War-related stressors are associated with asthma risk among older Kuwaitis following the 1990 Iraqi invasion and occupation.
BACKGROUND
Contemporary warfare involving civilian populations is a growing public health concern. In addition to the psychological impact, war-related trauma may result in physiological alterations and even broader health effects. Associations were examined between war-related stressors and incident asthma in elderly Kuwaiti civilians following the Iraqi invasion.


METHODS
A random sample of all Kuwaiti nationals aged 50-69 years on the day prior to the invasion were identified. Among the 7873 meeting eligibility criteria, 5567 (71%) agreed to participate and 5028 completed the questionnaire (91% of those eligible). Of these, 3759 were in Kuwait during the invasion, of whom 2294 were alive at follow-up. After exclusions for prevalent asthma or missingness on covariates, 2066 were available for analysis. War-related experiences were summarised into a continuous score using Rasch modelling. Relative Cox proportional hazard rates (HR) were calculated for asthma adjusting for covariates.


RESULTS
Over 13 years of follow-up, physician-diagnosed asthma was reported by 66/996 (6.6%) men and 104/1070 (9.7%) women. In models adjusted for gender, socioeconomic status, smoking, BMI, and air pollution related to burning oil fires, those reporting highest stress exposure were more than twice as likely to report asthma (HR 2.3, 95% CI 1.3, 3.9) compared to civilians reporting no stressors. Experiences were more salient when anchored to fear for loss of life.


CONCLUSIONS
War-related trauma is associated with increased asthma risk in these elderly civilians. Although prior research has documented the significant and persistent psychological toll of war, these findings implicate even broader health effects.
Channing Laboratory 181 Longwood Avenue, Boston, MA 02115, USA. rosalind.wright@channing.harvard.edu
R J
RJ
Wright
M E
ME
Fay
S Franco
SF
Suglia
C J
CJ
Clark
J S
JS
Evans
D W
DW
Dockery
J
J
Behbehani
D000368:Aged; D001249:Asthma / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007493:Iraq / Q000453:epidemiology; D007730:Kuwait / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014857:Warfare