Linked Exposures Across Databases (LEAD): An exposure data aggregation framework to facilitate clinical exposure review

Understanding the health outcomes of military exposures is a critical effort for Veterans, their health care team, and national leaders. Veterans Affairs providers receive reports of military exposure related concerns from 43% of Veterans. Understanding the causal influences of environmental exposures on health is a complex task advancement in exposure science and may require interpreting multiple data sources; particularly when exposure pathways and multi-exposure interactions are ill-defined, as is the case for complex and emerging military service-related exposures. Thus, there is a need to standardize clinically meaningful exposure metrics from different data sources to guide clinicians and researchers with a consistent model for investigating and communicating exposure risk profiles. The Linked Exposures Across Databases (LEAD) framework provides a unifying model for characterizing exposure from different exposure datatypes and databases with a focus on providing clinically relevant exposure metrics. Application of LEAD is demonstrated through comparison of different military exposure data sources: Veteran Military Occupational and Environmental Exposure Assessment Tool (VMOAT), Individual Longitudinal Exposure Record (ILER) database and a military incident report database, the Explosive Ordnance Disposal Information Management System (EODIMS). This cohesive method for evaluating military exposures leverages established information with new sources of data and has the potential to influence how military exposure data is integrated into exposure health care and investigational models.