A 39 Year mortality study of survivors exposed to sulfur mustard agent: A survival analysis
Hossein Amini,
Masoud Solaymani-dodaran,
Mostafa Ghanei,
Jamileh Abolghasemi,
Mahmoud Salesi,
Amir Vahedian Azimi,
Mohammad Farjami,
Amir Hosein Ghazale,
Batool Mousavi,
Amirhossein Sahebkar
Affiliations
Hossein Amini
Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
Masoud Solaymani-dodaran
Minimally Invasive Surgery Research Center, Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran; Division of Epidemiology and Public Health, The University of Nottingham, UK; Corresponding author. Minimally Invasive Surgery Research Center, Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran.
Mostafa Ghanei
Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran; Corresponding author.
Jamileh Abolghasemi
Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
Mahmoud Salesi
Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
Amir Vahedian Azimi
Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
Mohammad Farjami
Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Amir Hosein Ghazale
Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
Batool Mousavi
Prevention Department, Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
Amirhossein Sahebkar
Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Corresponding author. Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
Background: The primary objective of this study was to analyze the long-term survival of 48,067 chemical warfare survivors who suffered from pulmonary, cutaneous, and ocular lesions in the decades following the Iran-Iraq war. Methods: The data for this study were obtained from the Veterans and Martyr Affair Foundation (VMAF) database. The survivors were divided into two groups based on whether they were evacuated/admitted (EA) to a hospital or not evacuated/admitted (NEA) to a hospital. The proportional hazard (PH) assumption for age categories, gender, exposure statuses, and eye severity was not satisfied. Therefore, we used a Generalized Gamma (GG) distribution with an Accelerated Failure Time (AFT) model for analysis. Results: The study included a total of 48,067 observations, and among them, 4342 (9.03 %) died during the study period. The mean (SD) age of the survivors was 55.99 (7.9) years. The mortality rate increased with age, and higher rates were observed in males. Survival probabilities differed significantly among age categories, provinces, lung severity, and eye severity based on log-rank tests (p-value<0.05 for all). The GG model results showed that higher age and being male were associated with a shorter time to death. The study also found that the mortality rate was significantly higher in the EA group compared to the NEA group. Conclusion: The present study showed no significant difference in survival time between the EA and NEA groups. The findings suggest that pulmonary lesions caused by mustard gas are more likely to be fatal compared to skin and eye lesions. The results also indicate a potential association between survival time and the severity of lung damage.
