title: Assessing the potential health impact of the 1991 Gulf War on Saudi Arabian National Guard soldiers.
abstract: BACKGROUND
  There has been considerable publicity that the 1991 Gulf War may have caused a wide array of health problems in military personnel. Although post-war health outcomes have been studied in US, British, Canadian, Danish, and other deployed troops, this issue has not been previously evaluated in coalition forces native to the Gulf region.
  
  
  METHODS
  A collaborative team of US and Saudi health researchers was assembled, data sources evaluated, and hospitalizations among Saudi Arabian National Guard (SANG) soldiers between 1991 and 1999 analysed. Multivariate modelling was used to evaluate differences between 8342 soldiers exposed to combat at Al Khafji and a comparison group of 7270 soldiers in the Riyadh area.
  
  
  RESULTS
  Among 15 612 SANG soldiers, we identified 148 with at least one hospitalization over the 9 years following the war. The adjusted rate of hospitalization was higher in the combat-exposed group (risk ratio (RR) = 1.80, 95% confidence interval (CI) 1.25-2.59). No unusual patterns of diagnoses were found and, because the overall number of hospitalizations was low, the absolute difference in risk was found to be very small.
  
  
  CONCLUSIONS
  This is the first reported epidemiological investigation of post-war hospitalizations among coalition forces native to the Gulf region that participated in the 1991 Gulf War. A very small increase in hospitalizations was identified in SANG soldiers exposed to combat at Al Khafji. However, because of data limitations, the clinical relevance of this finding should be interpreted with caution. Future collaborative studies to better understand the health effects of deployment should be encouraged.
authors.affiliation: Department of Preventive Medicine and Biometrics, Room A1044, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA. ggackstetter@usuhs.mil
authors.forename: Gary D
authors.initials: GD
authors.lastname: Gackstetter
authors.forename: Tomoko I
authors.initials: TI
authors.lastname: Hooper
authors.forename: Mohammed S
authors.initials: MS
authors.lastname: Al Qahtani
authors.forename: Tyler C
authors.initials: TC
authors.lastname: Smith
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
authors.forename: Karen M
authors.initials: KM
authors.lastname: Schlangen
authors.forename: David F
authors.initials: DF
authors.lastname: Cruess
authors.forename: Drue H
authors.initials: DH
authors.lastname: Barrett
authors.forename: Margaret A K
authors.initials: MA
authors.lastname: Ryan
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D047830:Gulf War; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009784:Occupational Diseases / Q000453:epidemiology*; D016273:Occupational Exposure / Q000009:adverse effects; D018923:Persian Gulf Syndrome / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012529:Saudi Arabia / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data