Incidence of Selected Health Conditions Among TRICARE Beneficiaries Exposed to the Red Hill Fuel Release November 2019–December 2023

Red Hill and Comparison Cohort Study Prepared June 24, 2024 DCPH-P-EDC-TR-162-2024

from Defense Health Agency, Arlington, VA

Executive Summary

• This report examines incident cases of conditions that have been reported by Red Hill, Hawai’i community members to Defense Health Agency (DHA) Public Health following the JP-5 fuel release at the Red Hill Bulk Storage Facility in November 2021. This report provides analyses of new cases of migraine, hematuria, irritable bowel syndrome, peripheral neuropathy, eosinophilic esophagitis (EoE), and Raynaud’s syndrome following the potential JP-5 exposure among individuals included in the Red Hill Defense Occupational and Environmental Health Readiness System Incident Report roster.

• This analysis compares the incidence of these conditions to an unexposed cohort of DoD-affiliated individuals living on Oahu at the time of the Red Hill fuel release.

• Based on medical encounter diagnoses codes, individuals in the Red Hill Cohort were more likely to have incident (new) cases of migraine and EoE than the Comparison Cohort. There were no statistically significant differences in the incidence of the other listed conditions between the two cohorts.

• Within the Red Hill Cohort, there was a higher trend in the monthly number of individuals with health care encounters for migraine following the release event than in the period before the event. However, there was no statistically significant difference in overall trends for individuals with migraine diagnoses between the two cohorts.

• This report does not imply any causation links between the JP-5 exposure and the study outcomes. This report has several important limitations to note: The potential misclassification of conditions based on diagnosis codes from medical records, inability to account for all possible confounders, lack of current biological models linking JP-5 exposure to these conditions, and potential physician bias (the exposed cohort may be monitored for health conditions more closely than the comparison cohort).

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