Vaccination and risk of lone atrial fibrillation in the active component United States military

Figures & data

Table 1. Risk factors for atrial fibrillation among participants with a diagnosis of atrial fibrillation.

Category	ICD-9 Codes	Cases with risk factor (N= 1,955)^*	Percent of all cases (N = 4,390)
Neoplasms	162.2–162.9, 164.1, 164.8, 194, 197, 198.89, 212.3, 212.7, 227, 231.2, 235.7, 238.8, 239.1, 239.8, V10.1	64	1.5
Pre-existing/chronic heart disease and acute conditions generally predisposing to long-term complications	390, 391, 392, 393, 394, 395, 397, 398, 412, 414, 416, 424, 648.5, 648.6, V15.1, V42.1, V42.2, V42.6, V43.2, V45.0, 411, 410, 415, 426, 996.72, 997.1, 861.0–861.1, 996, V45.81, V45.82, V53.3, 429	1717	39.1
Pericarditis, myocarditis, and endocarditis	420, 421, 422, 423	108	2.5
Chronic lung disease	491.2, 492, 496	70	1.6
Endocrine disorders	241, 242, 245, 246, 250, 648.1	294	6.7
Rheumatologic disorders	710, 710.1, 714	90	2.1
Disorders of fluid, electrolyte, and acid-base balance	276	134	3.1
Drug or alcohol abuse	291, 305, 305.2, 305.6, 305.7, 305.9, 648.3	68	1.5
Stress/anxiety	300, 308	76	1.7
Pleurisy	511	50	1.1
Pneumonia	480, 481, 482, 483, 484, 485, 486	76	1.7
Miscarriage and abortion	634.4, 634.5, 634.6, 635.4, 635.5, 635.6, 636.4, 636.5, 636.6, 637.4, 637.5, 637.6, 638.4, 638.5, 638.6	0	0.0
Obstetrical cardiovascular complications	642, 668.1, 673	8	0.2
Trauma or shock	669.1, 785.5, 807, 901, 958.4, 991, 994.8, E965, E990-E999	42	1.0
Cardiomyopathy and heart failure	425, 428	190	4.3
Hypertension	401, 402, 403, 404, 405	912	20.8

* there were 1,955 patients with a diagnosis of 427.31 who were excluded from this study for receiving one or more of the listed codes

Table 2. Demographics of lone atrial fibrillation cases and non-cases service members exposed to anthrax vaccine adsorbed (AVA) during 1998–2006.

	Cases				Non-Cases
	(N = 2,435)				(N = 2,954,656)
Characteristic	Exposed N (%)		Unexposed N (%)		Exposed N (%)		Unexposed N (%)		P-value
Race									< 0.0001
White	535	(68.2)	1,187	(71.9)	729,169	(68.7)	1,369,233	(72.3)
Black	156	(19.9)	341	(20.7)	196,938	(18.6)	321,569	(17.0)
Other	74	(9.4)	93	(5.6)	112,436	(10.6)	171,065	(9.0)
Unknown	19	(2.4)	30	(1.8)	22,849	(2.2)	31,397	(1.7)
Ethnicity									< 0.0001
Hispanic	61	(7.8)	154	(9.3)	122,618	(11.6)	249,528	(13.2)
Non-Hispanic	704	(89.8)	1,467	(88.9)	915,924	(86.3)	1,611,593	(85.1)
Unknown	19	(2.4)	30	(1.8)	22,850	(2.2)	32,143	(1.7)
Sex
Male	746	(95.2)	1,458	(88.3)	946,523	(89.2)	1,554,620	(82.1)	< 0.0001
Female	38	(4.9)	193	(11.7)	114,854	(10.8)	338,450	(17.9)
Unknown	0	(0.0)	0	(0.0)	15	(0.0)	194	(0.0)

Table 3. Demographics of lone atrial fibrillation cases and non-cases based on person-time exposed and unexposed to anthrax vaccine (AVA) during 1998–2006.

