Home Journal Excerpts Gulf War Syndrome Prevalence and Patterns of Gulf War Illness in Kansas Veterans
Prevalence and Patterns of Gulf War Illness in Kansas Veterans PDF Print E-mail
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Saturday, 01 January 2000 00:00
“Gulf War veterans have reported health problems that they attribute to their military service, but little is understood about the nature or extent of these conditions. To determine whether Kansas Gulf War veterans are affected by excess health problems, a population-based survey of 1,548 veterans who served in the Persian Gulf War (PGW) and 482 veterans who served elsewhere (non-PGW) was conducted in 1998. Gulf War Illness, defined as having chronic symptoms in three of six domains, occurred in 34% of PGW veterans, 12% of non-PGW veterans who reported receiving vaccines during the war, and 4% of non-PGW veterans who did not receive vaccines. The prevalence of Gulf War Illness was lowest among PGW veterans who served on board ship (21%) and highest among those who were in Iraq and/or Kuwait (42%). Among PGW veterans who served away from the battlefield areas, Gulf War illness was least prevalent among those who departed the region prior to the war (9%) and most prevalent among those who departed in June or July of 1991 (41%). Observed patterns suggest that excess morbidity among Gulf War veterans is associated with characteristics of their wartime service, and that vaccines used during the war may be a contributing factor.”

“Since the war, Gulf War veterans have reported anomalous health problems that include a variety of chronic symptoms such as headache, fatigue, joint pain, rashes, respiratory problems, and neuropsychological difficulties. Despite a growing body of research on the health problems reported by Gulf War veterans, little is known about their nature or causes. Government review panels have generally not found a single "Gulf War syndrome" is likely to explain all of the health problems reported by veterans. At the same time, research studies have consistently documented similar types of symptoms and illnesses in different groups of Gulf War veterans and have invariably found these problems to occur at higher rates in Gulf War veterans than in veterans serving elsewhere.”

“PGW veterans generally reported worse overall health and more symptoms that did non-PGW veterans. Forty-seven percent of all PGW veterans reported a lower level of health in 1998 than in 1990, compared with 19 percent of non-PGW veterans. Non-PGW veterans who received vaccines during the war were more likely to report a worsened health status since 1990 than were non-PGW veterans who did not receive vaccines, and the former a greater number of symptoms. A significantly higher proportion of PGW than non-PGW veterans reported being diagnosed or treated by a physician for 10 or 21 types of medical conditions since 1990. One condition, hypertension, was significantly higher among non-PGW veterans who had received vaccines than among those who had not (not shown; 11 percent vs. 5 percent, odds ratio (OR) = 2.99, 95 percent confidence interval (CI): 1.19, 7.54).”

“Table 4 shows the proportion of veterans who reported each of 37 symptoms as persistent problems in the year prior to the interview, in the absence of exclusionary conditions. Prevalence odds ratios for the association of symptoms with PGW deployment ranged from 1.95 to 6.63. Among non-PGW veterans, six symptoms, all in the pain and neurologic/cognitive/mood symptom categories, were endorsed by significantly more veterans who received vaccines during the war.”

“A certain level of morbidity was common to all veterans, independent of deployment status. The proportion of veterans reporting any exclusionary condition was similar among PGW and non-PGW veterans (7 percent vs. 6 percent, p = 0.41), as was the proportion reporting moderate or multiple symptoms in only one or two defined symptom groups (30 percent vs. 29 percent, p = 0.78). For symptomatology in three or more symptom groups, however, a significant difference by deployment status emerged. This pattern of morbidity - moderate or multiple symptoms in at least three of the six defined groups, in the absence of diagnosed exclusionary conditions - was associated with deployment to the Gulf War and defined "Gulf War illness" for purposes of the present study.”

“Overall, veterans who served primarily on board ship were least affected by Gulf War illness. The prevalence of Gulf War illness was somewhat higher among those serving in only Saudi Arabia or Bahrain and highest among those who entered Iraq and/or Kuwait. … The prevalence of Gulf War illness was lowest among veterans who departed the region prior to the war, higher for those present during the war who left the region by March, and highest for those departing in June or July of 1991. … Finally, among non-PGW veterans, Gulf War illness was significantly associated only with self-reported receipt of vaccines and being female (OR = 3.19, 95 percent CI: 1.23, 8.29). In multivariable modeling, there was no significant association of Gulf War illness with age, income level, education level, rank, component, or branch of service.”

