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A Cross-sectional Epidemiologic Study

Robert W. Haley, MD; Thomas L. Kurt, MD, MPH

JAMA. 1997;277(3):231-237.

Abstract
Objective.
—To identify risk factors of factor analysis-derived Gulf War-related syndromes.

Design.
—A cross-sectional survey.

Participants.
—A total of 249 Gulf War veterans from the Twenty-fourth Reserve Naval Mobile Construction Battalion.

Data Collection.
—Participants completed standardized booklets measuring self-reported wartime exposures and present symptoms.

Main Outcome Measures.
—Associations of factor analysis—derived syndromes with risk factors for chemical interactions that inhibit butyrylcholinesterase and neuropathy target esterase.

Results.
—Risk of syndrome 1 ("impaired cognition") was greater in veterans who reported wearing flea collars during the war (5 of 20,25%) than in those who never wore them (7 of 229, 3%; relative risk [RR], 8.7; 95% confidence interval [CI], 3.024.7; P<.001). Risk of syndrome 2 ("confusion-ataxia") increased with a scale of advanced adverse effects from pyridostigmine bromide ( for trend, P<.001), was greater among veterans who believed they had been involved in chemical weapons exposure (18 of 108, 17%) than in those who did not (3 of 141, 2%; RR, 7.8; 95% CI, 2.3-25.9; P<.001), and was increased in veterans who had been in a sector of far northeastern Saudi Arabia on the fourth day of the air war (6 of 21, 29%) than in those who had not been (15 of 228,7%; RR, 4.3; 95% CI, 1.9-10.0.0; P=.004). Effects of perceived chemical weapons exposure and advanced adverse effects from pyridostigmine were synergistic (Rothman S, 5.3; 95% CI, 1.04-26.7). Risk of syndrome 3 ("arthro-myo-neuropathy") increased with an index of frequency and amount of government-issued insect repellent containing 75% DEET (N,N-diethylm-toluamide) in ethanol applied during the war (² for trend, P<.001) and with advanced adverse effects from pyridostigmine (² for trend, P<.001).

Conclusion.
—Some Gulf War veterans may have delayed, chronic neurotoxic syndromes from wartime exposure to combinations of chemicals that inhibit butyrylcholinesterase and neuropathy target esterase.

Author Affiliations
From the Epidemiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas.

Footnotes
Presented at the Intergovernmental Coordinating Board for the Gulf War Illness and to the staff of the Presidential Advisory Committee on Gulf War Veterans' Illnesses, Washington, DC, September 16,1995, and at a research conference on the Gulf War illness, Centers for Disease Control and Prevention, Atlanta, Ga, October 26, 1995.

Corresponding author: Robert W. Haley, MD, Epidemiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235-8874.

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