CONTACT: DAVE PEDERSEN
Iowa City IA 52242
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Release:May 8, 2002
Study identifies factors associated with poorer health status among Gulf
Military veterans who were deployed to the Persian Gulf in 1990-1991 reported
poorer health status than comparable veterans in the armed forces at that
time but who were not deployed to the Gulf, according to a study by University
of Iowa and Department of Veterans Affairs (VA) researchers and colleagues.
The report, published in the May 15 issue of the American Journal of Epidemiology,
also identifies several important other factors associated with worse health-related
quality of life among those deployed to the Gulf. The findings are based on
an analysis of survey responses and health outcome scores from nearly 3,700
Gulf War-era veterans from Iowa (both deployed and non-deployed military personnel)
obtained five years after the end of the Gulf War.
"Although it's been more than 10 years since the end of the Gulf War,
questions remain regarding the health of these veterans," said Bradley
Doebbeling, M.D., UI professor of internal medicine and epidemiology, researcher,
staff physician and co-director of the Research Enhancement Award Program
(REAP) in Health Services Research at the VA Medical Center in Iowa City,
and the paper's senior author. "This study is one of the first to look
at these veterans' overall health status how they're functioning
and what risk factors may predispose to decreased functioning."
Interviews were conducted with the veterans in 1995 and 1996 to assess a
broad range of health concerns. Participants were asked about multiple potential
risk factors for poorer health, such as personal and environmental factors,
pre-Gulf War deployment medical conditions, and mental health history. Veterans
were also asked about military preparedness, questions related to training,
physical fitness and height/weight requirements that reflected how prepared
participants were to do their jobs at the time of the Persian Gulf conflict.
The researchers used the Medical Outcome Study Short Form 36 (SF-36), an
established general-health questionnaire, to assess the veterans' health-related
quality of life. From this, researchers determined physical component summary
(PCS) and mental component summary (MCS) scores.
The results showed that, five years after the Gulf War, veterans deployed
to the Persian Gulf reported poorer health status and health-related quality
of life than the veterans who were not deployed to the region. The greatest
impact was on general health and vitality, although a wide range of health
domains from the survey was affected.
Cigarette smoking, military preparedness, pre-deployment medical health conditions,
marital status, race and service branch all were identified as risk factors
that predispose to poorer post-deployment health-related quality of life.
After adjusting for multiple risk factors, the research team found that deployment
to the Persian Gulf was associated with slightly poorer overall physical and
"Smoking and military preparedness are modifiable risk factors, which
is important in that these risks can be mitigated," said Margaret Voelker,
Ph.D., UI assistant research scientist in epidemiology and lead author of
the study. "The other factors identified help advance our understanding
about the factors influencing the health of military populations, who may
be at greatest risk of having a worse health outcome as a result of military
deployment and what might be done to prevent this in the future."
The study authors noted that while the non-deployed Persian Gulf veterans'
SF-36 scores were the same or better than standard scores for the general
U.S. population, deployed veterans' scores were slightly worse for most health
domains, specifically those related to physical health. These results demonstrate
the importance of studying a broad, representative group of military personnel
(who are typically healthier than the general population) as well as including
appropriate comparison groups. The authors noted that some studies have only
included the sickest persons, which makes it difficult to determine how well
they represent the military population.
"The SF-36 is a widely accepted and good general tool to look at health
status," Doebbeling said. "We conducted a broad-based health assessment
at a time when most of the other work being done on the health of Gulf War
veterans was considering primarily environmental exposures. For this study,
we were interested in veterans' reports of how they were functioning, not
just the symptoms, and in considering a broad range of potential risk factors."
He noted that this study also demonstrates the need to assess veterans' health
status before deployment and regularly over time.
Kenneth Saag, M.D., associate professor of medicine at the University of
Alabama at Birmingham and another of the study's lead authors, noted that
"although the differences associated with deployment observed were relatively
small, they appear to be important. More studies on factors influencing post-deployment
health-related quality of life are needed."
Doebbeling said the UI-led study is unique in that the research focused on
the health status of Gulf War veterans and considers factors present before
The study was funded by the Centers for Disease Control and Prevention and
the U.S. Department of Defense. Voelker's work on the study was partially
supported through a National Institute of Mental Health training grant. The
study's other authors include David Schwartz, M.D., professor of internal
medicine at the Duke School of Medicine and a researcher and staff physician
at the VA Medical Center in Durham, N.C.; Elizabeth Chrischilles, Ph.D., UI
professor of epidemiology; William Clarke, Ph.D., UI professor of biostatistics;
and Robert Woolson, Ph.D., professor of biostatistics and associate dean for
research in the UI College of Public Health.