title: The long-term hospitalization experience following military service in the 1991 Gulf War among veterans remaining on active duty, 1994-2004.
abstract: BACKGROUND
  Despite more than a decade of extensive, international efforts to characterize and understand the increased symptom and illness-reporting among veterans of the 1991 Gulf War, concern over possible long-term health effects related to this deployment continue. The purpose of this study was to describe the long-term hospitalization experience of the subset of U.S. Gulf War veterans still on active duty between 1994 and 2004.
  
  
  METHODS
  Gulf War veterans on active duty rosters as of October 1, 1994, were identified (n = 211 642) and compared with veterans who had separated from military service and then assessed for attrition at three-year intervals during a 10-year follow-up period, examining demographic and military service characteristics, Gulf War exposure variables, and hospitalization data. Cox proportional hazard modeling was used to evaluate independent predictors of all-cause hospitalization among those still on active duty and to estimate cumulative probability of hospitalization, 1994-2004, by service branch.
  
  
  RESULTS
  Members of our 1994 active duty cohort were more likely to be officers, somewhat older, and married compared with those who had separated from the military after serving in the 1991 Gulf War. Selected war-related exposures or experiences did not appear to influence separation with the exception of in-theater presence during the brief ground combat phase. Overall the top three diagnostic categories for hospitalizations were musculo-skeletal, injury and poisoning, and digestive disorders. Diseases of the circulatory system and symptoms, signs, and ill-defined conditions increased proportionately over time. In-theater hospitalization was the only significant independent predictor of long-term hospitalization risk among selected war-related exposures or experiences examined. The cumulative probability of hospitalization was highest for Army and lowest for Marines.
  
  
  CONCLUSIONS
  Our results were generally consistent with a previous hospitalization study of US Gulf War veterans for the period August 1991 to July 1999. Although lack of a comparison group for our study limits interpretation of overall findings, intra-cohort analyses showed no significant associations between long-term hospitalization and war-related exposures or experiences, with the exception of in-theater hospitalization, within our active duty subset of 1991 Gulf War veterans.
authors.affiliation: Department of Preventive Medicine and Biometrics, Uniformed Service University of the Health Sciences, Bethesda, Maryland, USA. thooper@usuhs.mil
authors.forename: Tomoko I
authors.initials: TI
authors.lastname: Hooper
authors.forename: Samar F
authors.initials: SF
authors.lastname: Debakey
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Nagaraj
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Bellis
authors.forename: Besa
authors.initials: B
authors.lastname: Smith
authors.forename: Tyler C
authors.initials: TC
authors.lastname: Smith
authors.forename: Gary D
authors.initials: GD
authors.lastname: Gackstetter
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003953:Diagnosis-Related Groups; D005260:Female; D005500:Follow-Up Studies; D047830:Gulf War; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*