Shortcomings of VA Data Collection on Airborne Hazard Exposures

Airborne Hazards Open Burn Pit RegistryMilitary forces have long relied on incineration in open-air pits as a means of getting rid of refuse in deployed locations. Concerns over possible adverse effects of exposure to smoke from trash burning in the theater were first expressed in the wake of the 1990–1991 Gulf War and stimulated a series of studies that indicated that exposures to smoke from oil-well fires and from other combustion sources, including waste burning, were stressors for troops.

In January 2013, Congress directed the Department of Veterans Affairs (VA) to establish and maintain a registry for service members who may have been exposed to toxic airborne chemicals and fumes generated by open burn pits.

A new report published this week by the National Academies Press, entitled “Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry,” analyzes the initial months of data collected by the registry and offers recommendations on ways to improve the instrument and best use the information it collects.

This report assesses the effectiveness of the VA’s information gathering efforts and provides recommendations for addressing the future medical needs of the affected groups, and provides recommendations on collecting, maintaining, and monitoring information collected by the VA’s Airborne Hazards and Open Burn Pit (AH&OBP) Registry.

Over the registry’s first 13 months, approximately 47,000 people completed the questionnaire, representing 1.0% of eligible Gulf War veterans and 1.7% of eligible post-9/11 veterans. Approximately 7.5% of registry respondents served in the 1990–1991 Gulf War only. Compared to post-9/11 respondents, they are more racially diverse, had less education, deployed fewer times, and were older, more likely to be enlisted, to have served in the Army, and to have been active-duty. Post-9/11 respondents comprise the majority—more than 85%. Analyses were adjusted for demographic and military characteristics, but factors such as the older age of Gulf War veterans might be more salient when examining associations with respiratory and cardiovascular diseases, which are more likely to become more prevalent as the population ages.

Among the most notable of the observations that can be drawn from these data are that nearly all respondents reported one or more airborne hazards encountered in theater: 96% of all respondents reported being exposed to a burn pit on at least one deployment, and 85.6% of Gulf War era respondents reported exposure to smoke from oil-well fires, while 85.2% of all respondents reported exposure to dust storms. The lack of data on those who were deployed and do not believe they were exposed to burn pits precludes using the registry to compare exposed to unexposed individuals. Therefore, the only means available for evaluating burn pit exposure is to examine gradations of exposure among the respondents.

This report identifies several weaknesses in the existing AH&OBP Registry questionnaire and in the data collected in the registry’s first 13 months. Their cumulative effect is evidenced by the high percentage of respondents who initiated but did not complete the instrument and the number of questions that had large nonresponse rates.

Highlighted weaknesses identified in the report include:

  • Inappropriate use of questions that were validated for and meant to be administered by other survey means such as a face-to-face or computer-assisted phone interview
  • Asks questions that may be confusing for respondents because they are ambiguous or otherwise poorly written
  • Elicits information on topics such as hobbies and places of childhood residence that do not yield information that could be productively used in any analysis that would be appropriate to undertake using registry data
  • Fails to ask questions (regarding non-burn-pit trash burning, for example) that could yield information related to relevant exposures
  • Does not take full advantage of its Web-based format to streamline and focus questions based on previous responses
  • Does not permit answers to be supplemented or updated later in time

The report outlines recommendations for the VA to clarify the intent and purpose of the registry; develop a specific plan for more seamlessly integrating relevant VA and DoD data sources with the registry’s data; and accomplish goals of reducing future participant burden, increasing data quality by restructuring questions to minimize recall and other biases, and improving the usefulness of the registry database as an information source for health care professionals and researchers.

Read the full report: Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry (2017).