The Longitudinal Study of Astronaut Health (LSAH) was a research study examining the incidence of acute and chronic morbidity and mortality of astronauts and describe the risks associated with the astronauts' occupational exposures, as compared to the risks for a matched control population, civil service employees at Johnson Space Center (JSC). This study was conducted between 1989 and 2010 and has been closed out. However data from this study may be available to approved investigators. Publications utilizing these data continue to be written and are being added to this record below.
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LSAH Phase I
Phase I of the LSAH was comprised of astronauts (two subgroups) and a comparison group. The first astronaut subgroup included 73 astronauts from selection classes between 1959 and 1969, of whom 8 were deceased and 9 had resigned, resulting in 56 remaining participants. The second astronaut subgroup included 122 astronauts from selection classes between 1978 and 1989. The comparison population was matched individually in a 5:1 ratio to the 178 total astronauts. The match criteria included gender, age, body size, smoking habits, time at JSC, and exercise habits if those habits were available.
Phase I had a number of weaknesses. The population was biased in that it was a prospective match to a retrospective cohort and was viewed from the vantage point of the 1980s. No controls were matched to the deceased or retired astronauts and controls chosen also had to be alive at the time of the match. There was no informed consent from any participants. Physical exams were not as extensive for the comparison population as for the astronauts. The study ended in 1991.
LSAH Phase II
Phase II ran from 1992 to May 2010. The comparison subjects were chosen on a 3:1 ratio basis with astronauts by selection class matching for age, sex and BMI. The match was performed for the entire astronaut population. The comparison population was chosen from the JSC civil service workforce, whose employee records date to 1962. There was a retrospective match to a retrospective cohort, meaning that the epidemiologists acted as if they were doing a prospective match. Employee records for the same year as the astronaut selection year were used to select comparison participants. Thus the pattern was preserved that would have occurred had the comparison participant selection taken place at the time of the astronaut selection. 68% of those comparison subjects invited chose to participate. From 1992 forward, there was a prospective match to a prospective cohort. The comparison subjects signed an informed consent document. For the retired astronauts, however, the consent was implied in that appearing for the annual exam was interpreted as consent for their data to be part of the study.
The Phase II study had a number of strengths. The astronaut data repository was used to populate the JSC Electronic Medical Record in 1999. Retired astronauts have been supportive of the study, with a 65-70% annual return for follow-up examination. The comparison subject population, a healthy working cohort, has also been very supportive of the study, with a 62-65% return rate. The data collected is unique among longitudinal studies, given the amount of standardized testing at regular intervals over a period of up to 50 years. The LSAH provided an annual cancer incidence report and a number of other reports and analyses (average 130/year).
The Phase II study also carried flaws, the most important being the fact that the comparison population did not mirror the astronauts. Differences between the populations include dissimilar demographics (e.g., the comparison population did not undergo a medical examination before admission to the subject pool) and different exam intervals between groups (bi-annually for controls; annually for astronauts). Laboratory studies, imaging, and follow-up testing also were not identical to the astronaut corps schedule and content. There were other inconsistencies in the data resulting in incomplete participant medical histories.
Study investigators conducted a thorough evaluation of other epidemiological studies. These studies evaluated were of short duration, experienced high drop-out rates, were of extremely small sample sizes, would drop participants if illness developed, and also had dissimilar demographics to the astronauts. As a result, it was concluded that no single group exists that can effectively serve as controls for the astronaut population. It was also noted that the astronaut data was not as complete as needed for thorough surveillance and did not capture occupational exposures. The follow-up activities and testing were not rigorous enough for a thorough scientific investigation.
Phases I and II of the LSAH program provided a retrospective look at astronaut health and disease, but did not provide for the prevention of disease occurrence. In addition, due to the issues noted above, the power of the study continues to diminish with time. In 2004, the Institute of Medicine (IOM) released a report entitled “A Review of NASA’s Longitudinal Study of Astronaut Health”. In this publication, the IOM recommended that NASA convert to an Occupational Surveillance program in addition to their research program, and specifically cited the Department of Energy, Veteran’s Administration, and Department of Defense as examples of successful government occupational surveillance programs. The IOM also stated that NASA had a moral obligation to provide surveillance and care to the astronaut corps due to occupational exposures.
The LSAH program is therefore being revamped to provide a lifelong surveillance program for all astronauts with vital follow-up care through an occupational program. The program will have a new design and name but the same acronym. LSAH now represents “Lifetime Surveillance of Astronaut Health”. The Phase II data remains as the basis for Phase III. With the new program design and larger sample size of the astronaut corps, comparison studies will draw from within the corps. For this reason, the original comparison population will not be required for this program and was released in May 2010. The new occupational surveillance program will develop personalized health care protocols for each individual astronaut. This is important because this population has not been exposed equally to all hazardous chemicals and elements.
