Healthcare utilization and mortality among veterans of the Gulf War

The authors conducted an extensive search for published works concerning healthcare utilization and mortality among Gulf War veterans of the Coalition forces who served during the1990–1991 Gulf War. Reports concerning the health experience of US, UK, Canadian, Saudi and Australian veterans were reviewed. This report summarizes 15 years of observations and research in four categories: Gulf War veteran healthcare registry studies, hospitalization studies, outpatient studies and mortality studies. A total of 149 728 (19.8%) of 756 373 US, UK, Canadian and Australian Gulf War veterans received health registry evaluations revealing a vast number of symptoms and clinical conditions but no suggestion that a new unique illness was associated with service during the Gulf War. Additionally, no Gulf War exposure was uniquely implicated as a cause for post-war morbidity. Numerous large, controlled studies of US Gulf War veterans' hospitalizations, often involving more than a million veterans, have been conducted. They revealed an increased post-war risk for mental health diagnoses, multi-symptom conditions and musculoskeletal disorders. Again, these data failed to demonstrate that Gulf War veterans suffered from a unique Gulf War-related illness. The sparsely available ambulatory care reports documented that respiratory and gastrointestinal complaints were quite common during deployment. Using perhaps the most reliable data, controlled mortality studies have revealed that Gulf War veterans were at increased risk of injuries, especially those due to vehicular accidents. In general, healthcare utilization data are now exhausted. These findings have now been incorporated into preventive measures in support of current military forces. With a few diagnostic exceptions such as amyotrophic lateral sclerosis, mental disorders and cancer, it now seems time to cease examining Gulf War veteran morbidity and to direct future research efforts to preventing illness among current and future military personnel.

Download Full-text

Neurological disorders in Gulf War veterans

Philosophical Transactions of the Royal Society B Biological Sciences ◽

10.1098/rstb.2006.1820 ◽

2006 ◽

Vol 361 (1468) ◽

pp. 605-618 ◽

Cited By ~ 10

Author(s):

Michael R Rose ◽

Kelley Ann Brix

Keyword(s):

Neurological Disorders ◽

Military Service ◽

Large Population ◽

Great Majority ◽

Epidemiological Studies ◽

Gulf War ◽

Neurological Function ◽

War Veterans ◽

Gulf War Veterans ◽

Increased Risk

We present a review of neurological function in Gulf War veterans (GWV). Twenty-two studies were reviewed, including large hospitalization and registry studies, large population-based epidemiological studies, investigations of a single military unit, small uncontrolled studies of ill veterans and small controlled studies of veterans. In nearly all studies, neurological function was normal in most GWVs, except for a small proportion who were diagnosed with compression neuropathies (carpal tunnel syndrome or ulnar neuropathy). In the great majority of controlled studies, there were no differences in the rates of neurological abnormalities in GWVs and controls. In a national US study, the incidence of amyotrophic lateral sclerosis (ALS) seems to be significantly increased in GWVs, compared to the rate in controls. However, it is possible that military service, in general, might be associated with an increased risk of ALS, rather than Gulf War service in particular. Taken together, the conclusion is that if a neurological examination in a GWV is within normal limits, then extensive neurological testing is unlikely to diagnose occult neurological disorders.

Download Full-text

Changes in Health Status in the Ft. Devens Gulf War Veterans Cohort: 1997-2017

Neuroscience Insights ◽

10.1177/2633105520952675 ◽

2020 ◽

Vol 15 ◽

pp. 263310552095267

Author(s):

Clara G Zundel ◽

Timothy Heeren ◽

Claudia M Grasso ◽

Avron Spiro ◽

Susan P Proctor ◽

...

Keyword(s):

Gulf War ◽

Medical Conditions ◽

Health Issues ◽

War Veterans ◽

Cross Sectional ◽

Gulf War Veterans ◽

Multivariable Regression ◽

Cerebrovascular Risk ◽

Post War

Gulf War veterans (GWVs) were exposed to numerous neurotoxicants during deployment. Upon returning home, many reported a multitude of symptoms including fatigue, pain, gastrointestinal and respiratory issues, and neurological, cognitive, and mood complaints, collectively termed “Gulf War Illness (GWI).” Now, nearly 30 years post-war, many GWVs continue to suffer from these symptoms, in addition to health concerns associated with normal aging. While most research on GWVs has been cross-sectional, it is important to evaluate the progression and onset of new GWI symptoms longitudinally. The current study investigated the health of GWVs 25+ years after the war by resurveying the Ft. Devens Cohort and comparing their current health to their health reported 15 to 20 years earlier. The sample consists of 317 GWVs (~54 years old at the latest survey, 38 women) who responded to both surveys (1997-1998 and 2013-2017). Multivariable regression analyses were used to assess changes in GWI symptomatology and prevalence of medical conditions. The rates of 12 of 25 health symptoms increased significantly from the prior 1997-1998 survey. Anxiety, numbness in extremities, depressed mood, and joint pain had the greatest increase in endorsement. The rates of 7 of 16 medical conditions increased significantly from the prior 1997-1998 survey. High blood pressure, diabetes, and cancer had the greatest increase in prevalence. In summary, this study demonstrates that both symptoms and physician-diagnosed medical conditions associated with GW deployment/exposure increased in prevalence. For GWVs, focus by providers on the treatment of cognitive and mental health issues as well as cardiovascular and cerebrovascular risk factors is warranted. Targeting symptom alleviation would help improve the quality of life in these veterans until treatments addressing the entire illness become available.

Download Full-text

War-related psychological stressors and risk of psychological disorders in Australian veterans of the 1991 Gulf War

The British Journal of Psychiatry ◽

10.1192/bjp.185.2.116 ◽

2004 ◽

Vol 185 (2) ◽

pp. 116-126 ◽

Cited By ~ 80

Author(s):

Jillian F. Ikin ◽

Malcolm R. Sim ◽

Mark C. Creamer ◽

Andrew B. Forbes ◽

Dean P. McKenzie ◽

...

Keyword(s):

Comparison Group ◽

Psychological Disorders ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Gulf War ◽

Post Traumatic Stress ◽

War Veterans ◽

Gulf War Veterans ◽

Psychological Stressors ◽

Increased Risk

BackgroundQuestions remain about the long-term health impacts of the 1991 Gulf War on its veterans.AimsTo measure psychological disorders in Australian Gulf War veterans and a military comparison group and to explore any association with exposure to Gulf War-related psychological stressors.MethodPrevalences of DSM–IV psychological disorders were measured using the Composite International Diagnostic Interview. Gulf War-related psychological stressors were measured using a service experience questionnaire.ResultsA total of 31% of male Gulf War veterans and 21% of the comparison group met criteria for a DSM–IVdisorder first present in the post-Gulf War period. The veterans were at greater risk of developing post-Gulf War anxiety disorders including post-traumatic stress disorder, affective disorders and substance use disorders. The prevalence of such disorders remained elevated a decade after deployment. The findings can be explained partly as a ‘war-deployment effect‘. There was a strong dose–response relationship between psychological disorders and number of reported Gulf War-related psychological stressors.ConclusionsService in the 1991 Gulf War is associated with increased risk of psychological disorders and these are related to stressful experiences.

Download Full-text