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4 Major Cohort Studies
Pages 55-114

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From page 55...
... The largest studies of Gulf War veterans have been conducted in countries that were members of the Gulf War coalition including: the United States, Canada, Denmark, Australia, and the United Kingdom. Most major cohort studies address several fundamental questions about Gulf War veterans' health: What are the nature and prevalence of veterans' symptoms and diagnoses?
From page 56...
... In population-based studies of Gulf War veterans, the cohort might be the entire deployed population, as in studies of Canadian and Australian veterans, or a random selection from the population of interest, as in several studies of US and British veterans. The committee, in evaluating major cohort studies, gave greater weight to Gulf War studies that were population-based.
From page 57...
... . Another limitation of most major cohort studies is self-reporting of exposures.
From page 58...
... Registry programs have been a valuable source of information for generating hypotheses that have been tested in rigorous epidemiologic studies with control groups to estimate the health status of Gulf War veterans. POPULATION-BASED STUDIES The Iowa Study The "Iowa study", a major population-based study of US Gulf War veterans, was a crosssectional survey of a representative sample of 4,886 military personnel who listed Iowa as their home of record at the time of enlistment (Iowa Persian Gulf Study Group 1997)
From page 59...
... The study concluded that no exposure to any single agent was related to the conditions that the authors found to be more prevalent in Gulf War veterans (Iowa Persian Gulf Study Group 1997)
From page 60...
... The study was designed to be representative of the nearly 700,000 US veterans sent to the Persian Gulf and 800,680 non-Gulf War veterans of the same era. Questionnaires were mailed to a stratified random sample of 15,000 Gulf War and 15,000 non-Gulf War veterans identified by DOD and representing various units and branches of the military.
From page 61...
... Runny nose 56 43 Headache 54 37 Unrefreshing sleep 47 24 Anxiety 45 28 Joint pain 45 27 Back pain 44 30 Fatigue 38 15 Ringing in ears 37 23 Heartburn 37 25 Difficulty in sleeping 37 21 Depression 36 22 Difficulty in concentrating 35 13 5 Most Common Self- Prevalence in Gulf War Prevalence in Non-Gulf War Reported Chronic Medical Veterans (%) Veterans (%)
From page 62...
... . The study evaluated 1,061 Gulf War and 1,128 non-Gulf War veterans who had been randomly selected from 11,441 Gulf War-deployed and 9,476 non-Gulf War-deployed veterans who previously had participated in a 1995 questionnaire survey (Kang et al.
From page 63...
... of 8,603 Gulf War veterans who listed Oregon or Washington as their home state of record at the time of deployment, according to data provided by the DOD Manpower Data Center. The response rate was 48.4%.
From page 64...
... . Kansas Veteran Study The state of Kansas established the Kansas Persian Gulf War Veterans Health Initiative to determine the patterns of veterans' health problems in the state.
From page 65...
... Gulf War veterans also reported significantly more visits to health-care practitioners, greater dissatisfaction with their health status, and greater health-related reductions in recent activity. Symptom Clustering The Canadian study did not search for potentially new syndromes.
From page 66...
... reported higher prevalences of symptoms and diminished functioning than did either comparison group. Gulf War veterans were 2-3 times more likely than comparison subjects to have met symptom-based criteria for chronic fatigue, posttraumatic stress reaction, and "chronic multisymptom illness", the label for the first case definition7 developed by CDC researchers to probe for the existence of a potential new syndrome among Gulf War veterans (Fukuda et al.
From page 67...
... None of the factors was exclusive to Gulf War veterans, so the investigators concluded that their findings did not support a new syndrome (Cherry et al.
From page 68...
... The symptoms most strongly associated with Gulf War deployment were mood swings, memory loss or lack of concentration, night sweats, general fatigue and sexual dysfunction. Overall, 6% of the Gulf War veterans believed that they had "Gulf War syndrome"; that belief was associated with the highest reporting of new symptoms or diseases.
From page 69...
... About 21% of Gulf War veterans vs 6.2% of controls reported a clustering of three to five of the relevant symptoms (p < 0.001)
From page 70...
... MILITARY-UNIT-BASED STUDIES Ft. Devens and New Orleans Cohort Studies The symptom experience of two deployed cohorts of Gulf War veterans was studied by Boston-based researchers.
From page 71...
