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Serum 2,3,7,8-Tetrachlorodibenzo-p-dioxin Levels and Their Association With Age, Body Mass Index, Smoking, Military Record-based Variables, and Estimated Exposure to Agent Orange in Korean Vietnam Veterans
Sang-Wook Yi, Heechoul Ohrr, Jong-Uk Won, Jae-Seok Song, Jae-Seok Hong
J Prev Med Public Health. 2013;46(5):226-236.   Published online September 30, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.5.226
  • 10,921 View
  • 87 Download
  • 12 Crossref
AbstractAbstract PDF
Objectives

The aim of this study was to examine the levels of serum 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and evaluate their association with age, body mass index, smoking, military record-based variables, and estimated exposure to Agent Orange in Korean Vietnam veterans.

Methods

Serum levels of TCDD were analyzed in 102 Vietnam veterans. Information on age, body mass index, and smoking status were obtained from a self-reported questionnaire. The perceived exposure was assessed by a 6-item questionnaire. Two proximity-based exposures were constructed by division/brigade level and battalion/company level unit information using the Stellman exposure opportunity index model.

Results

The mean and median of serum TCDD levels was 1.2 parts per trillion (ppt) and 0.9 ppt, respectively. Only 2 Vietnam veterans had elevated levels of TCDD (>10 ppt). The levels of TCDD did not tend to increase with the likelihood of exposure to Agent Orange, as estimated from either proximity-based exposure or perceived self-reported exposure. The serum TCDD levels were not significantly different according to military unit, year of first deployment, duration of deployment, military rank, age, body mass index, and smoking status.

Conclusions

The average serum TCDD levels in the Korean Vietnam veterans were lower than those reported for other occupationally or environmentally exposed groups and US Vietnam veterans, and their use as an objective marker of Agent Orange exposure may have some limitations. The unit of deployment, duration of deployment, year of first deployment, military rank, perceived self-reported exposure, and proximity-based exposure to Agent Orange were not associated with TCDD levels in Korean Vietnam veterans. Age, body mass index and smoking also were not associated with TCDD levels.

Summary

Citations

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  • Determinants of exposure to polychlorinated biphenyls in the Italian population in the last decades
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    EFSA Journal.2018;[Epub]     CrossRef
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    International Journal of Hygiene and Environmental Health.2017; 220(2): 378.     CrossRef
  • High Prevalence of Agent Orange Exposure Among Thyroid Cancer Patients in the National Va Healthcare System
    Karen T. Le, Mark P. Sawicki, Marilene B. Wang, Jerome M. Hershman, Angela M. Leung
    Endocrine Practice.2016; 22(6): 699.     CrossRef
  • Herbicide Exposure, Vietnam Service, and Hypertension Risk in Army Chemical Corps Veterans
    Yasmin S. Cypel, Amii M. Kress, Stephanie M. Eber, Aaron I. Schneiderman, Victoria J. Davey
    Journal of Occupational & Environmental Medicine.2016; 58(11): 1127.     CrossRef
  • Authors' response to: ME Ginevan et al. Exposure estimates in epidemiological studies of Korean veterans of the Vietnam War
    S.-W. Yi, S.-Y. Ryu
    International Journal of Epidemiology.2015; 44(1): 359.     CrossRef
  • A critical review of the epidemiology of Agent Orange or 2,3,7,8-tetrachlorodibenzo-p-dioxin and lymphoid malignancies
    Ellen T. Chang, Paolo Boffetta, Hans-Olov Adami, Jack S. Mandel
    Annals of Epidemiology.2015; 25(4): 275.     CrossRef
  • A critical review of the epidemiology of Agent Orange/TCDD and prostate cancer
    Ellen T. Chang, Paolo Boffetta, Hans-Olov Adami, Philip Cole, Jack S. Mandel
    European Journal of Epidemiology.2014; 29(10): 667.     CrossRef
  • Challenges in investigating the association between Agent Orange and cancer: Site‐specific cancer risk and accuracy of exposure assessment
    Thomas H. Sinks
    Cancer.2014; 120(23): 3595.     CrossRef
  • Agent Orange exposure and cancer incidence in Korean Vietnam veterans: A prospective cohort study
    Sang‐Wook Yi, Heechoul Ohrr
    Cancer.2014; 120(23): 3699.     CrossRef
  • Agent Orange exposure and risk of death in Korean Vietnam veterans: Korean Veterans Health Study
    Sang-Wook Yi, So-Yeon Ryu, Heechoul Ohrr, Jae-Seok Hong
    International Journal of Epidemiology.2014; 43(6): 1825.     CrossRef
Agent Orange Exposure and Prevalence of Self-reported Diseases in Korean Vietnam Veterans
Sang-Wook Yi, Heechoul Ohrr, Jae-Seok Hong, Jee-Jeon Yi
J Prev Med Public Health. 2013;46(5):213-225.   Published online September 30, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.5.213
  • 11,919 View
  • 149 Download
  • 32 Crossref
AbstractAbstract PDF
Objectives

