Compare the Medical Conditions of Gulf War Veterans to Non-Deployed Veterans
Compare the Medical Conditions of Gulf War Veterans to Non-Deployed Veterans
Primary Hypothesis: Gulf War veterans will have an equal prevalence or mean level of the
 following medical and psychological conditions frequently reported in the literature compared
 to a control group of nondeployed veterans: (1) chronic fatigue syndrome, (2) fibromyalgia,
 (3) post-traumatic stress disorder, (4) neurologic abnormalities, including peripheral
 neuropathy and cognitive dysfunction, and (5) general health status.
* 1,000 Gulf War veterans, spouses, & children and 1,000 non-deployed Gulf War era veterans,
 spouses, & children.

 Primary Hypothesis: Gulf War veterans will have an equal prevalence or mean level of the
 following medical and psychological conditions frequently reported in the literature compared
 to a control group of nondeployed veterans: (1) chronic fatigue syndrome, (2) fibromyalgia,
 (3) post-traumatic stress disorder, (4) neurologic abnormalities, including peripheral
 neuropathy and cognitive dysfunction, and (5) general health status.

 Secondary Hypotheses: (1) Medical conditions that were reported as more frequent among Gulf
 War veterans compared to nondeployed veterans in the self-reported data in Phase I will be of
 equal prevalence in the two groups upon objective clinical examination. These include
 arthritis, dermatitis, hypertension, bronchitis, and asthma. (2) The prevalence of the above
 medical conditions in the primary hypotheses and secondary hypothesis (#1) will be equal
 between the spouses of Gulf War veterans and those of nondeployed veterans. (3) The
 prevalence of major birth defects found on a pediatric physical examination of veterans'
 biologic children conceived after the war to Gulf War veterans and nondeployed veterans will
 be equal; the prevalence of medical conditions in children living in the veterans' household,
 whether conceived before or after the war, for Gulf War veterans and nondeployed veteran will
 be equal.

 Intervention: This is an observational study.

 Primary outcomes variables: chronic fatigue syndrome; post-traumatic stress disorder,
 fibromyalgia; peripheral neuropathy; cognitive dysfunction; and general health status:
 physical component and mental component.

 Study Abstract: In response to a legislative mandate, the VA initiated a survey entitled A
 National Health Survey of Persian Gulf Veterans and Their Families. The survey was designed
 as a retrospective cohort study in which the health of a population-based sample of 15,000
 troops deployed into the Persian Gulf area was compared to those of 15,000 troops not
 deployed in the Persian Gulf area. The survey was to be conducted in three phases. In Phase I
 of the study, a structured health questionnaire was mailed to each of the 30,000 Persian Gulf
 War-era veterans who were sampled for the survey. Up to four follow-up mailings were sent to
 non-respondents to increase the response rate in a six-month period. In Phase II, telephone
 interviews of a sample of 8,000 non-respondents and a review of selected medical records for
 a sample of 4,000 veteran respondents were conducted. Through additional telephone interviews
 with non-respondents, the potential for non-participant bias was evaluated. The medical
 records review helped in assessing validity of selected self-reported health data (clinic
 visit, hospitalization, pregnancy outcomes, birth defects among children, infant deaths,
 etc.).

 The present protocol represents Phase III of the study--clinical examinations of a sample of
 1,000 Gulf War (GW) veterans and their spouses and children and 1,000 Gulf War era
 nondeployed veterans and their spouses and children. Results from Phase I indicated that the
 prevalence of several self-reported health conditions are elevated in the GW veterans
 compared to the control group. The overall purpose of the Phase III study is to corroborate
 these findings through more objective clinical examination.

 A sample from a pool of Phase I and Phase II Persian Gulf War veterans and Persian Gulf era
 nondeployed veterans were generated. Dr. Kang's office provided the 16 participating medical
 centers with names and phone numbers of veterans to be contacted. Each medical center
 examined an average of 125 veterans, 95 spouses, and 123 children over a period of 30 months.
 The VA medical centers were strategically selected so that there was a VA medical center
 within driving distance of the majority of the families sampled. Veterans were contacted
 first by letter and then by telephone through the site closest to their home and invited to
 participate in the study. Exams were scheduled for the veteran and spouse/children if they
 were participating. Data from these exams were sent to the Hines CSPCC for cleaning and
 analysis. Travel arrangements and expenses were provided for the participants and they were
 reimbursed for their time.

 Characteristics of Participants: Mean age for deployed veterans who were examined was 38.9
 yrs. compared with 40.7 yrs. for non-deployed veterans who were examined (p<.0001). Mean
 income was $46,800 for deployed and $52,000 for non-deployed participants (p=.003).
 Non-deployed participants were more likely to be white (81.0% vs. 76.4%, p=.03), to be
 married (72.3% vs. 67.4%, p=.02), and to continue education past high school (42% vs. 32.5%,
 p<.0001). Results for Veterans: Both the physical and mental component scores derived from
 the SF-36 were significantly lower among deployed veterans who were examined. For the
 physical component score, the mean for the deployed group was 48.2 (s.d. 9.8) compared with
 50.8 (s.d. 8.3) for the non-deployed group, p<.0001. The mental component score averaged 49.6
 (s.d. 10.2) for the deployed group and 53.7 (s.d. 7.9) for the non-deployed group, p<.0001.
 There was a weak trend for a higher prevalence of fibromyalgia in the deployed group (3.1%)
 than in the non-deployed group (1.9%), [odds ratio 1.64, 95% confidence interval (.94, 2.87),
 p=.09]. There was a higher prevalence of chronic fatigue syndrome among deployed (1.6%) than
 non-deployed (0.4%), [odds ratio 4.58, 95% confidence interval (1.53, 13.64), p=.003]. Among
 the seven cognitive dysfunction factors, there was a trend towards a higher prevalence of
 impaired attention/working memory among deployed (6.6%) than non-deployed (4.2%), [odds ratio
 1.60, 95% confidence interval (1.10, 2.35), p=.02]. PTSD after the Gulf War was more
 prevalent among deployed (10.1%) than non-deployed participants (3.2%), [odds ratio 3.41, 95%
 confidence interval (2.30, 5.05), p<.0001]. No differences were found for peripheral
 neuropathy and 6 of the 7 factors defined to assess cognitive dysfunction. Among secondary
 outcome measures, several categories of skin conditions were found to be more prevalent among
 deployed veterans. Results for Spouses: The mean score for the mental component scale was
 lower in the spouses of deployed participants (50.3 (s.d. 9.9)) than in the spouses of
 non-deployed participants (52.6 (s.d. 8.6), p<.0001). No other outcome measures for spouses
 were found to be related to deployment status of the veteran. Birth Defects: No statistically
 significant relationship between deployment status and prevalence of birth defects among
 first live born offspring born after the Gulf War was found. Summary: Although participation
 rates were lower than anticipated, we found little evidence of participation bias. Veterans
 deployed to the Gulf War have higher rates of chronic fatigue syndrome and post-Gulf War
 onset PTSD, and poorer health-related quality of life. Attention/working memory deficits and
 fibromyalgia may also be related to deployment to the Gulf War. Additional Comments:
 Additional analytic work remains: (a) the results have not been adjusted for covariates such
 as age, (b) certain subgroups were oversampled and the results are not adjusted for the
 study's original sampling methodology, (c) analysis of subgroups that are purported to be at
 increased risk of health impacts due to their type of service in the Gulf War has not been
 done.
Gulf War (GW) veterans and their spouses and children and Gulf War era nondeployed veterans
 and their spouses and children.