Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
권호 표지

Mortality Patterns among Korean Vietnam Veterans

베트남 참전군인의 사망양상

  • Yi, Sang-Wook (Department of Preventive Medicine and Public Health, College of Medicine, Kwandong University) ;
  • Ohrr, Hee-Choul (Department of Preventive Medicine, College of Medicine, Yonsei University)
  • 이상욱 (관동대학교 의과대학 예방의학교실) ;
  • 오희철 (연세대학교 의과대학 예방의학교실)
  • Published : 2011.09.30
⟨ Previous Next ⟩

Abstract

Objectives: A total of 320,000 Korean soldiers in three combat units and four supporting units participated in the Vietnam War. The aim of this study was to investigate the association between Vietnam experience and mortality by comparing mortalities in Korean Vietnam War veterans to the general population. Methods: The deaths of 185,760 Vietnam veterans from January 1, 1992 to December 31, 2005 were confirmed by matching the veterans' information to death records from the National Statistical Office. Crude death rate, age adjusted rate and Standardized mortality ratios (SMRs) were calculated 95% confidence. Age was standardized to the total male population during 1992-2005 with the age of 36 to 83 years old. Results: The age adjusted death rate per 100,000 was 868.1 among veterans and 1226.5 among the general population. Mortality of all causes was significantly lower among veterans (SMR=0.83, 95% CI: 0.82-0.84). Mortalities from neoplasms (SMR=0.87), circulatory diseases (SMR=0.79), and external causes of deaths (SMR=0.92) were significantly lower among veterans. Mortalities from several external causes of deaths including Intentional self-harm (X60-X84), assault and accidental poisoning, angina pectoris, chronic ischemic heart diseases, prostate cancer, and malignant neoplasms of hematopoietic system including multiple myeloma, non-Hodgkin's lymphoma, and leukemia were not different between veterans and the general population. Conclusions: Mortality among Vietnam veterans was lower than that among the general population. It would be explained mainly by healthy veteran effect.

목적: 우리나라 베트남 참전군인의 사망률을 같은 연령대의 우리나라 남자전체인구 사망률과 비교하여 베트남참전이 참전군인의 사망에 미치는 영향을 살펴본다. 이를 통하여 고엽제노출이 사망에 미치는 영향을 간접적으로 살펴본다. 방법: 185,760명의 베트남 참전군인에 대해 1992년 1월 1일부터 2005년 12월 31일까지 사망여부를 추적하였다. 사망추적은 통계청의 사망통계자료를 이용하였다. 사망원인 분류는 통계청의 일반사망 19개 장 분류와 요약분류 103개 항목을 기본으로 하였다. 참전군인의 보통사망률과 연령조정사망률, 표준화사망비와 사망비의 95% 신뢰구간을 구하였다. 1992-2005년 우리나라 36-83세 남자인구를 표준인구로 하였다. 결과: 참전군인의 사망의 모든원인의 보통사망률은 10만명당 780.2명, 연령조정사망률은 868.1명이었다. 1992-2005년간 우리나라 36-83세군의 보통사망률은 1226.5명이었다. 사망의 모든 원인 사망률은 전체인구보다 유의하게 낮았다(SMR=0.83, 95% CI: 0.82-0.84). 신생물(SMR=0.87), 순환계통질환(SMR=0.79), 사망의외인(SMR=0.92)도 사망률이 전체인구보다 유의하게 낮았다. 참전군인의 사망건수가 많아 통계적 검정력이 있는 사망원인 중에서 자살, 사고성중독, 피살 등 일부 사망의 외인과 다발성골수종, 백혈병, 비호지킨림프종 등 조혈계신생물, 전립샘암, 협심증, 만성허혈심장질환 등에서 참전군인과 일반인구 사망률에 차이가 없었다. 결론: 참전군인의 사망률은 일반인구보다 낮았고, 이는 건강제대군인효과(Healthy veteran effect)으로 설명 할 수 있다. 건강제대군인효과를 고려할때, 사망건수가 많으면서 참전군인과 일반인간에 차이가 없는 사망원인들이 고엽제 또는 베트남 참전과 관련이 있을 가능성이 있다. 90%의 참전군인들이 생존해 있으므로, 계속적인 사망추적조사가 필요할 것이다.

