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IJE Advance Access published online on April 25, 2005
International Journal of Epidemiology, doi:10.1093/ije/dyi084
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2005; all rights reserved.
Accepted March 21, 2005

Original paper

Neurological status of Australian veterans of the 1991 Gulf War and the effect of medical and chemical exposures

Helen Kelsall 1*, Richard Macdonell 2, Malcolm Sim 1, Andrew Forbes 1, Dean McKenzie 1, Deborah Glass 1, Jillian Ikin 1, and Peter Ittak 1

1 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
2 Department of Neurology, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia

* To whom correspondence should be addressed.
Helen Kelsall, E-mail: helen.kelsall{at}med.monash.edu.au


  Abstract

Background Since the 1991 Gulf War, concerns have been voiced about the effects on the health of veterans of Gulf War related medical and chemical exposures.

Methods Our cross-sectional study compared 1424 male Australian Gulf War veterans and a randomly sampled military comparison group (n = 1548). A postal questionnaire asked about the presence of current neurological type symptoms, medically diagnosed neurological conditions, and medical and chemical exposures. A neurological examination was performed as part of a physical assessment.

Results Veterans have a higher prevalence of neurological type symptoms (ratio of means 1.4, 95% confidence interval (CI) 1.2-1.5). Although the odds ratio (OR) of lower limb neurological type symptoms and signs in veterans compared with the comparison group was increased (OR = 1.6, 95% CI 1.0-2.7), it was of borderline significance, and there was no difference between groups according to a Neuropathy Score based on neurological signs alone (ratio of means 1.1, 95% CI 0.9-1.3). The increased OR of neurological type symptoms and signs suggestive of a central nervous system disorder (OR = 1.8, 95% CI 1.0-3.1) was also of borderline significance. Veterans were not more likely to have self-reported medically diagnosed neurological conditions, or to have neurological type symptoms and signs suggestive of an anterior horn cell disorder (OR = 0.9, 95% CI 0.5-1.6). The total number of neurological type symptoms reported by veterans, but not the Neuropathy Score, was associated with Gulf War related exposures including immunizations and pyridostigmine bromide in dose-response relationships, anti-biological warfare tablets, solvents, pesticides, and insect repellents.

Conclusions This study shows increased reporting of neurological type symptoms in Gulf War veterans, but no evidence for increased neurological effects based on objective physical signs. There may be a number of factors, including information bias, relating to increased neurological type symptom reporting in veterans.

Keywords: Gulf War veterans; nervous system diseases; chemical exposure; medical exposure; pyridostigmine bromide; immunizations.
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