Table of Contents
Copyright
Letter from the Commissioner
Letter from Professor Kincaid-Smith
Abbreviations
Definitions
1. Korean war veterans
2. 'Allotted for Duty' and 'Operational Service'
3. Tours and visits
Executive Summary
Identifying Deaths Amongst Veterans
Number of Veteran Deaths Studied
Findings
Cancer mortality
Effect of Nature of Service
Strengths and Weaknesses of the Study
Conslusions
Recommendations
Chapter 1 introduction
1.1 Korean War Veterans Mortality Study
1.1.1 Ethical approval
1.1.2 Study Aims
1.1.3 Study design
1.1.4 Study implementation
1.1.5 Definition
1.1.6 Data collection
1.1.7 Specific causes of death
1.2 Influences on Mortality
1.2.1 Medical assessment for entry into the military
1.2.2 Pesticide, solvent and chemical exposure
1.3 Report Structure
Chapter 2 Australia's Involvement in Korea
2.1 Korean Geography and Climate
2.1.1 Geography and Geology
2.1.2 Overview by Region
2.1.3 Climate
2.2 Korean War
2.2.1 Overview
2.2.2 Chronology of Events2
2.2.3 Forces involved in the Korea War
2.3 Australian Involvement
2.3.1 General Issues
2.3.2 The Royal Australian Navy
2.3.3 The Australian Army
2.3.4 The Royal Australian Air Force
2.3.5 Civilian groups
2.4 Definitions: 'Allotted for Duty' and 'Operational Service'
2.5 Operational Area
2.6 Health and Environmental Threats
2.6.1 Environmental Risks
2.6.2 Infectious Disease Risks
References
Chapter 3 The Nominal Roll of Australian Veterans of the Korean War
3.1 Sources of Data
3.1.1 Royal Australian Navy Korean War veterans
3.1.2 Australian Army Korean War veterans
3.1.3 Royal Australian Air Force Korean War veterans
3.1.4 Civilians
3.2 Completeness of the Nominal Roll
3.3 Accuracy of Data
3.4 Total Number of Veterans
3.4.1 Male Korean War veterans
3.4.2 Female Korean War veterans
References
Chapter 4 Characteristics of the Study Cohort
4.1 Birth Year Distribution of Veterans
4.2 Age at First Service in Korea
4.3 Nature of Service in Korea
4.3.1 Total days in Korea
4.3.2 Tours and visits to Korea
4.4 Involvement in other conflicts
4.4.1 Involvement in the Vietnam War
4.4.2 Involvement in World War II
4.4.3 Compensation claims attributed to Korean War service
4.5 Summary
References
Chapter 5 Data Sources, Methods and Limitations
5.1 Sources of data on vital status
5.1.1 Client Data Base
5.1.2 The National Death Index and the National Mortality Database
5.1.3 The electoral roll
5.1.4 Medicare
5.1.5 National Cancer Statistics Clearing House
5.2 Quality of Korean War Nominal Roll
5.3 Record linkage between the nominal roll and selected data sources
5.3.1 Matching by DVA
5.3.2 Matching by the AIHW
5.3.3 Matching with the NDI and NCSCH
5.3.4 Matching with the State and Territory BDM
5.3.5 Matching with overseas databases
5.3.6 Matching with the electoral roll
5.3.7 Matching by the Health Insurance Commission
5.4 Results of the matching process
5.4.1 Duplicate records in the nominal roll
5.4.2 Final results of matching
5.5 Summary and Discussion on Determination of Vital Status
5.5.1 Potential reasons for unknown status
5.6 Statistical Methods
5.6.1 Population at risk
5.6.2 Deaths amongst veterans
5.6.3 Expected number of deaths
5.6.4 Cause of death analysis
5.6.5 Mortality analysis by duration of service
5.6.6 Mortality analysis by period of service
5.7 Statistical Power
5.8 Smoking Prevalence
5.8.1 Calculation of estimated cancer mortality rates for varying levels of smoking prevalence
5.9 Statistical software used
References
Chapter 6 Results
6.1 Overview of Analysis
6.2 Deaths from diseases of a Priori interest
6.3 Mortality of Korean War veterans
6.3.1 Conditions with a statistically lower SMR
6.3.2 Conditions with a statistically elevated SMR
6.4 Mortality by Branch of Service
6.4.1 Deaths of Navy Korean War veterans
6.4.2 Deaths of Army Korean War veterans
6.4.3 Deaths of Air Force Korean War veterans
6.4.4 Summary
6.5 Neoplasms
6.5.1 Navy veterans
6.5.2 Army veterans
6.5.3 Air Force veterans
6.5.4 Smoking-related cancers
6.6 Effect of Service in Korea
6.6.1 Days served in Korea
6.6.2 Period of service in Korea
6.7 Summary
Chapter 7 Discussion of Mortality Findings
7.1 Consideration of Study Design
7.1.1 Retrospective cohort study
7.1.2 Potential biases and confounding
7.2 Factors influencing mortality
7.2.1 Healthy Worker Effect
7.2.2 Occupational and environmental exposures
7.2.3 Lifestyle and at risk behaviours
7.2.4 Involvement in other conflicts
7.3 Discussion of causes of death of a Priori interest
7.4 Discussion of specific causes of death
7.4.1 Neoplasms
7.4.2 External causes
7.4.3 Respiratory diseases
7.4.4 Digestive diseases
7.4.5 Circulatory diseases
7.4.6 Other causes
7.4.7 Variations in mortality experience by branch of Service
7.5 Possible exposures that could contribute to the elevation in mortality among Korean War veterans
7.5.1 Occupational and environmental exposures
7.5.2 Tobacco Consumption
7.5.3 Alcohol Consumption
7.5.4 Combat Stress
References
Chapter 8 Summary, Conclusions and Recommendations
8.1 Summary of Findings
8.2 Conclusions
8.3 Recommendations
References
Appendices
Appendix A: Protocol for a Retrospective Study of Mortality of Korean Veterans
Appendix B: Review of the Literature on the Health of Korean Veterans
Appendix C: Australian and other United Nations Forces in Korea
Appendix D: Tables of Results
Appendix E: Location of surviving Korean veterans
Appendix F: Membership of the Consultative Committee
Appendix G: Membership of the Study Scientific Advisory Committee
Appendix H: Project Staff