to Dr. Robinette who laid the ground work for this study and assembled the comparison cohort. We regret he was not able to see the fruits of his labors in the publication of this report.
The Committee to Study the Crossroads Nuclear Test has met periodically since 1988 to review and guide the work of the MFUA staff as they have conducted the study. As with all research, resources are not boundless, and decisions must be made to apply them where the potential for gain is the
Acknowledgments
The Committee and the authors wish to express their appreciation to the veterans, too numerous to thank individually, who have provided us with information on their participation in CROSSROADS and to the veterans' groups that represent them. We are particularly indebted to Mr. Boley Caldwell of the National Association of Atomic Veterans (NAAV), who gave us the list of CROSSROADS veterans that we used as one source in verifying our participant list; Dr. Oscar Rosen for his perspective on Operation CROSSROADS as a participant and Director of NAAV; Mr. Robert Campbell, for the relevant information and documents he has provided over the course of the study; and Mrs. Pat Broudy, for her insights on the legislative aspects of atomic veteran compensation programs.
We have performed this study under Department of Veterans Affairs (VA) contracts (V101(93)P1431 and V101(93)P1165) which were cofunded by the Defense Special Weapons Agency (DSWA). We are appreciative of their support. The DSWA also provided indispensable information about the participants in Operation CROSSROADS study from their Nuclear Test Personnel Review (NTPR) database. In addition to funding, the VA has provided support in ascertaining the mortality of the cohort.
We are also in the debt of the National Archives and particularly the National Personnel Records Center, St. Louis MO, and their staffs, who provided us with necessary individual, mortality and unit data. Dr. Eric Gunderson and Dr. Frank Garland of the Naval Health Research Center, San Diego, gave us much useful information on the classification of both ships and personnel within the Navy.
Glossary and Acronyms
A
ABLE.
Military code name of 1 July 1946 nuclear detonation in Operation CROSSROADS.
AMFIT.
A statistical modeling program (in the Epicure software package) used to compute standardized mortality ratios (SMRs).
B
background radiation.
Detected disintegration events not emanating from the sample. Natural background is that radiation that is a natural part of a person's environment, primarily terrestrial radioactivity and cosmic rays.
BAKER.
Military code name of 25 July 1946 nuclear detonation in Operation CROSSROADS.
BEIR.
Biological Effects of Ionizing Radiation: A series of reports by committees of the National Academy of Sciences.
BEIR IV.
Biological Effects of Ionizing Radiation, 1988 Report IV (see References).
BEIR V.
Biological Effects of Ionizing Radiation, 1990 Report V (see References).
BIRLS.
Beneficiary Identification and Records Locator Subsystem, Department of Veterans Affairs.
BRER.
Board on Radiation Effects Research, National Research Council.
C
CDC.
Centers for Disease Control and Prevention, DHHS.
CFR.
Code of Federal Regulations.
CI.
Confidence interval (epidemiology/statistics).
CJTF-1.
Commander, Joint Task Force One.
CLL.
Chronic lymphocytic leukemia, a form of leukemia that has not been found in studies to be radiogenic.
CNS.
Central nervous system.
cohort study.
An epidemiologic investigation or follow-up of a group of individuals who are known to have had an exposure or a disease and whose health status is followed over time. Can usually provide a basis for calculating risk or disease outcome.
confounder.
A variable that is causally related to the disease under study and is associated with exposure in the study population, but is not a consequence of this exposure.
CROSSROADS.
Military code name of atmospheric test of nuclear weapons, July 1946, Bikini Atoll, Marshall Islands.
D
DD-214.
Military service discharge form.
DHHS.
Department of Health and Human Services, USA.
DNA.
Defense Nuclear Agency. The name was changed to Defense Special Weapons Agency (DSWA) in June 1996.
DoD.
Department of Defense, USA.
dose.
The amount of absorbed radiation energy.
DSWA.
Defense Special Weapons Agency (new name for DNA as of June 1996).
