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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
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Considerations for Designing an
Epidemiologic Study for Multiple Sclerosis
and Other Neurologic Disorders in Pre and
Post 9/11 Gulf War Veterans

Committee on Designing an Epidemiologic Study for Multiple Sclerosis and Other
Neurologic Disorders in Veterans of the Persian Gulf and Post 9/11 Wars

Board on the Health of Select Populations

Institute of Medicine

images

THE NATIONAL ACADEMIES PRESS

Washington, DC

www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×

THE NATIONAL ACADEMIES PRESS     500 Fifth Street, NW     Washington, DC 20001

This activity was supported by Contract No. VA241-P-2024/VA119A-15-J-0030 from the U.S. Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-38865-8
International Standard Book Number-10: 0-309-38865-1
DOI: 10.17226/21870

Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2015 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×

COMMITTEE ON DESIGNING AN EPIDEMIOLOGIC STUDY FOR MULTIPLE SCLEROSIS AND OTHER NEUROLOGIC DISORDERS IN VETERANS OF THE PERSIAN GULF AND POST 9/11 WARS

Roderick J. Little, PhD (Chair), Richard D. Remington Distinguished University Professor of Biostatistics, Department of Biostatistics, School of Public Health, University of Michigan

Babette Brumback, PhD, Professor and Associate Chair, Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida

Francesca Dominici, PhD, Professor and Senior Associate Dean for Research, Department of Biostatistics, Harvard T.H. Chan School of Public Health

Elena Erosheva, PhD, Associate Professor of Statistics and Social Work, Center for Statistics and the Social Sciences, Department of Statistics and the School of Social Work, University of Washington

Michael E. Goldberg, MD, David Mahoney Professor of Brain and Behavior, Departments of Neuroscience, Neurology, Psychiatry, and Ophthalmology, College of Physicians and Surgeons, Columbia University Medical Center

Donald Hedeker, PhD, Professor of Biostatistics, Department of Public Health Sciences, Biological Sciences Division, University of Chicago

Annette M. Langer-Gould, MD, PhD, Research Scientist MD, Neurology, Kaiser Permanente Research

Lorene Nelson, PhD, MS, Associate Professor, Division of Epidemiology, Department of Health Research and Policy and Associate Director of Stanford Center for Population Health Sciences, Stanford University School of Medicine

DeJuran Richardson, PhD, Professor of Mathematics, Department of Mathematics and Computer Science, Lake Forest College

Ira Shoulson, MD, Professor of Neurology, Pharmacology and Human Science and Director, Program for Regulatory Science and Medicine, Georgetown University

Lawrence Steinman, MD, George A. Zimmermann Professor of Neurology and Neurological Sciences and Pediatrics, Beckman Center for Molecular Medicine, Stanford University

Barbara G. Vickrey, MD, MPH, Chair, Department of Neurology, Icahn School of Medicine at Mount Sinai

Christina Wolfson, PhD, Director of the Neuroepidemiology Research Unit, McGill University Health Centre and Professor, Department of Epidemiology, Biostatistics and Occupational Health, McGill University

Staff

Carolyn E. Fulco, Scholar

Anne Styka, Program Officer

Sulvia Doja, Research Associate

Joseph Goodman, Senior Program Assistant

Frederick Erdtmann, Director, Board on the Health of Select Populations

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×

REVIEWERS

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Sandro Galea, Boston University School of Public Health

Kenneth Kizer, University of California, Davis, School of Medicine and Betty Irene Moore School of Nursing and University of California, Davis, Health System

Richard Mayeux, Sergievsky Center and Columbia University

Barbara McKnight, University of Washington

Tyler Smith, National University School of Health and Human Services

Alan Zaslavsky, Harvard Medical School

Although reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by Dan G. Blazer, Emeritus, Duke University Medical Center, and Floyd E. Bloom, The Scripps Research Institute. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×

ABBREVIATIONS AND ACRONYMS

AFHSC Armed Forces Health Surveillance Center
CDC Centers for Disease Control and Prevention
CI confidence interval
CMS Centers for Medicare & Medicaid Services
DMDC Defense Manpower Data Center
DOD Department of Defense
ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification
IOM Institute of Medicine
MS multiple sclerosis
MSMR Medical Surveillance Monthly Report
NewGen National Health Study for a New Generation of US Veterans
NHS National Health Survey of Gulf War Era Veterans and Their Families
ODD other demyelinating disease
OEF Operation Enduring Freedom
OIF Operation Iraqi Freedom
OND Operation New Dawn
OR odds ratio
PTSD posttraumatic stress disorder
RR relative risk
SOT statement of task
VA Department of Veterans Affairs
VBA Veterans Benefits Administration
VHA Veterans Health Administration
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
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In January 2015, the Institute of Medicine conducted a study to determine the incidence and prevalence, as well as the risk of developing multiple sclerosis (MS) and other neurologic diseases as a result of service in the 1990-1991 Persian Gulf and post 9/11 Global Operations theaters. The other neurologic diseases to be considered include: Parkinson’s disease, and brain cancers, as well as central nervous system abnormalities that are difficult to precisely diagnose. This report presents the committee’s data collection and findings.

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