The Promise to Address Comprehensive Toxics (PACT) Act expanded U.S. Veterans' health care and benefits for conditions linked to service-connected exposures (e.g., Burn Pits, Agent Orange). However, myeloproliferative neoplasms (MPN) are not recognized as presumptive conditions for Veterans exposed to these toxic substances. This study evaluated the development of MPN among U.S. Veterans from the Korean, Vietnam, and Persian Gulf War eras. This retrospective cohort study included 65 425 Korean War era Veterans; 211 927 Vietnam War era Veterans; and 214 007 Persian Gulf War era Veterans from January 1, 2006, to January 26, 2023. Veterans with MPN, thrombosis, bleeding, and cardiovascular risk factors were identified through ICD-9 and -10 codes. Veterans from the Persian Gulf War era had the highest risk of developing MPN compared with Veterans from the Korean and Vietnam War eras, hazard ratio (HR) 4.92, 95% confidence interval (CI) 4.20–5.75 and HR 2.49, 95% CI 2.20–2.82, both p < .0001, respectively. Vietnam War era Veterans also had a higher risk of MPN development compared with Korean War era Veterans, HR 1.97, 95% CI 1.77–2.21, p < .0001. Persian Gulf War era Veterans were diagnosed with MPN at an earlier age, had higher risks of thrombosis and bleeding, and had lower survival rates compared with Korean War and Vietnam War era Veterans. This study reinforces evidence that environmental and occupational hazards increase the risk of clonal myeloid disorders and related complications, impacting overall survival with MPN. Limitations include the inability to confirm clonality and fully verify deployment and exposure status.

中文翻译：

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韩国、越南和波斯湾战争时期美国退伍军人发生骨髓增生性肿瘤的风险


《承诺解决综合毒物 （PACT） 法案》扩大了美国退伍军人的医疗保健和福利，适用于与服务相关的暴露（例如，烧伤坑、橙剂）。然而，骨髓增生性肿瘤 （MPN） 不被认为是暴露于这些有毒物质的退伍军人的推定条件。本研究评估了朝鲜、越南和波斯湾战争时期美国退伍军人 MPN 的发展。这项回顾性队列研究包括 65 425 名朝鲜战争时期退伍军人;211 927 越南战争时期退伍军人;以及 2006 年 1 月 1 日至 2023 年 1 月 26 日期间的 214 007 名波斯湾战争时期退伍军人。通过 ICD-9 和 -10 代码确定患有 MPN、血栓形成、出血和心血管危险因素的退伍军人。与朝鲜战争和越南战争时期的退伍军人相比，波斯湾战争时期的退伍军人患 MPN 的风险最高，风险比 （HR） 4.92,95% 置信区间 （CI） 4.20-5.75 和 HR 2.49,95% CI 2.20-2.82，均 p < .0001，分别为。与朝鲜战争时期的退伍军人相比，越南战争时期的退伍军人患 MPN 的风险也更高，HR 1.97,95% CI 1.77–2.21，p < .0001。 波斯湾战争时期的退伍军人在较早的年龄被诊断出患有 MPN，与朝鲜战争和越南战争时期的退伍军人相比，血栓形成和出血的风险更高，存活率更低。这项研究强化了环境和职业危害会增加克隆性髓系疾病和相关并发症的风险，从而影响 MPN 的总生存期的证据。限制包括无法确认克隆性并完全验证部署和暴露状态。