"A report of veterans participating in the US Department of Veterans Affairs' registry suggested that veterans exhibit different illness profiles in connection with their location of service during the war. Iowa PGW veterans were found to have more health problems if they served in Iraq, Kuwait, or Saudi Arabia than if they served elsewhere in the region. In addition, Kansas Army veterans, enlisted personnel, and women were disproportionately affected by Gulf War illness, supporting previous indications that ground troops, enlisted personnel, and women may have more health problems than other PGW veterans.”

“A question of central importance to veterans, government officials, and healthcare providers is, "How many veterans are affected by Gulf War-related health problems?" The answer depends on how such problems are conceptualized and defined, but a surprisingly consistent estimate for the excess burden of symptom-defined illness in emerging from existing population-based studies. Among four Air National Guard units, 45 percent of PGW veterans and 15 percent of non-PGW veterans met criteria for Centers for Disease Control and Prevention-defined multisymptom illness, an excess of 30 percent associated with PGW deployment. Among servicemen from the United Kingdom, 62 percent of PGW and 36 percent of non-PGW veterans met similar criteria, an excess of 26 percent among PGW veterans. In the present study, 47 percent of Kansas PGW veterans met criteria for Centers for Disease Control and Prevention-defined multisymptom illness, compared with 20 percent of non-PGW veterans, an excess of 27 percent. In addition, 34 percent of PGW veterans met the more restrictive criteria for Kansas-defined Gulf War illness, compared with 8 percent of non-PGW veterans, an excess of 26 percent among PGW veterans. Thus, using two definitions in three distinct veteran populations, the excess burden of illness associated with deployment to the Gulf War has consistently been between 25 and 30 percent.”

“A revelation between vaccinations and illness has been observed among Gulf War veterans from the United Kingdom and Canada, and a mechanism for an association of illness with multiple vaccinations has been proposed. The prevalence of multisymptom illness was associated with reports by veterans from the United Kingdom of receiving vaccines against biologic warfare agents (anthrax, plague, pertussis adjuvant) and with receiving multiple vaccinations during deployment. A 1998 study of Canadian Gulf War veterans found a significant association between receiving "nonroutine immunization" (anthrax, plague) and several symptom-defined outcomes.”

“Patterns associated with where and when a veteran served suggest that multiple factors likely contributed to the excess morbidity experienced by Gulf War-era veterans. Fewer than 4 percent of era veterans with no identified PGW-related exposures experience symptoms of Gulf War illness. Between 9 and 12 percent of veterans likely to have had the lowest level of Gulf War-related exposures (non-PGW veterans who received vaccines during the war and veterans returning from the Gulf prior to Desert Storm) had symptoms of Gulf War illness. The highest rate of illness, independent of time period, occurred among veterans who were in Iraq and/or Kuwait suggesting that the factor or factors contributing to Gulf War illness were most concentrated in battlefield areas. Veterans in those areas might have encountered a greater number of concentration of potentially toxic exposures and experienced more battle-related trauma.”

“The observation that veterans in support areas who departed the region soon after the war were less likely to be ill than those who departed months later is particularly intriguing. It suggests an association of illness with toxic exposures, since battle-related stressors were reduced in later months. Potential risk factors that would have been more prevalent in support areas in later months might include exposure to contaminants from oil well fires, exposure to toxicants transferred via people or equipment from battlefield areas, and exposures associated with cleanup and refurbishing of equipment.”

“Over a decade after Iraq invaded Kuwait, the health problems reported by Gulf War veterans remain largely an unsolved mystery. These health problems appear to be complex, and their understanding will likely require an approach that considers "clusters of causes" and "combinations of effects". The basic epidemiologic approach taken here - describing excess health problems reported by veterans and their association with person, place, and time - provides answers to preliminary questions and suggests areas of follow-up that might produce useful insights regarding etiology and illness subtypes. Such investigations should include comparisons between veteran subgroups with higher and lower rates of illness and among those with different types of symptoms. In this way, as the results of this study and of other recent studies suggest, many of the outstanding questions regarding Gulf War-related health problems may be answerable.”


Steele, Lee, "Prevalence and Patterns of Gulf War Illness in Kansas Veterans: Association of Symptoms with Characteristics of Person, Place, and Time of Military Service", American Journal of Epidemiology, January 1, 2000, Vol. 152, Num. 0, pp. 992-1002

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