Keywords

References

  1. Yi SW, Won JU, Hong JS, Ohrr H. A Proposal of Study Designs and Methods for Evaluating The Adverse Health Effects of Agent Orange among Korean Vietnam Veterans. Korean J Prev Med 2001;34:228-36. (Korean)
  2. Institute of Medicine. Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam. National Academy Press. Washington DC. 1994. pp 24-34.
  3. Na JS. The dispatch of troops to Vietnam and National Development. (translated by YI SW) Institute for National Defence and Military History. Seoul. 1996. pp 329-31. (Korean)
  4. Gye UB. A Study on epidemiological investigation and defoliant sprayed by the Republic of Korea Armed forces during Vietnam War. Kyonggi University. Suwon. 2009. pp 1-4.
  5. Ohrr H. Yi SW. Won JU, Park WS. Hong JS, Sull JW, Lee HN, Kim HS, Woo EK, Han JH, Lee ES, Lee DH. An Epidemiologic Study on the Adverse Health Effect of Agent Orange. Yonsei University Health System. Seoul. 2001. pp 1-2. (Korean)
  6. Act on care of people with diseases associated with Agent Orange exposure. (translated by YI SW) Available: http://www.law.go.kr/ [cited 10 May 2011].
  7. 120,000 Vietnam Veterans are weeping in Korea. (translated by YI SW) Available: http://article.joinsmsn.com/news/article/article.asp?total_id=3670308" [cited 10 May 2011].
  8. Boehmer TK, Flanders WD, McGeehin MA, Boyle C, Barrett DH. Postservice mortality in Vietnam veterans: 30-year follow-up. Arch Intern Med 2004;164(17):1908-16. https://doi.org/10.1001/archinte.164.17.1908
  9. Cypel Y, Kang H. Mortality patterns of Army Chemical Corps veterans who were occupationally exposed to herbicides in Vietnam. Ann Epidemiol 2010;20(5):339-46. https://doi.org/10.1016/j.annepidem.2010.02.003
  10. Michalek JE, Wolfe WH, Miner JC. Health Status of Air Force Veterans Occupationally Exposed to Herbicides in Vietnam 2. Mortality. JAMA 1990; 264(14):1832-6. https://doi.org/10.1001/jama.1990.03450140054033
  11. Watanabe KK, Kang HK. Military Service in Vietanam and the Risk of Death from Trauma and Selected Cancers. Ann Epidemiol 1995;5(5):407-12. https://doi.org/10.1016/1047-2797(95)00039-A
  12. Dalager NA, Kang HK. Mortality Among Army Chemical Corps Vietnam Veterans. American Journal of industrial Medicine 1997;31:719-26. https://doi.org/10.1002/(SICI)1097-0274(199706)31:6<719::AID-AJIM8>3.0.CO;2-L
  13. Wilson EJ, Horsley KW, van der Hoek R. Australian Vietnam Veterans Mortality Study 2005. Canberra: Department of Veterans' Affairs, 2005.
  14. Crane PJ, Barnard DL, Horsley KD, Adena MA. Mortality of Vietnam veterans: the veteran cohort study. A report of the 1996 retrospective cohort study of Australian Vietnam veterans. Canberra: Department of Veterans' Affairs, 1997.
  15. Rothman KJ, Greenland S, Modern epidemiology. 2nd ed. Lippincott Williams & Wilkins, Philadelphia, 1998. pp 260-4.
  16. Centers for Disease Control. Postservice mortality among Vietnam veterans. JAMA 1987;257:790-5. https://doi.org/10.1001/jama.1987.03390060080028
  17. Institute of Medicine. Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam. National Academy Press. Washington DC. 1994. pp 6.
  18. Institute of Medicine. Veterans and Agent Orange: Update 2002. Washington DC. National Academy Press. 2003. pp 8.
  19. Swaen GM, van Amelsvoort LG, Slangen JJ, Mohren DC. Cancer mortality in a cohort of licensed herbicide applicators. Int Arch Occup Environ Health 2004;77:293-5. https://doi.org/10.1007/s00420-004-0503-8
  20. Institute of Medicine. Veterans and Agent Orange: Update 2008. Washington DC. National Academy Press. 2008. pp 7-8.