TABLE 7.4 Gulf War Studies and Neurobehavioral Effects

Reference

Population

Self-Reported Exposure to Relevant Pesticides or Solvents

Health Outcome or Test Type

Results

Limitations

Population-Based Studies

Unwin et al., 1999

UK

2735 UK veterans deployed to Gulf War vs 2393 deployed to Bosnia vs 2422 deployed elsewhere

Four of 29 related to pesticides or solvents: “personal pesticides,” “other paints or solvents,” “handled prisoners of war,” “pesticides on clothing or bedding”

Symptom questionnaires, exposure questionnaire

All solvent or pesticide exposures associated with chronic multisymptom syndrome, posttraumatic stress reaction; physical functioning in all three cohorts “Concentration” factor not associated with any relevant pesticide or solvent exposure in multivariate regression analysis; “neurologic” factor associated with pesticide handling in multivariate regression analysis (p< 0.001), but no clear dose-response relation; “neurologic” factor not associated with other pesticide, solvent exposures in multivariate analysis

Self-reported symptoms and exposures; lack of adjustment for interrelationships between multiple exposures; use of p value of 0.05 despite multiple comparisons

Cherry et al, 2001a

UK

(see also Table 7.1)

4795 UK veterans deployed to Gulf War (and validation cohort of 4750) vs 4793 UK veterans not deployed to Gulf War

Four of 14 related to pesticides or solvents: “days exposed to handling pesticides,” “days living in quarters sprayed with insecticides,” “days respraying vehicles,” “days applying insecticide to skin”

Symptom questionnaire, exposure questionnaire; surveys completed 7 years or more after war

Self-reported symptoms and exposures

Iowa Persian Gulf Study Group, 1997

US

1896 deployed veterans from Iowa as home of record vs 1799 nondeployed veterans from Iowa as home of record

Two of over 20 items related to solvents or pesticides: “solvents/petrochemicals,” “pesticides”

Symptom questionnaires, exposure questionnaire

Symptoms of cognitive dysfunction associated with higher prevalence of exposure to “solvents/petrochemicals” (prevalence difference of 6.6%, p<0.001), “pesticides” (prevalence difference of 14.2%, p<0.001)

Self-reported symptoms and exposures; low proportion of minority-group subjects; internal validation of responses not assessed; no adjustment for multiple comparisons; multiple associations between variety of exposures and variety of outcomes



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