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. 2001 May;58(5):299–306. doi: 10.1136/oem.58.5.299

Health and exposures of United Kingdom Gulf war veterans. Part II: The relation of health to exposure

N Cherry 1, F Creed 1, A Silman 1, G Dunn 1, D Baxter 1, J Smedley 1, S Taylor 1, G Macfarlane 1
PMCID: PMC1740138  PMID: 11303078

Abstract

OBJECTIVES—To investigate whether, in personnel who served with the United Kingdom forces in the Gulf war, self reported exposures were related to symptoms in a way that was consistent, specific, and credible.
METHODS—Responses to symptom and exposure questionnaires, completed 7 or more years after the war, were collected from 7971 subjects deployed in the Gulf, from two exposed cohorts, in a study with an overall response rate of 85.5%. Exposures were considered in three groups, those outside the control of the subjects, the use of prophylaxis, and indicators of susceptibility. Health indices derived from symptom questionnaires were related to reports of 14 exposures in these three groups in a series of multiple regression analyses to allow for confounding. The relation of exposure to complaints of widespread pain and to symptoms suggesting peripheral neuropathy were examined by logistic regression.
RESULTS—Consistent but weak correlations between exposures and with health effects were found in independent analyses of the two (main and validation) cohorts. Three exposures outside the control of the subject, the number of inoculations, the number of days handling pesticides, and the days exposed to smoke from oil fires, were consistently and independently related to severity. The number of inoculations was also associated with higher scores on a factor weighted on symptoms associated with skin and musculoskeletal complaints. The number of days handling pesticides related particularly to scores on a neurological factor and to symptoms consistent with toxic neuropathy.
CONCLUSION—The relations between exposures and ill health were generally weak. Consistent, specific, and credible relations, warranting further investigation, were found between health indices and two exposures, the reported number of inoculations and days handling pesticides.