	Cases				Non-Cases
	(PY* = 8,383)				(PY = 11,321,362)
Characteristic	Exposed PY (%)		Unexposed PY (%)		Exposed PY (%)		Unexposed PY (%)		P-value
Branch									< 0.0001
Army	710.1	(30.4)	1869.2	(30.9)	1,423,968	(37.0)	2,519,907	(33.7)
Air Force	623.1	(26.7)	1785.9	(29.5)	870,492.8	(22.6)	1,982,105	(26.5)
Marine Corps	343.8	(14.7)	498.8	(8.3)	618,084.9	(16.1)	880,167.7	(11.8)
Navy	657.23	(28.2)	1895.4	(31.3)	935,655.8	(24.3)	2,090,981	(28.0)
Grade category									< 0.0001
Enlisted	1780.8	(76.3)	4208.9	(69.6)	3,277,671	(85.2)	6,272,072	(83.9)
Officer	552.2	(23.7)	1833.4	(30.3)	566,106.2	(14.7)	1,179,731	(15.8)
Unknown	1.2	(0.1)	7.0	(0.1)	4424.9	(0.1)	21,356.9	(0.3)
Deployment									< 0.0001
Yes	220.8	(9.5)	97.8	(1.6)	534,404.9	(13.9)	226,459.9	(3.0)
No	2113.4	(90.5)	5951.5	(98.4)	3,313,797	(86.1)	7,246,700	(97.0)
Occupation category									< 0.0001
Medical/Scientific/Research	195.9	(8.4)	905.8	(15.0)	235,146.7	(6.1)	680,921.3	(9.1)
Hazardous	151.8	(6.5)	386.1	(6.4)	286,206.7	(7.4)	500,919.9	(6.7)
Combat	1017.7	(43.6)	1971.2	(32.6)	1,678,459	(43.6)	2,514,991	(33.7)
Administrative/Communication	966.3	(41.4)	2746.9	(45.4)	1,634,969	(42.5)	3,731,092	(49.9)
Unknown	2.6	(0.1)	39.5	(0.7)	13,420.1	(0.4)	45,236.6	(0.6)
Age category (years)									< 0.0001
18–24	454.7	(19.5)	1386.1	(22.9)	1,315,014	(34.2)	3,574,402	(47.8)
25–34	911.3	(39.0)	2321.2	(38.4)	1,616,786	(42.0)	2,388,168	(32.0)
35–44	844.6	(36.2)	2003.5	(33.1)	819,874.1	(21.3)	1,317,741	(17.6)
45–55	121.8	(5.2)	321.4	(5.3)	93,644.5	(2.4)	185,861.8	(2.5)
> 55	1.8	(0.1)	17.2	(0.3)	2883.1	(0.1)	6988.2	(0.1)
Year									< 0.0001
1998	75.9	(3.3)	1576.1	(26.1)	64,751.9	(1.7)	1,187,963	(15.9)
1999	333.0	(14.3)	1126.3	(18.6)	293,837.8	(7.6)	927,429	(12.4)
2000	392.4	(16.8)	905.1	(15.0)	374,107.3	(9.7)	850,607.6	(11.4)
2001	348.6	(14.9)	775.2	(12.8)	354,239.5	(9.2)	874,654.5	(11.7)
2002	274.8	(11.8)	669.8	(11.1)	325,945.6	(8.5)	931,926.9	(12.5)
2003	335.1	(14.4)	424.7	(7.0)	573,712.7	(14.9)	711,387.3	(9.5)
2004	292.9	(12.6)	286.6	(4.7)	652,324.1	(17.0)	647,259	(8.7)
2005	200.2	(8.6)	200.5	(3.3)	627,401.5	(16.3)	647,977.9	(8.7)
2006	81.5	(3.5)	85.1	(1.4)	581,881.3	(15.1)	693,954.9	(9.3)

* PY = person-years

Table 4. Distribution of vaccine recipients and observation time for cases and non-cases by vaccine.

	Observation Time^* (PY^† = 11,329,746)
	Cases (PY = 8,383)				Non-Cases (PY = 11,321,362)				Percent of Individuals^* (N = 2,957,091)
Vaccine Type	Pre-exposure PY(%)		Post-exposure PY(%)		Pre-exposure PY(%)		Post-exposure PY(%)		Cases (N = 2,435)	Non-Cases (N = 2,954,656)	P-value
Anthrax Vaccine (AVA)	6,049.3	(72.2)	2,334.2	(27.8)	7,473,160.0	(66.0)	3,848,202.0	(34.0)	32.2	35.9	< 0.0001
Influenza	3,358.2	(40.1)	5,025.4	(59.9)	3,762,097.0	(33.2)	7,559,265.0	(66.8)	64.3	71.4	< 0.0001
Smallpox	7,803.8	(93.1)	579.7	(6.9)	9,585,590.0	(84.7)	1,735,772.0	(15.3)	13.0	26.3	< 0.0001

* individuals may be represented more than once

^† PY = person-years

Table 5. Results of Poisson regression analysis of lone atrial fibrillation.

			Univariate Analysis		Multivariable Analysis^*
Vaccine exposure	Cases	Person-years at risk	Risk ratio (95% CI)†	P-value	Risk ratio (95% CI)†	P-value
Anthrax Vaccine Adsorbed (AVA)
Unvaccinated	1,651	7,479,210	1	-	1	-
At least 1 dose	784	3,850,536	0.92 (0.85, 1.00)	0.0605	0.99 (0.90, 1.09)	0.84
Influenza Vaccine
Unvaccinated	869	3,765,455	1	-	1	-
At least 1 dose	1,566	7,564,291	0.90 (0.82, 0.97)	0.0095	0.94 (0.84, 1.04)	0.25
Smallpox Vaccine
Unvaccinated	2,118	9,593,394	1	-	1	-
At least 1 dose	317	1,736,352	0.83 (0.73, 0.93)	0.0016	1.05 (0.91, 1.22)	0.51

^* other covariates in the model included military service branch, sex, age, race, ethnicity, military grade, occupation, deployment status, and calendar year

† estimates of effect for atrial fibrillation following exposure to the indicated vaccine