The Lifetime Surveillance of Astronaut Health (LSAH) is a proactive occupational surveillance program for the astronaut corps to screen and monitor astronauts for occupational related injury or disease. The LSAH program examines the incidence of acute and chronic morbidity and mortality of astronauts, and defines health risks associated with the occupational exposures encountered by astronauts. From the evidence obtained through clinical testing, individually tailored follow-up medical examinations and surveillance for particular outcomes will be designed to track the astronaut population more rigorously and to capture sub-clinical medical events.
Space Medicine Operations Division
The mission of the Space Medicine Operations Division is to optimize the health, fitness, and well being of flight crews. As such, requirements exist to ensure accurate and consistent collection of astronaut medical data. Data collected during these medical tests are generally housed in the Lifetime Surveillance of Astronaut Health Repository (LSAH-R). Several types of medical data may be available through the LSAH-Repository.
- Medical Requirements Integration Documents (MRID) / Medical Evaluation Documents, Volume B (MEDB) Medical data is collected for clinical purposes, and requirements are periodically reviewed and updated according to medical need. The initial medical requirements were developed in the MRID documents. More recently, some of the MRIDs have been updated by newer requirements called MEDBs. These requirements may list both MRID and MEDB numbers as a result, and the data available for these tests may vary based upon the implementation dates of the specific MRID and MEDB requirements.
- LSAH Annual Preventive Examinations: Active and retired astronauts receive an annual preventive medical examination as part of the LSAH occupational surveillance program. Much of the data collected as part of this annual examination is listed under “Therapeutics and Clinical Care” as MR089S. Other tests may be added to the annual exam based on an individual’s family or personal medical history and based upon updates to the United States Preventive Services Task Force national guidelines.
- Other Clinical Data: As the new LSAH occupational surveillance program develops individual hazard exposure profiles and monitoring protocols, some of this data may become available once an adequate dataset is available to protect astronaut confidentiality. Check back over the next 1-2 years for information related to occupational surveillance data.
Limitations of LSAH Data
The primary reason for collecting LSAH data is, and always has been, primarily for clinical purposes, rather than for a research study. Much of the data content is driven by crew surgeon need – the data may list outcome (e.g. “normal”) rather than a specific value, the data may not always be collected for each crew member, or the data may be taken under different circumstances (e.g. an astronaut returning on a Soyuz may have different test dates or even types of tests than an astronaut returning on a Space Shuttle).
In addition, medical requirements have evolved throughout the human spaceflight program. Therefore data collected under an early medical requirement may not be consistent for all flights over time, and the specific data collected may vary. For example, medical requirements documented in the MRID documents may have been updated by newer requirements called MEDBs.
Annual preventive medical exam data is typically collected during each astronaut’s birth month, but may be inconsistent based upon schedule conflicts or, for retired astronauts, travel issues. Individual participation in the LSAH annual exams is optional after retirement from the astronaut corps, therefore the number of available data sets and even content of the exams may vary from year to year.
Annual preventive medical exam data is typically collected during each astronaut’s birth month, but may be inconsistent based upon schedule conflicts or, for retired astronauts, travel issues. Individual participation in the LSAH annual exams is optional after retirement from the astronaut corps, therefore the number of available data sets and even content of the exams may vary from year to year.
LSAH History: Research Study to Occupational Surveillance Program
The Longitudinal Study of Astronaut Health (LSAH) originated as a research study in 1989 to examine the incidence of acute and chronic morbidity and mortality of astronauts to determine whether the unique occupational exposures encountered by astronauts are associated with increased risks of total or cause-specific morbidity and mortality.
Specifically, the primary a priori hypotheses to be tested were: 1) astronauts are at different risk of total morbidity (defined as rate of incident cases of diseases/disorders, rate of hospitalizations, and average number of hospitalization days per person), than ground-based employees; and 2) astronauts are at different risk of total mortality than ground-based employees. All astronauts selected for the NASA astronaut program were followed as "exposed" subjects from selection through-out the course of the study.
The Longitudinal Study of Astronaut Health (LSAH) was a designed as a cohort study, and risk was measured relative to civil service employees located at the Johnson Space Center (JSC) who worked and lived, at least for a time, in the same geographical area as the astronauts. All cohorts volunteered to participate in the study. Civil service employees who received routine annual physical examinations at the JSC Occupational Medicine Clinic were selected as comparison subjects using age, sex, and body mass index as selection criteria, and they were followed in the same manner as the astronauts. As new astronauts were selected, matching groups of comparison participants were identified and recruited. The ratio of participants was three comparison subjects for every one astronaut, later changed to a ratio of 5:1. Morbidity, mortality, physical examination, and laboratory data were collected utilizing medical records routinely collected at the Johnson Space Center, as well as medical consultant reports, hospital discharge summaries, death certificates, and, when available, autopsy reports.
Analyses on the LSAH data continue to be performed though the research study was closed and comparison subjects were released in May 2010. The LSAH databases are useful as computerized medical records as well as for research purposes. The personal medical data included in the data bases of the LSAH are protected by the Privacy Act of 1974, as amended, by the HIPAA (Health Insurance Portability and Accountability Act (HIPAA) of 1996 (Public Law 104-191)), and by the additional security procedures and policies of NASA, the LSAH and the JSC Clinics. Individual participant data are not included in reports or publications; only grouped data are presented.
The Longitudinal Study of Astronaut Health (LSAH) was a designed as a cohort study, and risk was measured relative to civil service employees located at the Johnson Space Center (JSC) who worked and lived, at least for a time, in the same geographical area as the astronauts. All cohorts volunteered to participate in the study. Civil service employees who received routine annual physical examinations at the JSC Occupational Medicine Clinic were selected as comparison subjects using age, sex, and body mass index as selection criteria, and they were followed in the same manner as the astronauts. As new astronauts were selected, matching groups of comparison participants were identified and recruited. The ratio of participants was three comparison subjects for every one astronaut, later changed to a ratio of 5:1. Morbidity, mortality, physical examination, and laboratory data were collected utilizing medical records routinely collected at the Johnson Space Center, as well as medical consultant reports, hospital discharge summaries, death certificates, and, when available, autopsy reports.
Analyses on the LSAH data continue to be performed though the research study was closed and comparison subjects were released in May 2010. The LSAH databases are useful as computerized medical records as well as for research purposes. The personal medical data included in the data bases of the LSAH are protected by the Privacy Act of 1974, as amended, by the HIPAA (Health Insurance Portability and Accountability Act (HIPAA) of 1996 (Public Law 104-191)), and by the additional security procedures and policies of NASA, the LSAH and the JSC Clinics. Individual participant data are not included in reports or publications; only grouped data are presented.
Publications
LSAH newsletters are published semiannually with the intent to keep participants informed and up to date on the program's findings.
The LSAH Data Repository (LSAH-R) was established to implement a research component to enable analysis of astronaut medical data.
Bagian JP, Ward DF. A retrospective study of promethazine and its failure to produce the expected incidence of sedation during space flight.J Clin Pharmacol1994;34(6):649-651. [
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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 Med1998;69(2):142-144. []
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 Med1988;59(5):448-451. []
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 Med2007 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 Med1999;70(7):705-8. []
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.
The LSAH Data Repository (LSAH-R) was established to implement a research component to enable analysis of astronaut medical data.
Bagian JP, Ward DF. A retrospective study of promethazine and its failure to produce the expected incidence of sedation during space flight.J Clin Pharmacol1994;34(6):649-651. []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 Med1998;69(2):142-144. [
]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 Med1988;59(5):448-451. [
]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 Med2007 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 Med1999;70(7):705-8. [
]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: