Dapsone exposure, mortality and cancer incidence amongst Australian Vietnam war veterans
Introduction: Malaria prophylaxis was a top priority during the Vietnam War. When an increase of cases was noted in 1968, Dapsone was added to the standard Paludrine prophylaxis. This study investigates the mortality and cancer incidence amongst Vietnam veterans who consumed Dapsone during their service compared to those who did not.
Materials and Methods: The study was a retrospective cohort study of male Army Vietnam veterans. Cause of death and diagnosed cancers were ascertained by matching the study roll against the National Death Index and the National Cancer Statistics Clearing House. Cumulative Dapsone consumption was obtained from data compiled in a previous study. Relative mortality and cancer incidence rates were calculated for personnel who consumed Dapsone
compared to those who did not. Standardised ratios comparing the two treatment groups to the Australian population were also calculated. Models were developed to assess the effect of the total cumulative Dapsone dose received during Vietnam service on mortality and cancer incidence.
Results and Discussion: The all cause mortality did not differ between the two exposure groups, RR = 1.00 (95% CI 0.94, 1.07). Overall cancer incidence was 10% lower amongst the Dapsone exposed group, RR = 0.90 (95% CI 0.83, 0.97). There was no significant relationship between increasing Dapsone dose and all cause mortality or cancer mortality. There was borderline significant inverse relationship between Dapsone dose and cancer incidence.
This study concludes that the anti-malarial Dapsone/Paludrine prophylaxis did not cause adverse health, as measured by mortality and cancer incidence.
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