Abstract Details

Title Military Service and Survival with Amyotrophic Lateral Sclerosis

Topic General Neurology

Presentation(s) P6 - Poster Session 6 (8:00 AM-9:00 AM)

Poster/Presentation
Number 15-004

Objective We examined the relationship between military service and ALS survival while considering occupational lead exposure.

Background Military service has been associated with increased amyotrophic lateral sclerosis (ALS) incidence. Prior studies investigating the impact of military-related factors on ALS survival have yielded mixed results and have not disentangled the effect of lead from military service, despite lead exposure being common in the military and potentially associated with ALS progression.

Design/Methods We collected clinical measures and self-reported occupational history including military occupations from 135 ALS patients enrolled in the international CReATe PGB study in 2015-2019. We determined lead exposure from military and civilian occupations using a job-exposure matrix and the military-occupational-classification crosswalk. We evaluated survival using Cox proportional hazard models, considering sex, age of onset, site of symptom onset, smoking, and BMI as covariates.

Results Among the 135 ALS cases, 38 reached a survival endpoint (death or permanent assisted ventilation), and median survival was 3.6 years. Among 23 military veterans, 14 had military occupational lead exposure. Among 112 non-veterans, 13 had a lead-exposed civilian occupation. Results presented here are adjusted for age at onset only; further adjustment did not meaningfully change the estimates. Excluding lead exposure, military service was associated with a hazard ratio (HR) of 0.59 (95%CI: 0.23-1.54), and adjustment for lead pronounced this effect (HR=0.36 , 95%CI: 0.13-1.00). The result was similar when restricted to those without lead exposure (HR=0.23, 95%CI: 0.03-1.70). Lead exposure itself was associated with shorter survival (HR=3.25, 95%CI: 1.45-7.28).

Conclusions Results suggest that military service prior to onset of ALS is associated with longer survival following ALS onset, an effect that is more pronounced after accounting for occupational lead exposure. This association is independent of other prognostic factors and suggests “military service” may be too broad to capture the variance of multiple exposures. Supported by U54NS092091, R01TS00024, T32ES007069, and P30ES000002

Authors/Disclosures
Ian Tang, PhD (Harvard TH Chan School of Public Health) PRESENTER	Dr. Tang has received research support from NIH.
Zihan Sun	No disclosure on file
Joanne Wuu, SCM (Univ of Miami, Dept Of Neurology)	The institution of Ms. Wuu has received research support from NIH NINDS. The institution of Ms. Wuu has received research support from NIH NCATS/NINDS. The institution of Ms. Wuu has received research support from CDC. The institution of Ms. Wuu has received research support from Target ALS. The institution of Ms. Wuu has received research support from ALS Recovery Fund. The institution of Ms. Wuu has received research support from NIH/NINDS. The institution of Ms. Wuu has received research support from NIH NINDS. The institution of an immediate family member of Ms. Wuu has received research support from NIH NINDS.
Michael G. Benatar, MBChB, DPhil, FAAN (University of Miami)	Dr. Benatar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. The institution of Dr. Benatar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Arrowhead. Dr. Benatar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alexion. Dr. Benatar has received personal compensation in the range of $0-$499 for serving as a Consultant for Annexon. Dr. Benatar has received personal compensation in the range of $0-$499 for serving as a Consultant for UniQure. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Immunovant. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cartesian. Dr. Benatar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Horizon. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Benatar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for CorEvitas. Dr. Benatar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Canopy. Dr. Benatar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alaunos. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Prilenia. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alector. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Benatar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for BMS. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Woolsey. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Takeda. Dr. Benatar has received intellectual property interests from a discovery or technology relating to health care.
Marc Weisskopf, PhD (Harvard TH Chan School of Public Health)	Prof. Weisskopf has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kaiser Permanente Research Biobank. The institution of Prof. Weisskopf has received research support from ALS Network. The institution of Prof. Weisskopf has received research support from NIH. The institution of Prof. Weisskopf has received research support from Paralyzed Veterans of America. The institution of Prof. Weisskopf has received research support from CDC/ATSDR. The institution of Prof. Weisskopf has received research support from JPB Foundation.

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