Evidence map›Paper›PMID 26923711›Full record

ArticleEnvironment international2016

Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis etiology.

John D Beard, Lawrence S Engel, David B Richardson, Marilie D Gammon, Coleen Baird, David M Umbach, Kelli D Allen, Catherine L Stanwyck, Jean Keller, Dale P Sandler and 2 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Environment international, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 3 pooled it
4.5field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 3 syntheses or guidelines pooled it, 35 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
  5. Military Service Roles and ALS Among Veterans: A Matched Case-Control Study.Annals of clinical and translational neurology · 2025
    Article
  6. Article
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  8. Epidemiology of Sarcoidosis in U.S. Veterans from 2003 to 2019.Annals of the American Thoracic Society · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 6 institutions in 1 country.

John D BeardDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
Lawrence S EngelDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
David B RichardsonDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Marilie D GammonDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Coleen BairdEnvironmental Medicine Program, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
David M UmbachBiostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
Kelli D AllenDurham VA Medical Center, Durham, NC, USA; Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Catherine L StanwyckDurham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Jean KellerWestat, Inc., Durham, NC, USA.
Dale P SandlerEpidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
Silke SchmidtDepartment of Medicine, Duke University Medical Center, Durham, NC, USA.
Freya KamelEpidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA. Electronic address: kamel@niehs.nih.gov.
National Institute of Environmental Health Sciences · USUniversity of North Carolina at Chapel Hill · USDuke Medical Center · USDurham VA Medical Center · USUnited States Army Medical Command · USWestat (United States) · US

Funding

Biostatstics for Research in Environmental HealthT32ES007018 · NIEHS · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Stephanie Engel, Rebecca Fry · 1985 to 2026
$31.3M
Genetic Epidemiology of ALS in VeteransR01ES013244 · NIEHS · DUKE UNIVERSITY · PI SCHMIDT, SILKE A · 2004 to 2008
$2.3M
Statistical Methods In Human Development/clinical StudiesZIAES049004 · NIEHS · NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES · PI UMBACH, DAVID M · 2009 to 2025
$1.8M
Environmental Exposures And Risk For Cancer and Chronic Diseases In AdultsZIAES049028 · NIEHS · NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES · PI SANDLER, DALE P · 2009 to 2024
$1.6M
Lead And Other Neurotoxins As Risk Factors For Amyotrophic Lateral SclerosisZIAES049005 · NIEHS · NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES · PI SANDLER, DALE P · 2009 to 2017
$718k
LEAD AND OTHER NEUROTOXINS AS RISK FACTORS FOR AMYOTROPHIC LATERAL SCLEROSISZ01ES049005 · NIEHS · NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES · PI SANDLER, DALE P · 1992 to 2008
$158k
Intramural NIH HHS Z01 ES049005NIEHS NIH HHS R01 ES013244NIEHS NIH HHS R01 ES13244NIEHS NIH HHS T32 ES007018NIEHS NIH HHS T32ES007018NIOSH CDC HHS T42OH00867302
6 · The paper itself

Abstract

backgroundFactors underlying a possible excess of amyotrophic lateral sclerosis (ALS) among military veterans remain unidentified. Limitations of previous studies on this topic include reliance on ALS mortality as a surrogate for ALS incidence, low statistical power, and sparse information on military-related factors.

objectivesWe evaluated associations between military-related factors and ALS using data from a case-control study of U.S. military veterans.

methodsFrom 2005 to 2010, we identified medical record-confirmed ALS cases via the National Registry of Veterans with ALS and controls via the Veterans Benefits Administration's Beneficiary Identification and Records Locator System database. In total, we enrolled 621 cases and 958 frequency-matched controls in the Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis study. We collected information on military service and deployments and 39 related exposures. We used unconditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). We used inverse probability weighting to adjust for potential bias from confounding, missing covariate data, and selection arising from a case group that disproportionately included long-term survivors and a control group that may or may not differ from U.S. military veterans at large.

resultsThe odds of ALS did not differ for veterans of the Air Force, Army, Marines, and Navy. We found higher odds of ALS for veterans whose longest deployment was World War II or the Korean War and a positive trend with total years of all deployments (OR=1.27; 95% CI: 1.06, 1.52). ALS was positively associated with exposure to herbicides for military purposes, nasopharyngeal radium, personal pesticides, exhaust from heaters or generators, high-intensity radar waves, contaminated food, explosions within one mile, herbicides in the field, mixing and application of burning agents, burning agents in the field, and Agent Orange in the field, with ORs between 1.50 and 7.75.

conclusionsAlthough our results need confirmation, they are potentially important given the large number of U.S. military veterans, and they provide clues to potential factors underlying the apparent increase of ALS in veteran populations.

Indexed as

Environmental Exposure2,4,5-Trichlorophenoxyacetic Acid2,4-Dichlorophenoxyacetic AcidAdultAgedAgent OrangeAmyotrophic Lateral SclerosisCase-Control StudiesFemaleHumansIncidenceLogistic ModelsMaleMiddle AgedMilitary PersonnelOdds Ratio2,4,5-Trichlorophenoxyacetic Acid2,4-Dichlorophenoxyacetic AcidAgent OrangePesticidesPolychlorinated DibenzodioxinsRadiumAmyotrophic lateral sclerosisCase-controlDeploymentEtiologyMilitary

Identifiers

PMID26923711
PMCPMC4876822
OpenAlexW2284036987

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.