Bagian JP, Ward DF. A retrospective study of promethazine and its failure to produce the expected incidence of sedation during space flight. J Clin Pharmacol
Baker E, Barratt MR, Wear M. Human Response to Spaceflight. In Principles of Clinical Medicine for Space Flight, Chapter 2. Edited by Barratt MR and Pool SL. Springer Science, Inc, New York. 2008.
Billica RD, Simmons SC, Mathes KL, McKinley BA, Chuang CC, Wear ML, and Hamm PB. Perception of the medical risk of spaceflight. Aviation, Space and Environmental Medicine. 1996;67:467-473.[
Cucinotta FA, Manuel FK, Jones J, Iszard G, Murray JD, Djojonegoro BM and Wear ML. Space Radiation and Cataracts in Astronauts. Radiation Research 2001;156(5):460-466. [Erratum in: Radiation Research 2001 Dec;156(6):811][
Hamilton DR, Murray JD, and Ball CG. Cardiac health for astronauts: coronary calcification scores and CRP as criteria for selection and retention. Aviation, Space & Environmental Medicine. 2006 Apr;77(4):377-87.[
Hamilton DR, Murray JD, Kapoor D, and Kirkpatrick AW. Cardiac health for astronauts: current selection standards and their limitations. Aviation, Space & Environmental Medicine 2005 Jul;76(7):615-26. Review.[
Hamm PB, Billica RD, Johnson GS, Wear ML, Pool SL. Risk of cancer mortality among the longitudinal study of astronaut health (LSAH) participants. Aviat Space Environ Med
Hamm PB, Nicogossian AE, Pool SL, Wear ML, and Billica RD. Design and Current Status of the Longitudinal Study of Astronaut Health. Aviation, Space and Environmental Medicine. 2000;71(6):564-570.[
Jennings RT, Davis JR, Santy PA. Comparison of aerobic fitness and space motion sickness during the shuttle program. Aviat Space Environ Med
Jones JA, McCarten M, Manuel K, Djojonegoro B, Murray J, Feiverson A, Wear M. Cataract formation mechanisms and risk in aviation and space crews. Aviation, Space & Environmental Medicine 2007; 78(4,Suppl.):A56–A66.[
Longnecker DE, Manning FJ, and Worth MH, Editors. Review of NASA’S Longitudinal Study of Astronaut Health. Committee on the Longitudinal Study of Astronaut Health, Board on Health Sciences Policy, Institute of Medicine of the National Academies. National Academies Press, Washington, D.C., 2004.
Mader TH, Gibson CR, Pass AF, Kramer LA, Lee AG, Fogarty J, Tarver WJ, Dervay JP, Hamilton DR, Sargsyan A, Phillips JL, Tran D, Lipsky W, Choi J, Stern C, Kuyumjian R, Polk JD. Optic Disc Edema, Globe Flattening, Choroidal Folds, and Hyperopic Shifts Observed in Astronauts after Long-duration Space Flight. Ophthalmology. 2011 Aug 17. [
McMonigal KA; Braverman LE; Dunn JT; Stanbury JB; Wear ML; Hamm PB; Sauer RL; Billica RD; and Pool SL. Thyroid Function Changes Related to Use of Iodinated Water in the U.S. Space Program. Aviation, Space and Environmental Medicine. 2000;71(11):1120-1125[
Peterson LE, Pepper LJ, Hamm PB and Gilbert SL. Longitudinal Study of Astronaut Health: Mortality in the years 1959-1991. Radiation Research. 1993;133:257-264.[
Pietrzyk RA, Jones JA, Sams CF, Whitson PA. Renal stone formation among astronauts. Aviat Space Environ Med
2007 Apr;78(4 Suppl):A9-A13. [
Putcha L, Berens KL, Marshburn TH, Ortega HJ, Billica RD. Pharmaceutical use by U.S. astronauts on space shuttle missions. Aviat Space Environ Med
Scheuring, Richard A; Mathers, Charles H; Jones, Jeffrey A; Wear, Mary L. Musculoskeletal Injuries and Minor Trauma in Space: Incidence and Injury Mechanisms in U.S. Astronauts. Aviation, Space & Environmental Medicine. 2009 Feb;80(2):117-124.[
View Other Presentations and Analyses:
Amirian E, Clark A, Halm M, Hartnett HJ. An Update on Mortality in the U.S. Astronaut corps: 1959-2009. Presented at the American Public Health Association Annual Meeting, November 2009.