Keywords: Gulf war; inoculations; pesticides

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Selected References

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  1. Abou-Donia M. B., Wilmarth K. R., Jensen K. F., Oehme F. W., Kurt T. L. Neurotoxicity resulting from coexposure to pyridostigmine bromide, deet, and permethrin: implications of Gulf War chemical exposures. J Toxicol Environ Health. 1996 May;48(1):35–56. doi: 10.1080/009841096161456. [DOI] [PubMed] [Google Scholar]
  2. Cherry N., Creed F., Silman A., Dunn G., Baxter D., Smedley J., Taylor S., Macfarlane G. J. Health and exposures of United Kingdom Gulf war veterans. Part I: The pattern and extent of ill health. Occup Environ Med. 2001 May;58(5):291–298. doi: 10.1136/oem.58.5.291. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Fukuda K., Nisenbaum R., Stewart G., Thompson W. W., Robin L., Washko R. M., Noah D. L., Barrett D. H., Randall B., Herwaldt B. L. Chronic multisymptom illness affecting Air Force veterans of the Gulf War. JAMA. 1998 Sep 16;280(11):981–988. doi: 10.1001/jama.280.11.981. [DOI] [PubMed] [Google Scholar]
  4. Furlong C. E. PON1 status and neurologic symptom complexes in Gulf War veterans. Genome Res. 2000 Feb;10(2):153–155. doi: 10.1101/gr.10.2.153. [DOI] [PubMed] [Google Scholar]
  5. Gray G. C., Hawksworth A. W., Smith T. C., Kang H. K., Knoke J. D., Gackstetter G. D. Gulf War Veterans' Health Registries. Who is most likely to seek evaluation? Am J Epidemiol. 1998 Aug 15;148(4):343–349. doi: 10.1093/oxfordjournals.aje.a009651. [DOI] [PubMed] [Google Scholar]
  6. Gray G. C., Kaiser K. S., Hawksworth A. W., Hall F. W., Barrett-Connor E. Increased postwar symptoms and psychological morbidity among U.S. Navy Gulf War veterans. Am J Trop Med Hyg. 1999 May;60(5):758–766. doi: 10.4269/ajtmh.1999.60.758. [DOI] [PubMed] [Google Scholar]
  7. HILL A. B. THE ENVIRONMENT AND DISEASE: ASSOCIATION OR CAUSATION? Proc R Soc Med. 1965 May;58:295–300. [PMC free article] [PubMed] [Google Scholar]
  8. Haley R. W., Billecke S., La Du B. N. Association of low PON1 type Q (type A) arylesterase activity with neurologic symptom complexes in Gulf War veterans. Toxicol Appl Pharmacol. 1999 Jun 15;157(3):227–233. doi: 10.1006/taap.1999.8703. [DOI] [PubMed] [Google Scholar]
  9. Haley R. W., Kurt T. L. Self-reported exposure to neurotoxic chemical combinations in the Gulf War. A cross-sectional epidemiologic study. JAMA. 1997 Jan 15;277(3):231–237. [PubMed] [Google Scholar]
  10. Ishøy T., Suadicani P., Guldager B., Appleyard M., Gyntelberg F. Risk factors for gastrointestinal symptoms. The Danish Gulf War Study. Dan Med Bull. 1999 Nov;46(5):420–423. [PubMed] [Google Scholar]
  11. Ishøy T., Suadicani P., Guldager B., Appleyard M., Hein H. O., Gyntelberg F. State of health after deployment in the Persian Gulf. The Danish Gulf War Study. Dan Med Bull. 1999 Nov;46(5):416–419. [PubMed] [Google Scholar]
  12. Joellenbeck L. M., Landrigan P. J., Larson E. L. Gulf War veterans' illnesses: a case study in causal inference. Environ Res. 1998 Nov;79(2):71–81. doi: 10.1006/enrs.1998.3873. [DOI] [PubMed] [Google Scholar]
  13. Kang H. K., Mahan C. M., Lee K. Y., Magee C. A., Murphy F. M. Illnesses among United States veterans of the Gulf War: a population-based survey of 30,000 veterans. J Occup Environ Med. 2000 May;42(5):491–501. doi: 10.1097/00043764-200005000-00006. [DOI] [PubMed] [Google Scholar]
  14. Korgeski G. P., Leon G. R. Correlates of self-reported and objectively determined exposure to Agent Orange. Am J Psychiatry. 1983 Nov;140(11):1443–1449. doi: 10.1176/ajp.140.11.1443. [DOI] [PubMed] [Google Scholar]
  15. Kroenke K., Koslowe P., Roy M. Symptoms in 18,495 Persian Gulf War veterans. Latency of onset and lack of association with self-reported exposures. J Occup Environ Med. 1998 Jun;40(6):520–528. doi: 10.1097/00043764-199806000-00004. [DOI] [PubMed] [Google Scholar]
  16. McCauley L. A., Joos S. K., Spencer P. S., Lasarev M., Shuell T. Strategies to assess validity of self-reported exposures during the Persian Gulf War. Portland Environmental Hazards Research Center. Environ Res. 1999 Oct;81(3):195–205. doi: 10.1006/enrs.1999.3977. [DOI] [PubMed] [Google Scholar]
  17. Petruccelli B. P., Goldenbaum M., Scott B., Lachiver R., Kanjarpane D., Elliott E., Francis M., McDiarmid M. A., Deeter D. Health effects of the 1991 Kuwait oil fires: a survey of US army troops. J Occup Environ Med. 1999 Jun;41(6):433–439. doi: 10.1097/00043764-199906000-00008. [DOI] [PubMed] [Google Scholar]
  18. Proctor S. P., Heeren T., White R. F., Wolfe J., Borgos M. S., Davis J. D., Pepper L., Clapp R., Sutker P. B., Vasterling J. J. Health status of Persian Gulf War veterans: self-reported symptoms, environmental exposures and the effect of stress. Int J Epidemiol. 1998 Dec;27(6):1000–1010. doi: 10.1093/ije/27.6.1000. [DOI] [PubMed] [Google Scholar]
  19. Rook G. A., Zumla A. Gulf War syndrome: is it due to a systemic shift in cytokine balance towards a Th2 profile? Lancet. 1997 Jun 21;349(9068):1831–1833. doi: 10.1016/S0140-6736(97)01164-1. [DOI] [PubMed] [Google Scholar]
  20. Shih D. M., Gu L., Xia Y. R., Navab M., Li W. F., Hama S., Castellani L. W., Furlong C. E., Costa L. G., Fogelman A. M. Mice lacking serum paraoxonase are susceptible to organophosphate toxicity and atherosclerosis. Nature. 1998 Jul 16;394(6690):284–287. doi: 10.1038/28406. [DOI] [PubMed] [Google Scholar]
  21. Soter N. A., Wasserman S. I., Austen K. F. Cold urticaria: release into the circulation of histamine and eosinophil chemotactic factor of anaphylaxis during cold challenge. N Engl J Med. 1976 Mar 25;294(13):687–690. doi: 10.1056/NEJM197603252941302. [DOI] [PubMed] [Google Scholar]
  22. Southwick S. M., Morgan C. A., 3rd, Nicolaou A. L., Charney D. S. Consistency of memory for combat-related traumatic events in veterans of Operation Desert Storm. Am J Psychiatry. 1997 Feb;154(2):173–177. doi: 10.1176/ajp.154.2.173. [DOI] [PubMed] [Google Scholar]
  23. Unwin C., Blatchley N., Coker W., Ferry S., Hotopf M., Hull L., Ismail K., Palmer I., David A., Wessely S. Health of UK servicemen who served in Persian Gulf War. Lancet. 1999 Jan 16;353(9148):169–178. doi: 10.1016/S0140-6736(98)11338-7. [DOI] [PubMed] [Google Scholar]

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