Multiple Sclerosis in Gulf War Era Veterans. 2. Military Deployment and Risk of Multiple Sclerosis in the First Gulf War

Wallin, Mitchell T.; Kurtzke, John F.; Culpepper, William J.; Coffman, Parisa; Maloni, Heidi; Haselkorn, Jodie K.; Mahan, Clare M.

doi:10.1159/000360701

Cited by 12 publications

(4 citation statements)

References 84 publications

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“…By contrast however, a previous study in this setting showed that being in the country during the first Gulf War was significantly associated with increased odds of being a MS case than a control [ 28 ]. The finding of this study is also in contrast to the results of the previous studies based on the data from the United States veterans of World War II, Korean War [ 23 , 53 ] and a postwar epidemic in Iceland [ 21 ], which, together showed somewhat elevated MS risk in this subpopulation relative to the general population of the United States [ 25 , 54 ]. Furthermore, historically, it was claimed that the invasion and five-year occupation of Faroe Islands by British troops during the World War II introduced a widespread, specific, persistent (but unknown) and probably mild asymptomatic infection, as only one in 500 exposed individuals were clinically affected with primary MS [ 55 ].…”

Section: Discussioncontrasting

confidence: 99%

Impact of the first Gulf war on multiple sclerosis risk in Kuwait: a quasi-experimental study

2023

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Objective It has been reasoned that stressful life events tend to alter immune function thereby increasing the susceptibility to autoimmune diseases including multiple sclerosis (MS). Using the database of Kuwait National MS Registry, this quasi-experimental study assessed the impact of the first Gulf War (Iraqi invasion of Kuwait in 1990) on MS risk in Kuwait. Methods MS incidence data from 1980 to 2019 were obtained from the Kuwait National MS Registry. Annual age-standardized incidence rates (ASIRs) (per 105 person-years) were computed using the World Standard Population as a reference. Interrupted time series analysis with the option of autoregressive order (1) was used to evaluate the impact of the first Gulf War on MS risk by treating 1990 as an intervention year. Results Estimated baseline annual ASIR (per 105 person-years) was 0.38 (95% CI: -1.02, 1.78; p = 0.587). MS ASIRs (per 105 person-years) tended to increase significantly every year prior to 1990 by 0.45 (ASIR per 105 person-years = 0.45; 95% CI: 0.15, 0.76; p = 0.005). During the first year of the first Gulf War, there seemed to be a non-significant increase (step change) in ASIRs (per 105 person-years) of MS (ASIR per 105 person-years = 0.85; 95% CI: − 5.16, 6.86; p = 0.775) followed by a non-significant increase in the annual trend in MS ASIRs per 105 person-years (relative to the preintervention trend i.e., the difference between the pre-first Gulf War versus the post-first Gulf War trends) by 0.65 (ASIR per 105 person-years = 0.65; 95% CI: − 0.22, 1.52; p = 0.138). However, a postestimation measure of the post-first Gulf War trend was statistically significant (ASIR per 105 person-years = 1.10; 95% CI: 0.40, 1.80; p = 0.003), which implies that the post-first Gulf War trend in the annual ASIRs (per 105 person-years) inclined to be the same as was the pre-first Gulf War (i.e., counterfactual of the pre-first Gulf War trend in annual ASIRs (per 105 person-years) as if no first Gulf War took place).The Durbin-Watson test statistic (d = 1.89) showed almost non-significant autocorrelations across the time series observations on ASIRs (per 105 person-years). Conclusions This study suggests that the first Gulf War was not significantly associated with the increasing trend in MS risk at population level in Kuwait neither with any short-term change nor with secular trend. Future studies may consider confirming the role of conflict-related stress or other stressful life events in potential exacerbation of MS risk along with unraveling biologically plausible mechanistic pathways.

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Section: Discussioncontrasting

confidence: 99%

Impact of the first Gulf war on multiple sclerosis risk in Kuwait: a quasi-experimental study

2023

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“…A study of MS in veterans who served in the military between 1990 and 2007 and had applied for disability compensation identified increased MS rates in women, African Americans, and Army veterans compared to other groups but did not focus specifically on deployed veterans of the 1991 GW ( Wallin et al, 2012 ). A later report indicated that rates of MS were not significantly different between GW veterans and nondeployed veterans in this convenience cohort ( Wallin et al, 2014 ). Neither mortality data nor the number of veterans seeking disability benefits for MS provides a valid indication of whether GW veterans have been affected by excess rates of MS or most other neurological disorders since the war.…”

Section: The Epidemiology Of Gwimentioning

confidence: 59%

Recent research on Gulf War illness and other health problems in veterans of the 1991 Gulf War: Effects of toxicant exposures during deployment

