title: The postwar hospitalization experience of Gulf War Veterans possibly exposed to chemical munitions destruction at Khamisiyah, Iraq.
abstract: Using Department of Defense hospital data, the authors examined the postwar hospitalization experience from March 1991 through September 1995 of US Gulf War veterans who were near Khamisiyah, Iraq, during nerve agent munition destruction in March 1991. Multiple sources of meteorologic, munition, and toxicology data were used to circumscribe geographic areas of low level, vaporized nerve agent for 4 days after the destruction. Plume estimates were overlaid on military unit positions, and exposure was estimated for the 349,291 US Army Gulf War veterans. Exposure was classified as not exposed (n = 224,804), uncertain low dose exposure (n = 75,717), and specific estimated subclinical exposure (n = 48,770) categorized into three groups for dose-response evaluation. Using Cox proportional hazard modeling, the authors compared the postwar experiences of these exposure groups for hospitalization due to any cause, for diagnoses in 15 unique categories, and for specific diagnoses an expert panel proposed as most likely to reflect latent disease from such subclinical exposure. There was little evidence that veterans possibly exposed to the nerve agent plumes experienced unusual postwar morbidity. While there were several differences in hospitalization risk, none of the models suggested a dose-response relation or neurologic sequelae. These data, having a number of limitations, do not support the hypothesis that Gulf War veterans are suffering postwar morbidity from subclinical nerve agent exposure.
authors.affiliation: Department of Health Sciences and Epidemiology, Naval Health Research Center, San Diego, CA 92186-5122, USA.
authors.forename: G C
authors.initials: GC
authors.lastname: Gray
authors.forename: T C
authors.initials: TC
authors.lastname: Smith
authors.forename: J D
authors.initials: JD
authors.lastname: Knoke
authors.forename: J M
authors.initials: JM
authors.lastname: Heller
mesh_terms: D000293:Adolescent; D000328:Adult; D002618:Chemical Warfare; D004781:Environmental Exposure; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007493:Iraq; D008297:Male; D018923:Persian Gulf Syndrome / Q000453:epidemiology*; D016016:Proportional Hazards Models; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data