E
E1-E7.
Enlisted personnel paygrades.
exposure (radiation).
A term describing the amount of ionizing radiation that is incident upon living or inanimate material.
F
FARC.
Federal Archives Records Center.
film badge.
Photographic film shielded from light; worn by an individual to measure radiation exposure.
G
gamma ray.
Radiation emitted from the nucleus having a wavelength range of 10-9–10-12 centimeters.
GAO.
General Accounting Office, USA.
H
HCFA.
Health Care Financing Administration, DHHS.
I
ICD9.
International Classification of Diseases, 9th revision. (See References, World Health Organization, 1995)
ICRP.
International Commission on Radiological Protection.
incidence.
The number of persons who have developed a disease in a given period of time divided by the total population at risk.
IOM.
Institute of Medicine.
ionizing radiation.
Radiation that produces ion pairs along its path through a substance.
irradiation.
Exposure to radiation.
J
JTF.
Joint task force.
L
LTFU.
Lost to follow-up.
M
MFUA.
Medical Follow-up Agency, Institute of Medicine.
mrem.
Millirem, one-thousandth of a rem.
MSN.
Military service number.
mSv.
Millisievert, one-thousandth of a Sv.
N
NAAV.
National Association of Atomic Veterans.
NARA.
National Archives and Records Administration.
NAS.
National Academy of Sciences.
NCRP.
National Council on Radiation Protection and Measurements.
NDI.
National Death Index, maintained by the National Center for Health Statistics, CDC, DHHS.
NPRC.
National Personnel Records Center.
NRC.
National Research Council.
NRC
Nuclear Regulatory Commission. United States government agency regulating by-product material.
NRPB.
National Radiological Protection Board, U.K.
NTPR.
Nuclear Test Personnel Review, DNA.
O
O1–O10.
Commissioned officer paygrades.
odds ratio (OR).
Used as an estimation of relative risk. Primarily used for case-control studies and is calculated from the odds of exposure among the cases to that among controls.
OTA.
Office of Technology Assessment, U.S. Congress.
P
p.
Probability (epidemiology/statistics, e.g., p = .05).
PHREG.
Proportional hazards regression program, SAS.
R
radiation.
Energy propagated through space or matter as waves (gamma rays, ultraviolet light) or as particles (alpha or beta rays). External radiation is from a source outside the body, whereas internal radiation is from a source inside the body (e.g., radionuclides deposited in tissues).
RADSAFE.
Radiation safety monitor units, or personnel.
relative risk—RR.
The ratio of the incidence of a condition in the exposed population divided by the incidence in the nonexposed population. If there is no difference as a result of exposure, the RR is 1.0.
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List of Tables
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TABLE 6-1. |
Distribution of Participation in Nuclear Test Series |
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TABLE 8-1. |
Broad Occupational Specialty Groupings of Navy Enlisted Ratings Developed from "Navy Career Paths" (1949) |
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TABLE 8-2. |
General Rank/Rating and Occupational Specialty Categories for Navy Personnel |
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TABLE 10-1. |
Age-at-Shot Distribution of Navy Participants and Controls |
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TABLE 10-2. |
Distribution of Ranks and Ratings Among Navy Participants and Controls |
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TABLE 10-3. |
Distribution of Occupational Specialties Among Navy Participants and Controls |
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TABLE 10-4. |
Distribution of Boarders in the Study Cohort |
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TABLE 10-5. |
Number and Percent of Records with Missing Needed Data Item |
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TABLE 10-6. |
Vital Status on Follow-Up |
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TABLE 10-7. |
Information Available on Deaths |
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TABLE 10-8. |
Definitions of Analysis Variables |
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TABLE 10-9. |
ICD9 Mortality Codes Used as Case Definitions for Analyses |
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TABLE 11-1. |
Rate Ratios of Major Mortality Endpoints for Exposed to Not Exposed Personnel |
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TABLE 11-2. |
Mortality Rate Ratios from Six Selected Major Cause-of-Death Categories (subset of Table 11-1) |
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TABLE 11-3. |