White

Steele

O’Callaghan

et al. 2016

Cortex

350

398

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Veterans of Operation Desert Storm/Desert Shield – the 1991 Gulf War (GW) – are a unique population who returned from theater with multiple health complaints and disorders. Studies in the U.S. and elsewhere have consistently concluded that approximately 25–32% of this population suffers from a disorder characterized by symptoms that vary somewhat among individuals and include fatigue, headaches, cognitive dysfunction, musculoskeletal pain, and respiratory, gastrointestinal and dermatologic complaints. Gulf War illness (GWI) is the term used to describe this disorder. In addition, brain cancer occurs at increased rates in subgroups of GW veterans, as do neuropsychological and brain imaging abnormalities.Chemical exposures have become the focus of etiologic GWI research because nervous system symptoms are prominent and many neurotoxicants were present in theater, including organophosphates (OPs), carbamates, and other pesticides; sarin/cyclosarin nerve agents, and pyridostigmine bromide (PB) medications used as prophylaxis against chemical warfare attacks. Psychiatric etiologies have been ruled out.This paper reviews the recent literature on the health of 1991 GW veterans, focusing particularly on the central nervous system and on effects of toxicant exposures. In addition, it emphasizes research published since 2008, following on an exhaustive review that was published in that year that summarizes the prior literature (RACGWI, 2008).We conclude that exposure to pesticides and/or to PB are causally associated with GWI and the neurological dysfunction in GW veterans. Exposure to sarin and cyclosarin and to oil well fire emissions are also associated with neurologically based health effects, though their contribution to development of the disorder known as GWI is less clear. Gene-environment interactions are likely to have contributed to development of GWI in deployed veterans. The health consequences of chemical exposures in the GW and other conflicts have been called “toxic wounds” by veterans. This type of injury requires further study and concentrated treatment research efforts that may also benefit other occupational groups with similar exposure-related illnesses.

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“…Other racial/ethnic minorities, including blacks, Hispanics and Asians, are also at risk of developing MS, although reported to have lower incidence rates in the United States [6, 7]. All-cause mortality has been reported to be significantly higher in people with MS compared to the general population with an estimated shorten life expectancy of 6–7 years [3, 8-11].…”

Section: Introductionmentioning

confidence: 99%

Multiple Sclerosis Mortality by Race/Ethnicity, Age, Sex, and Time Period in the United States, 1999–2015

et al. 2018

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Background: Multiple sclerosis (MS) carries high morbidity and shortens life span. While there is recent recognition of other US minority populations such as blacks and Hispanics being affected with MS, examination of MS-specific mortality trends by race/ethnicity has been lacking. Objective: To investigate MS mortality rates and trends in the United States by sex, age, and race/ethnicity. Methods: We used the Compressed Mortality data file for 1999–2015 in the Wide-ranging online Data for Epidemiological Research system developed by the Center for Disease Control and Prevention to calculate the age-adjusted (US 2000 standard population) and age-specific MS mortality rate (per 100,000) by race/ethnicity and sex over time. Five mutually exclusive racial/ethnic groups were included in the analysis: non-Hispanic (NH) white, NH black, NH Asian or Pacific Islander (API), NH American Indian or Alaska Native, and Hispanic. Results: The average annual age-adjusted MS mortality rate was highest among NH whites (0.90 for males and 1.50 for females) immediately followed by NH blacks (0.75 for males and 1.42 for females), and lowest among APIs (0.05 for males and 0.12 for females). Statistically significant, increasing trend in age-adjusted MS mortality was observed during 1999–2015 among NH whites and NH blacks regardless of sex, more substantially in the latter. Age-specific MS mortality patterns showed NH blacks had the highest rate under age 55 and NH whites had the highest rate after that age point. For these 2 groups, MS mortality increased with age in both sexes and peaked at ages 55–64 for NH blacks and 65–74 for NH whites before declining substantially, while for Hispanic and API groups the risk plateaued after age 55. Conclusion: MS-specific mortality trends demonstrate distinctive differences by race/ethnicity and age. The observations that whites and females are more likely to die from MS is in line with the overall understanding that these groups are affected more by MS. However, the findings of blacks dying at an earlier age and having more substantially increasing mortality trends than whites suggest that MS burden weighs unequally by race. Further investigation into these trends may provide additional evidence into risk or protective factors within each group.

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Multiple Sclerosis in Gulf War Era Veterans. 2. Military Deployment and Risk of Multiple Sclerosis in the First Gulf War

Cited by 12 publications

References 84 publications

Impact of the first Gulf war on multiple sclerosis risk in Kuwait: a quasi-experimental study

Impact of the first Gulf war on multiple sclerosis risk in Kuwait: a quasi-experimental study

Recent research on Gulf War illness and other health problems in veterans of the 1991 Gulf War: Effects of toxicant exposures during deployment

Multiple Sclerosis Mortality by Race/Ethnicity, Age, Sex, and Time Period in the United States, 1999–2015

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