Neurological mortality among U.S. veterans of the Persian Gulf War: 13‐year follow‐up

Barth, Shannon K.; Kang, Han K.; Bullman, Tim A.; Wallin, Mitchell T.

doi:10.1002/ajim.20718

Cited by 62 publications

(61 citation statements)

References 47 publications

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“…Our results are consistent with two prior studies that have shown a nonsignificant risk of MS in deployed GW1 veterans based on mortality data [12] and a postal survey performed with Australian GW veterans [14]. However, the methodology and relatively small numbers utilized in these reports made them suboptimal.…”

Section: Discussionsupporting

confidence: 82%

“…The cause of MS remains elusive despite decades of research, but environmental exposures are hypothesized to be a critical factor in initiating the disease [11]. We examined the mortality from MS and other neurologic conditions in deployed GW1 veterans between 1991 and 2004 [12]. The adjusted mortality rate ratio for MS for deployed GW1 veterans compared to nondeployed veterans was nonsignificant at 0.61 (95% confidence interval, CI: 0.23-1.63).…”

Section: Introductionmentioning

confidence: 99%

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Multiple Sclerosis in Gulf War Era Veterans. 2. Military Deployment and Risk of Multiple Sclerosis in the First Gulf War

et al. 2014

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Background: Concern has been raised that US veterans of the 1990-1991 Gulf War (GW1) may be at increased risk to develop neurologic disease. Methods: An incident cohort of multiple sclerosis (MS) and other demyelinating disease (ODD) was assembled from the US military comprising the Gulf War era (1990-2007). Cases of MS and ODD meeting standard diagnostic criteria were matched to a database of all active duty personnel from the Department of Defense. Relative risk (RR) estimates for MS and all demyelinating disease based on onset, deployment status, and exposures were calculated. Results: For GW1, a total of 1,841 incident cases of definite MS and ODD were identified, with 387 among 696,118 deployed and 1,454 among 1,786,215 nondeployed personnel. The RR for MS alone among those deployed compared to those nondeployed was 0.69 (confidence interval, CI: 0.61-0.78), with 0.72 (CI: 0.62-0.83) in men and 0.96 (CI: 0.75-1.22) in women. Deployment was also nonsignificant or protective as an MS risk factor across racial groups, all age groups, and each military service. RRs for MS by service were: Air Force 0.71 (CI: 0.53-0.96), Army 0.80 (CI: 0.67-0.96), Marines 0.96 (CI: 0.63-1.47), and Navy 0.56 (CI: 0.43-0.74). Conclusion: Military deployment to GW1 was not a risk factor for developing MS.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Multiple Sclerosis in Gulf War Era Veterans. 2. Military Deployment and Risk of Multiple Sclerosis in the First Gulf War

et al. 2014

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“…In this study the associations of the case definitions of Gulf War illness with the binary plume indicator and the number of days of exposure were so weak that further subclassification is unlikely to bring out any strong association. It is possible, however, that other conditions with symptoms unlike Gulf War illness, such as brain cancer [24,25], might have been caused by exposure to fallout from the Khamisiyah demolition.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas this dose-related association does not remain after excluding the unexposed category [23], given the large amount of illness misclassification in the CDC CMI definition and the large potential for misclassification of exposure in the computer-generated Khamisiyah plume model [11], one wonders if this small signal might indicate a risk association with some condition other than Gulf War illness hidden in the region of the CDC CMI definition not overlapping the Factor definition. As one possible example, the risk of glial brain cancer has been found in 2 large epidemiologic studies to be significantly associated with the number of days exposed to the 2000 Khamisiyah plume [24,25]. …”

Section: Discussionmentioning

confidence: 99%

Epidemiologic Evidence of Health Effects from Long-Distance Transit of Chemical Weapons Fallout from Bombing Early in the 1991 Persian Gulf War

Haley

Tuite²

2012

Neuroepidemiology

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Background: Military intelligence data published in a companion paper explain how chemical fallout from US and Coalition bombing of Iraqi chemical weapons facilities early in the air campaign transited long distance, triggering nerve agent alarms and exposing US troops. We report the findings of a population-based survey designed to test competing hypotheses on the impact on chronic Gulf War illness of nerve agent from early-war bombing versus post-war demolition. Methods: The US Military Health Survey performed computer-assisted telephone interviews of a stratified random sample of Gulf War-era veterans (n = 8,020). Early-war exposure was measured by having heard nerve agent alarms and post-war exposure, by the computer-generated plume from the Khamisiyah demolition. Gulf War illness was measured by two widely published case definitions. Results: The OR (95% CI) for the association of alarms with the Factor case definition was 4.13 (95% CI 2.51–6.80) compared with 1.21 (95% CI 0.86–1.69) for the Khamisiyah plume. There was a dose-related trend for the number of alarms (p_trend < 0.001) but not for the number of days in the Khamisiyah plume (p_trend = 0.17). Conclusions: Exposure to low-level sarin nerve agent in fallout from bombing early in the air campaign contributed more to chronic illness than post-war demolition.

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“…We reported 23 ALS deaths, a difference of 11 ALS deaths [Barth et al, 2009]. They reported 48 ALS cases among individuals self-identified as Gulf War veterans.…”

mentioning

confidence: 92%

Response to the letter to the editor on “Neurological mortality among Gulf War veterans”

Barth¹,

Kang²,

Bullman³

et al. 2010

American J Industrial Med

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Neurological mortality among U.S. veterans of the Persian Gulf War: 13‐year follow‐up

Abstract: The risk of death due to ALS, MS, Parkinson's disease, and brain cancer was not associated with 1991 GW service in general. However, GW veterans potentially exposed to nerve agents at Khamisiyah, Iraq, and to oil well fire smoke had an increased risk of mortality due to brain cancer.

Cited by 62 publications

References 47 publications

Multiple Sclerosis in Gulf War Era Veterans. 2. Military Deployment and Risk of Multiple Sclerosis in the First Gulf War

Multiple Sclerosis in Gulf War Era Veterans. 2. Military Deployment and Risk of Multiple Sclerosis in the First Gulf War

Epidemiologic Evidence of Health Effects from Long-Distance Transit of Chemical Weapons Fallout from Bombing Early in the 1991 Persian Gulf War

Response to the letter to the editor on “Neurological mortality among Gulf War veterans”

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