The aim of this study was to evaluate the association between Agent Orange exposure and self-reported diseases in Korean Vietnam veterans.

Methods

A postal survey of 114 562 Vietnam veterans was conducted. The perceived exposure to Agent Orange was assessed by a 6-item questionnaire. Two proximity-based Agent Orange exposure indices were constructed using division/brigade-level and battalion/company-level unit information. Adjusted odds ratios (ORs) for age and other confounders were calculated using a logistic regression model.

Results

The prevalence of all self-reported diseases showed monotonically increasing trends as the levels of perceived self-reported exposure increased. The ORs for colon cancer (OR, 1.13), leukemia (OR, 1.56), hypertension (OR, 1.03), peripheral vasculopathy (OR, 1.07), enterocolitis (OR, 1.07), peripheral neuropathy (OR, 1.07), multiple nerve palsy (OR, 1.14), multiple sclerosis (OR, 1.24), skin diseases (OR, 1.05), psychotic diseases (OR, 1.07) and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the division/brigade-level proximity-based exposure analysis, compared to the low exposure group. The ORs for cerebral infarction (OR, 1.08), chronic bronchitis (OR, 1.05), multiple nerve palsy (OR, 1.07), multiple sclerosis (OR, 1.16), skin diseases (OR, 1.05), and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the battalion/company-level analysis.

Conclusions

Korean Vietnam veterans with high exposure to Agent Orange experienced a higher prevalence of several self-reported chronic diseases compared to those with low exposure by proximity-based exposure assessment. The strong positive associations between perceived self-reported exposure and all self-reported diseases should be evaluated with discretion because the likelihood of reporting diseases was directly related to the perceived intensity of Agent Orange exposure.