... , and there was no comparison cohort of nondeployed veterans. All those features strongly suggest selection bias, which could lead to overestimation of health effects among participants.
From page 72...
... Finally, "arthromyoneuropathy" was associated with higher scores on the scale of advanced adverse effects of PB and with an index created by the investigators to enable veterans to self-report the amount and frequency of their use of government-issued insect repellent. The authors concluded that some Gulf War veterans had delayed chronic nervous system syndromes as a result of exposure to combinations of neurotoxic chemicals (Haley and Kurt 1997)
From page 73...
... , who did not find differences in PON1 activity among symptomatic vs healthy Gulf War veterans in a more representative, population-based sample. Larger Seabee Cohort Studies The first in a series of studies by Gray and collaborators (1999a)
From page 74...
... Pennsylvania Air National Guard Study A large study by Fukuda and colleagues (1998) used factor analysis and other methods to assess the health status of Gulf War veterans in response to requests from DOD, VA, and the state of Pennsylvania to assess the prevalence and causes of an unexplained illness in members of one currently active Air National Guard unit.
From page 75...
... Having an injury requiring medical attention was also associated with having a severe case of chronic multisymptom illness. OTHER COHORT STUDIES The following studies are grouped because they are more narrowly focused than the major cohort studies and often lack analysis of symptom clustering or exposure-symptom relationships.
From page 76...
... . It found that veterans deployed to the Gulf War reported higher prevalence of 21 of 23 symptoms on a symptom checklist than nondeployed veterans.
From page 77...
... Connecticut National Guard Southwick and colleagues studied two deployed units of the Connecticut National Guard (n = 240) (Morgan et al.
From page 78...
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From page 79...
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From page 80...
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From page 81...
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From page 82...
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From page 83...
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From page 84...
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From page 85...
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From page 86...
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From page 87...
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From page 88...
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From page 89...
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From page 90...
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From page 91...
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From page 92...
... 3.7(549 va co lean su su ati ible ns Or any ns ns entdn foni toser =na ond Popul Elig Deve weN 9911-1em Germ Ti survsneveD 9931-2em survsne acttn Ti Deve Deve depe Dev (co Resp datlul(f y studt udystl yd hor naoi only rs colain udystl naoi stula design sect- itudg sect Study ossrC responde Lon ossrC s-sections Cro with motpm veyrus2 fo cigo aredp com sycigo time ess physical holc and1 rsotcid on illn ncea holc g time predna pact im motpm opsyr opsyr rtino Purpose Neu perform neu rep Devens rseuoC ltisy PTSD PTSD ealthh Mu al.
From page 93...
... 8%. nse onde lled ponse 83(6 57(1 Resp Enro (Res 68 23 (Respo d lled ted te)
From page 94...
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From page 95...
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From page 96...
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From page 97...
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From page 98...
... Rate) onde lled ponse omhwno ofyadts1 nse -013/ =n Resp Enro (Res oseht on (Respo WGni levels: d = ty lled ed ted caoL fo od due te)
From page 99...
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From page 100...
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From page 101...
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From page 102...
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From page 103...
... 103 with aredp onitalup ts)
From page 104...
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From page 105...
... 1999. Subjective cognitive complaints, affective distress, and objective cognitive performance in Persian Gulf War veterans.
From page 106...
... 2001. Prevalence of Gulf war veterans who believe they have Gulf war syndrome: Questionnaire study.
From page 107...
... 1999b. The postwar hospitalization experience of Gulf War Veterans possibly exposed to chemical munitions destruction at Khamisiyah, Iraq.
From page 108...
... 2003b. Paraoxonase in Persian Gulf War veterans.
From page 109...
... 1997. A comprehensive clinical evaluation of 20,000 Persian Gulf War veterans.
From page 110...
... 2002a. Chronic fatigue in a population-based study of Gulf War veterans.
From page 111...
... 1998. Health status of Persian Gulf War veterans: Self-reported symptoms, environmental exposures and the effect of stress.
From page 112...
... 1996b. Post traumatic stress disorder symptoms among Gulf War veterans.
From page 113...
... 2001. Neuropsychological function in Gulf War veterans: Relationships to self-reported toxicant exposures.
From page 114...
... 1999b. Course and predictors of posttraumatic stress disorder among Gulf War veterans: A prospective analysis.


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