Semester

Fall

Date of Graduation

2020

Document Type

Dissertation

Degree Type

PhD

College

School of Public Health

Department

Epidemiology

Committee Chair

Robert Bossarte

Committee Co-Chair

Thomas Hulsey

Committee Member

Kim Innes

Committee Member

Ronald Kessler

Abstract

Background:

Nearlythirty years after the 1990-1991 Persian Gulf War a definitive case definition for Gulf War Illness (GWI) is lacking. The objective is to explore health outcomes associated with GWI using currently accepted classifications in order to better understand GWI by examining pre-war medical conditions as predictors of probable GWI, mortality outcomes of veterans with probable GWI, and female-specific medical conditions among women with probable GWI. Additionally, we utilize an alternative GWI case definition.

Methods:

Data come from theDepartment of Veterans Affairs (VA)1995-1997 National Health Survey of Persian Gulf War Era Veterans, a population-based survey of deployed and non-deployed veterans. We examined pre-war medical conditions as predictors for GWI using the two currently accepted classifications in addition to our new definition. We characterized cause-specific mortality risk among those with and without probable GWI. We analyzed risk for female-specific medical conditions among those with and without probable GWI.

Results:

Pre-war medical condition predictor variables were significantly associated with measures of GWI. Deployed veterans meeting criteria for GWI were at increased risk for cause-specific mortality due to malignant neoplasms, circulatory system disorders, and digestive system disorders. Deployed women meeting GWI criteria were at increased risk for disorders of the breast and female genital tract compared to non-deployed women who did not meet GWI criteria.

Conclusion:

Our findings add to the GWI literature by presenting results for previously unexplored aspects of the disorder. We were able to identify an association between pre-war medical conditions and post-war probable GWI, indicating that some veterans may have had a pre-existing vulnerability for developing GWI-related conditions. Additionally, we demonstrate use of an alternative case definition for GWI, which was also associated with pre-war predictors. Our mortality results indicate that deployed veterans meeting criteria for GWI in 1995 had some increased risk for GWI-related causes of death, plus mortality due to malignant neoplasms. Finally, we found some evidence of increased risk for female-specific medical conditions among deployed women with GWI symptoms, though we are unable to determine if the findings are related to GWI domains, deployment conditions, or pre-war factors. Our findings support the ongoing need to prioritize GWI research and continued development of a validated and reliable measure for classification of GWI.

Embargo Reason

Publication Pending

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