Gulf War and Health Volume 1: Depleted Uranium, Sarin, Pyridostigmine Bromide, and Vaccines (2000) / Chapter Skim
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Illnesses in Gulf War Veterans
Illnesses in Gulf War Veterans
Pages 39-68
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From page 39... ...
3This chapter employs the term "Gulf War veterans" in the broadest sense. Unless otherwise specified, the term denotes all military personnel who served in the Gulf War theater between August 2, 1990, and June 13, 1991, regardless of whether they later continued on active duty, returned to the reserves or National Guard, or left military service.
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The chapter summarizes studies of veterans' mortality, hospitalizations, and diagnosable illnesses and provides a brief overview of the Gulf War veterans' registry programs established by the Department of Veterans Affairs (VA) and the Department of Defense (DoD)
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Gulf War veterans found similar types and frequencies of symptoms and diagnoses (Coker et al., 1999~. Across the registries, musculoskeletal diseases; mental disorders; and symptoms, signs, and ill-defined conditions5 were the three most s"Symptoms, signs, and ill-defined conditions" refers to International Classif~cation of Diseases, Ninth Revision, Classical Modification (ICD-9-CM)
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As self-selected case series of veterans who presented for care, registries cannot, and were not intended to, be representative of the symptoms and illnesses of the entire group of Gulf War veterans. Nor were registries designed with control groups or with diagnostic standardization across the multiple sites at which examinations took place (Joseph, 1997; Roy et al., 1998~.
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Registry programs are, however, a valuable resource for information and for generating hypotheses. These hypotheses can be tested in more rigorous epidemiologic studies with control groups in order to estimate the population prevalence of symptoms among Gulf War veterans and to compare these to rates among otherwise similar troops who were not deployed to the Gulf War.
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on the health of Gulf War veterans. When factor analysis is employed in studies of veterans, the observed variables are measurements of veterans' symptoms, and the fundamental factors are symptom groupings that may represent a potentially new syndrome.
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Gulf War veterans. was a cross-sectional 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, 19979.
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The subscales for bodily pain, general health, and vitality showed the greatest absolute differences between deployed and nondeployed veterans. In short, this large, well-controlled study demonstrated that certain sets of symptoms are more frequent and quality of life is poorer among Gulf War veterans than among nondeployed military controls.
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Exposur~symptom relationships. In Canadian Gulf War veterans, the greatest number of symptom groupings were associated with self-reported exposures to psychological stressors and physical trauma.
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Gulf War veterans constitute a new syndrome. By applying factor analysis, the researchers were able to identify three fundamental factors, which they classified as mood, respiratory system, and peripheral nervous system, according to the types of symptoms that contributed to each factor.
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Other Studies of Veterans' Symptoms and General Health Status One of the first epidemiologic studies of U.S. Gulf War veterans was of more than 4,000 active duty and reserve personnel from the states of Pennsylvania and Hawaii (Stretch et al., 1995~.
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Numerous ongoing studies are designed to probe further whether Gulf War veterans have measurable impairments of neurological or neuropsychological performance (CDC, 1999; Research Working Group, 1999~.
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A large study by Fukuda and colleagues (1998) used factor analysis and other methods to assess the health status of Gulf War veterans.
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The investigators therefore concluded that their case definition could not uniquely characterize Gulf War veterans with unexplained illnesses (Fukuda et al., 1998~. The study, however, had several limitations, the most important of which was its coverage of only active Air Force personnel (several years after the Gulf War)
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Hospitalization Studies The risk of hospitalization was the subject of two large studies of active duty personnel discharged from DoD hospitals before and after the Gulf War. The first study, compared almost 550,000 Gulf War veterans with almost 620,000 nondeployed veterans and found no significant and consistent differences in hospitalizations after the war (Gray et al., 1996~.
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A small study of two Mississippi National Guard units (n = 282) deployed to the Persian Gulf found no excess rate of birth defects in their children compared with expected rates from surveillance systems and previous surveys (Penman et al., 1996~.
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This study covers all Gulf War veterans and Gulf War era controls, a total of 106,000 veterans (Doyle et al., 1999~. Studies of Stress-Related Disorders Two population-based epidemiologic studies described earlier (Iowa Persian Gulf Study Group, 1997; Goss Gilroy, 1998)
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Researchers compiled diagnoses from among all Gulf War veterans (n = 13,161) who sought health examinations through the DoD registry during its first year of operation (199= 1995~.
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Finally, 19 cases of cutaneous leishmaniasis and 12 cases of a variant of visceral leishmaniasis have been reported among U.S. Gulf War veterans.23 The latter is an unusual finding because the etiological agent found in veterans' tissue samples the protozoan parasite Leishmania tropica, transmitted by sandflies is not endemic to the Persian Gulf area and is usually associated with cutaneous leishmaniasis (CDC, 1992; Magill et al., 1993; Hyams et al., 1995~.
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Gulf War veterans. Although it is considered the most representative, the cohort contained few members of racial and ethnic minorities (Iowa Persian Gulf Study Group, 1997~.
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The third phase is a comprehensive medical examination and laboratory testing of a random sample of 2,000 veterans drawn from both the Gulf War and the comparison group (Research Working Group, 1998~. The purpose of the third phase is to establish diagnoses that will make it possible to see what proportion of self-reported symptoms are due to established diseases rather than unexplained illnesses.26 A major problem for most epidemiologic studies of Gulf War veterans is the lack of biological measures of exposure to potentially harmful agents.
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study of veterans' health has yet to be completed. However, current research demonstrates that Gulf War veterans report more symptoms than their nondeployed counterparts, based on methodologically robust studies Tom three different countries (Iowa Persian Gulf Study Group, 1997; Goss Gilroy, 1998; Unwin et al., 19994.
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1997. The risk of birth defects among children of Persian Gulf War veterans.
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1997. A comprehensive clinical evaluation of 20,000 Persian Gulf War veterans.
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1996. No evidence of increase in birth defects and health problems among children born to Persian Gulf War veterans in Mississippi.
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1998. Signs, symptoms, and ill-defined conditions in Persian Gulf War veterans: Findings from the Comprehensive Clinical Evaluation Program.
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1999. Relationship of psychiatric status to Gulf War veterans' health problems.
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CONTENTS METHODS OF GATHERING AND EVALUATING THE EVIDENCE.............................................................................................. TYPES OF EVIDENCE Animal and Other Nonhuman Studies, 71 Human Studies, 72 Epidemiologic Studies, 72 Experimental Studies, 76 Case Reports and Case Series, 77 70 CONSIDERATIONS IN ASSESSING THE STRENGTH OF THE EVIDENCE 78 Strength of Association, 78 Dose-Response Relationship, 78 Consistency of Association, 79 Temporal Relationship, 79 Specificity of Association, 79 Biological Plausibility, 80 Other Considerations, 80 SUMMARY OF THE EVIDENCE 81 Understanding Causation and Association, 82 Categories of Association, 83 COMMENTS ON INCREASED RISK OF ADVERSE HEALTH OUTCOMES AMONG GULF WAR VETERANS 84 REFERENCES 85
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