Mortality Rate Ratios from Remaining Major Cause-of-Death Categories (subset of Table 11-1) |
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TABLE 11-4. |
Mortality Rate Ratios from Selected Cancer Sites within All Malignancies (Table 11-2) |
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TABLE 11-5. |
Mortality Rate Ratios for Selected Cancer Sites within Digestive, Respiratory, and Lymphopoietic Cancers (subset of Table 11-4) |
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TABLE 11-6. |
Mortality Rate Ratio for Selected Subset of Other Lymphatic Tissue (subset of Table 11-5) |
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TABLE 11-7. |
Mortality Rate Ratios for Subset of External Causes (subset of Table 11-2) |
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TABLE 11-8. |
Mortality Rate Ratio for Subset of All Accidents (subset of Table 11-7) |
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TABLE 11-9. |
Rate Ratios for All-Cause Mortality of Engineering & Hull to Non-Engineering & Hull Groups by Status as Participants or Controls |
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TABLE 11-10. |
Mortality Rate Ratios of Participants Relative to Controls (Marines, n = 1,137) |
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TABLE 11-11. |
Mortality Rate Ratios of Participants Relative to Controls (Army, including Army Air Corps, n = 6,482) |
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TABLE 11-12. |
Nonsignificant Risk Estimates from Tables 11-4 and 11-5 that Indicate at Least a 40 Percent Excess or Deficit in Mortality |
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TABLE 11-13. |
All-Cause Mortality Rate Ratios, Including and Excluding Records with Imputed Dates of Birth |
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TABLE C-1. |
Standardized Mortality Ratios for All Causes of Death in Navy Participants and Controls |
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TABLE C-2. |
Standardized Mortality Ratios for All-Malignancy Deaths in Navy Participants and Controls |
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TABLE C-3. |
Standardized Mortality Ratios (SMR) for Leukemia (including CLL) for Navy Enlisted Personnel (n = 66,831) |
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TABLE C-4. |
Standardized Mortality Ratios (SMR) for Army (including Army Air Corps, n = 6,482) |
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TABLE C-5. |
Standardized Mortality Ratios (SMR) for Marines (n = 1,137) |
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TABLE D-1. |
Tabulation of DNA Assigned Total Doses (rem [cSv]) by Study Grouping and Status as a Boarder or Nonboarder |
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TABLE E-1. |
Resolution of 617 Apparent Participant Deletions Between 1986 and 1994 |
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TABLE E-2. |
Summary of Completeness of the NTPR Participant List as Indicated by Veteran Responses to MFUA Solicitations Published in Veterans' Publications |
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TABLE E-3. |
Disposition of 103 Records of Putative Participants in CROSS-ROADS Whose Status Was Uncertain |
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TABLE E-4. |
Disposition of 89 Discrepant Records from the NAAV Medical Survey List, |
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TABLE E-5. |
Summary of Completeness of the NTPR Participant List According to Write-in Data (includes verification of 17 discrepancies by personnel record searches at DNA), |
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TABLE F-1. |
Procedural Steps and Success Rates for Determination of Vital Status Information, |
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TABLE F-2. |
Vital Status for Navy Personnel, |
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TABLE F-3. |
Completeness of Mortality Information, |
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TABLE F-4. |
Summary of Vital Status for Study Records Submitted to HCFA, |
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TABLE F-5. |
Comparison of VA and HCFA Vital Status for Operation CROSS-ROADS Participants and Controls, |
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TABLE F-6. |
Number of Potential Matches for Each Record Submitted to NDI, |
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TABLE F-7. |
Comparison of NDI and MFUA Mortality Information, |
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TABLE F-8. |
NDI and HCFA Comparisons, |
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TABLE F-9. |
Distribution of Causes of Death for 641 Death Certificates Sent for Recoding, |
