Complex Factors in the Etiology of Gulf War Illness: Wartime Exposures and Risk Factors in Veteran Subgroups.

Complex Factors in the Etiology of Gulf War Illness: Wartime Exposures and Risk Factors in Veteran Subgroups.

http://ehp03.niehs.nih.gov/article/info:doi/10.1289/ehp.1003399

Steele L, Sastre A, Gerkovich MM, Cook MR 2011. Environ Health Perspect :-. http://dx.doi.org/10.1289/ehp.1003399

Abstract

Background. At least one fourth of U.S. veterans who served in the 1990-1991 Gulf War are affected by the chronic symptomatic illness known as Gulf War illness (GWI). Clear determination of the causes of GWI has been hindered by many factors, including limitations in how epidemiologic studies have assessed the impact of the complex deployment environment on veterans' health.

Objective. To address GWI etiologic questions by evaluating the association of symptomatic illness with characteristics of veterans' deployment.

Methods. Veteran-reported wartime experiences were compared in a population-based sample of 304 Gulf War veterans: 144 cases who met pre-established criteria for GWI and 160 controls. Analyses considered veteran subgroups and confounding among deployment variables.

Results. Deployment experiences and the prevalence of GWI differed significantly by veterans' location in theater. Among personnel who were in Iraq or Kuwait, where all battles took place, GWI was most strongly associated with using pyridostigmine bromide pills (OR=3.5, CI=1.7-7.4) and being within one mile of an exploding SCUD missile (OR=3.1, CI=1.5-6.1). For veterans who remained in support areas, GWI was significantly associated only with personal pesticide use, with increased prevalence (OR=12.7, CI=2.6-61.5) in the relatively small subgroup who wore pesticide-treated uniforms, nearly all of whom also used skin pesticides. Combat service was not significantly associated with GWI.

Conclusions. Findings support a role for a limited number of wartime exposures in the etiology of GWI, which differed in importance with the deployment milieu in which veterans served.