Association of Gulf War Illness-Related Symptoms with Military Exposures among 1990-1991 Gulf War Veterans Evaluated at the War-Related Illness and Injury Study Center (WRIISC).

Sarah T Ahmed,Donna L White,Kellie J Sims,Drew A Helmer,Elizabeth R Hauser,Alice Nono Djotsa,Shree Nadkarni,Peter Richardson,Jose-Miguel Yamal,Helena Chandler,Lea Steele,Theresa H Nguyen,Sandhya Bandi,Elizabeth J Gifford,Mazhgan Rowneki,Jacqueline Vahey,Stephen H Boyle

doi:10.3390/brainsci12030321

Abstract

Veterans with difficult-to-diagnose conditions who receive care in the Department of Veterans Affairs (VA) healthcare system can be referred for evaluation at one of three specialty VA War-Related Illness and Injury Study Centers (WRIISC). Veterans of the 1990–1991 Gulf War have long experienced excess rates of chronic symptoms associated with the condition known as Gulf War Illness (GWI), with hundreds evaluated at the WRIISC. Here we provide the first report from a cohort of 608 Gulf War Veterans seen at the WRIISC who completed questionnaires on chronic symptoms (>6 months) consistent with GWI as well as prominent exposures during Gulf War deployment. These included veterans’ reports of hearing chemical alarms/donning Military-Ordered Protective Posture Level 4 (MOPP4) gear, pesticide use, and use of pyridostigmine bromide (PB) pills as prophylaxis against the effects of nerve agents. Overall, veterans in the cohort were highly symptomatic and reported a high degree of exposures. In multivariable models, these exposures were significantly associated with moderate-to-severe chronic symptoms in neurocognitive/mood, fatigue/sleep, and pain domains. Specifically, exposure to pesticides was associated with problems with concentration and memory, problems sleeping, unrefreshing sleep, and joint pain. Use of MOPP4 was associated with light sensitivity and unrefreshing sleep and use of PB was associated with depression. We also evaluated the association of exposures with symptom summary scores based on veterans’ severity of symptoms in four domains and overall. In multivariable modeling, the pain symptom severity score was significantly associated with pesticide use (Odds ratio (OR): 4.13, 95% confidence intervals (CI): 1.78–9.57) and taking PB pills (OR: 2.28, 95% CI: 1.02–5.09), and overall symptom severity was significantly associated with use of PB pills (OR: 2.41, 95% CI: 1.01–5.75). Conclusion: Decades after deployment, Gulf War veterans referred to a VA tertiary evaluation center report a high burden of chronic symptoms, many of which were associated with reported neurotoxicant exposures during the war.

Highlights

30–44% of the nearly 700,000 U.S military personnel who served in the 1990–1991 Gulf War developed a complex of chronic, poorly understood symptoms in the wake of their deployment
The study cohort consisted of 608 Gulf War veterans seen at the War-Related Illness and Injury Study Centers (WRIISC) for evaluation of difficult to diagnose conditions
Compared to the overall population of veterans who served in the 1990–1991 Gulf War, the WRIISC cohort included a higher proportion of Army veterans (58% of WRIISC veterans vs. 50% overall) and a lower proportion of Navy veterans (12% WRIISC vs. 23% overall) [20]

Summary

Introduction

30–44% of the nearly 700,000 U.S military personnel who served in the 1990–1991 Gulf War developed a complex of chronic, poorly understood symptoms in the wake of their deployment. This condition is commonly known as Gulf War Illness (GWI) and is characterized by persistent fatigue, pain, neurocognitive, gastrointestinal, respiratory, and dermatological symptoms that are not explained by familiar medical or psychiatric diagnoses [1–3]. Studies have identified a range of neurological, immune, and other biological measures that significantly distinguish veterans with GWI from healthy veterans [1], no diagnostic test has yet been established [4]. GWI is identified primarily based on veterans’ symptoms, many of which have persisted for decades [5,6].

Methods

Results

Conclusion