Baisden DL, Effenhauser RK, and Wear ML. Inflight medical events in the Shuttle program. Presented at the 71st Annual Scientific Meeting of the Aerospace Medical Association, May 2000.
Barratt MR, Houser SA, and Wear ML. Operational monitoring of pre- and post-flight blood parameters for first time shuttle-flyers. Presented at the 68th Meeting of the Aerospace Medical Association, May 1997. Abstract published in Aviation, Space, and Environmental Medicine. 1997;68(7):618.
Clark A, Hartnett HJ, Amirian E. Spaceflight and Cancer Risk in the U.S. Astronaut Corps: 1959-2010. To Be Presented at Aerospace Medical Association 82nd Annual Scientific Meeting, May 8-12, 2011.
Eudy DA, Parisian D, Rodriguez S and Wear ML. CyberCafe demonstration of SNOMED coding techniques. SNOMED Users Group, September 2003.
Halm MK, Clark A, Wear ML, Murray JD, Polk JD, Amirian E. Traditional Cardiovascular Risk Factors as Predictors of Cardiovascular Events in the U.S. Astronaut Corps. Presented at the Kelsey Research Foundation 10th Annual Health Services and Outcomes Research Conference. Houston, Texas. December 2009.
Jones JA. Urolithiasis in Space. 2nd International Urolithiasis Research Symposium. April 17 - 18, 2008, Indianapolis, Indiana.
Johnston SJ, Marshburn TH, and Lindgren K. Predicted incidence of evacuation-level illness/injury during Space Station operation. Presented at the 71st Annual Scientific Meeting of the Aerospace Medical Association, May 2000.
Johnston SL, Wear ML, and Hamm PB. Incidence of herniated nucleus pulposis among astronauts and other selected populations. Presented at the 69th Meeting of the Aerospace Medical Association, May 1998.
Jones JA, Sargsyan A, Pietryzk R, Sams C, Stepaniak P, and Whitson P. Urolithiasis and Genitourinary Systems Issues for Spaceflight. 2nd International Urolithiasis Research Symposium. April 17 - 18, 2008, Indianapolis, Indiana.
Kerstman EL, Minard CG, Freire de Carvalho MH, Walton ME, Myers JG, Saile LG, Lopez V, Butler DJ, Johnson-Throop KA. Validation of the Integrated Medical Model Using Historical Space Flight Data. Proceedings of the Winter Simulation Conference, December 2010.
Manuel FK. Vision aspects of space flight. Presented at the 71st Annual Scientific Meeting of the Aerospace Medical Association, May 2000.
Minard CG, Freire de Carvalho MH, Iyengar MS. Optimizing Medical Kits for Space Flight. Proceedings of the Winter Simulation Conference, December 2010.
Scheuring RA, Mathers CH, Jones JA, Wear ML, Djojonegoro B. In-flight Musculoskeletal Injuries and Minor Trauma in the U.S. Space Program: A Comprehensive Summary of Occurrence and Injury Mechanism. Presented at Aerospace Medical Association Annual Scientific Meeting, May 2008.
Thomas MM, McGinnis PJ, McCulley PA, Billica RD, and Wear ML. Building an EMR on an Epidemiological Foundation. Presented at Smart Systems 2000 Conference, Houston, TX. September 2000.
Wear ML. Lifetime Surveillance of Astronaut Health. Presented at Innovation 2010, Johnson Space Center, April 28, 2010.
Wear ML and Eudy DA. The Longitudinal Study of Astronaut Health. Presented at a Quarterly meeting of the Houston Area Health Information Management Association, June 26, 2003.
Wear ML, Johnson KA, Krog RL, Eudy DA, Rogers J. SNOMED CT: Out of This World with NASA. Presented at the 4th Annual SNOMED International Users Group, November 2002.
Wear ML, Marshburn T, and Billica RD. Medical Risk Assessment for Mars Missions. Presented at the 71st Annual Scientific Meeting of the Aerospace Medical Association, May 2000. Also presented at Smart Systems 2000 Conference, Houston, TX. September 2000.
Wear ML, Pepper LJ, Hamm PB, Pool SL, and Billica RD. The Longitudinal Study of Astronaut Health. Panel presentation on "Medical Informatics and the U.S. Space Program" at the 17th Annual Symposium on Computer Applications in Medical Care, October 30-November 1, 1993, Washington, DC.