Summary

Citations

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    Endocrine Practice.2016; 22(6): 699.     CrossRef
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    Annals of Epidemiology.2015; 25(4): 275.     CrossRef
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  • A critical review of the epidemiology of Agent Orange/TCDD and prostate cancer
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    European Journal of Epidemiology.2014; 29(10): 667.     CrossRef
  • Agent Orange exposure and cancer incidence in Korean Vietnam veterans: A prospective cohort study
    Sang‐Wook Yi, Heechoul Ohrr
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  • Agent Orange exposure and risk of death in Korean Vietnam veterans: Korean Veterans Health Study
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Pilot Study on Recruiting Medical Checkup Participants by Mail Survey among Korean Vietnam Veterans.
Sang Wook Yi, Jae Seok Hong, Heechoul Ohrr
Korean J Prev Med. 2003;36(2):171-178.
  • 2,014 View
  • 21 Download
AbstractAbstract PDF
OBJECTIVE
The aim of this study was to identify the validity of recruiting medical checkup participants of Vietnam veterans using a mail survey, and to identify the 'Vietnam service related characteristics' and `general characteristics' of Vietnam veterans groups. METHOD: In this study, a total 900 veterans were randomly selected from the list of Vietnam veterans from 1964 to 1973. The veterans were classified into 5 groups, taking into consideration their registered status in the Ministry of Patriots and Veterans Affairs; the VRD (veterans who have agent orange-related diseases), VSD (veterans who have agent orange-suspected disease), VM (veterans who performed meritorious deeds during the war), VR (veterans who were registered with the Ministry of Patriots and Veterans Affair) and OV (other veterans) groups. By means of postal surveys, the veterans' intention to participate in the medical checkup for our research, and their socioeconomic and general characteristics were investigated. 52 surveys were returned due to the subjects not residing at the listed address, and were excluded from the analysis. RESULT: 699 of the 848 veterans (82.4%) responded to the survey, of which 619 (88.6%) intended to participate in the medical checkup for our research. The 5 veterans groups all had similar ages, Vietnam service period, Agent Orange exposure, troop characteristic and wartime class, with the exception of VM, who were older, and with a greater number of officers than the other 4 groups. There was a big difference in the health statius among the Vietnam veterans group. The VM and OV were much healthier than VRD, VSD and VR groups. The socioeconomic stati of the VRD, VSD and VR groups were lower than those of the VM and OV groups. CONCLUSION: Although there were some limitations, the recruitment, by mail, of medical checkup participants from Vietnam veterans is a valid and feasible method. The VM and OV groups were much healthier, and with higher socioeconomic stati, than the VRD, VSD, and VR groups.
Summary
A Study on the Correlation between Categorization of the Individual Exposure Levels to Agent Orange and Serum Dioxin Levels Among the Korean Vietnam Veterans.
Joung Soon Kim, Han K Kang, Hyun Sul Lim, Hae Kwan Cheong, Min Kyung Lim
Korean J Prev Med. 2001;34(1):80-88.
  • 2,159 View
  • 28 Download
AbstractAbstract PDF
OBJECTIVES
In an epidemiologic study on the health impact of Agent Orange exposure, the valid estimation of exposure level is the most important step. Based on recent studies, we examined the correlation between exposure levels categorized by personal exposure estimates and serum 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8-TCDD, Dioxin), exploring the possibility of utilizing the exposure level as a surrogate for the estimate of exposure to agent orange. METHODS: During the study period (Jan 1996-Feb 1996), blood specimens of 745 subjects taken randomly among 1,329 persons and kept frozen, were analyzed for 2,3,7,8-TCDD and six other dioxin congeners. The serum dioxin and congeners were measured in 1998 by CDC ,adjusted for serum lipids. We categorized the total exposure scores into five groups based on Agent Orange exposure data collected by interview and military records. Pearson and Spearman's correlation coefficients & multiple regression analysis were used to identify the relationship of the exposure level categorized with serum concentration of 2,3,7,8-TCDD, and six other dioxin congeners. RESULTS: Dioxin and the other congeners, except 1,2,4,6,7,8-HpCDD, showed significant correlations to exposure categories (p<0.005); 2,3,7,8-TCDD and OCDD showed positive correlations, whereas the other congeners did negative. The values of 2,3,7,8-TCDD differed according to exposure category and proportionally increased from the low exposure group to the high, a dose-response relationship, even after other possible confounding variables were adjusted for. In multiple regression analysis, age(beta=0.033), dioxin(beta=0.433), 1,2,3,7,8-PeCDD(beta=0.998), 1,2,3,4,7,8-HxCDD(beta=0.773), 1,2,3,6,7,8-HxCDD(beta=0.255), 1,2,3,7,8,9-HxCDD(beta=3.468), 1,2,3,4,6,7,8-HpCDD(beta=0.109) were found to be significantly related to the total exposure score(p<0.005). CONCLUSION: This study demonstrated that the use of such categorizations as a surrogate measure of agent orange exposure in identifying exposure degrees in a health impact study is valid.
Summary

JPMPH : Journal of Preventive Medicine and Public Health