Deployment Environmental Epidemiology in the Army

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Deployment Environmental Epidemiology in the Army

• Determining its Feasibility and Applications
• Vivian Rush, MD, MPH
• USACHPPM

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Deployment Environmental Epidemiology

• Use of Army and DoD Databases to evaluate/
  analyze data being generated by deployed Army
  Service members, for surveillance and risk
  communication purposes.
• CHPPMs interest is occupational/environmental
  exposures and health effects/outcomes
• Objective and Subjective data are available
• The DEE team plans to hone in on specific cohorts

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Data needs and availability 1

• There are systematic weaknesses in data
  collection
• Rosters are needed but difficult and incomplete
  (set up for other purposes)
• The DEE team is undertaking a Pilot Project to
  determine data availability and use potential
• Roster construction under development through
  Georoster sub-effort

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Data needs and availability 2

• Objective exposure data DESP (Special teams,
  FSTs, Prev. Med documentation, etc)
• Subjective exposure data DD 2796 exposure
  questions
• Objective Health Outcome data SIDR/SADR DD 2796
  post-deployment evaluation
• Subjective Health Outcome data DD 2796 health
  outcome and perception of health questions

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Pilot Project 1

• Surveillance of Afghan Cohort (2001-2003) focus
  on air quality in Kabul
• Aims
• Feasibility of obtaining data from a pre-defined
  cohort
• Describe tracking databases, assess validity,
  lessons learned
• Evaluate correlations between exposure and
  health outcomes/utilization

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Pilot Project 2

• Comparisons
• Entire cohort Exposed Kabul vs Nonexposed
  Rest
• Subcohort (Kabul only) Exposed Self-reported
  exposure concerns vs Nonexposed No (or less)
  exposure concerns
• Entire Cohort Use of objective air quality
  sampling data to define exposure

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GEOROSTER

• A CHPPM ad hoc OIF/OEF troop tracking database
• -- under development --
• Purpose
• By location/time generate personnel rosters
• By person generate geo-location timelines
• Attributes
• Focus on Army personnel
• Collection of multiple electronic data sources
• Includes field data and reference data
• Will generate analytic data files
• Validity of location/time data currently unknown

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GEOROSTER Database process
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GEOROSTER Example

• Location timeline for 1 Army soldier
• Prior to data validation
• Five electronic data source files
• Six records

Right- censored

• Challenging data interpretation problem.
• Was this soldier in Kabul from Sep Jan?

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GEOROSTER Validation Next Steps

• Roster Completeness
• Can we capture all who were deployed to
  Afghanistan?
• Differences by component (active, guard,
  reserve)?
• Quality of Tracking Data
• Validity (accuracy and reliability)
• Detail (e.g., country vs. camp)
• Completeness (across deployment)

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Summary

• DoD and Army Deployment data collection and
  analysis for surveillance is evolving
• Deployment Environmental Epidemiology at CHPPM is
  evolving
• CHPPM is uniquely positioned to recognize and
  assemble specific cohorts of concern and evaluate
  objective and subjective exposure and health
  outcome deployment data

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DEE Pilot Project Team

• US ARMY CENTER FOR HEALTH PROMOTION PREVENTIVE
  MEDICINE
• Directorate of Occupational and Environmental
  Medicine (DOEM)
• Directorate of Health Risk Management (DHRM)
• Terrence Lee (DOEM)
• Matthew McAtee (DHRM)
• MAJ Ronald Ross (DOEM)
• Vivian Rush (DOEM)
• Coleen Weese (DOEM)
• Warren Wortman (DHRM)