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Release:May 8, 2002

Study identifies factors associated with poorer health status among Gulf War veterans

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 mental health.

"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 deployment.

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.