95% CI 0.85-1.39) and a small and statistically nonsignificant reduction in risk of death from assault (SMR 0.46, 95% CI 0.15-1.38).

Finally, one hospitalization study addresses the question of transportation-related injuries. A study of armed services personnel on active duty during the Gulf War was conducted after the war (1991-1994) at DOD, VA, and nonfederal hospitals in California (Gray et al. 2000). The purpose of including the latter type of hospitalization was to eliminate potential bias related to veterans’ seeking care outside DOD and VA facilities. The authors found increased rates of hospitalization for the category “injury and poisoning” in DOD hospitals (PMR 1.03, 95% CI 1.01-1.05) and California hospitals (PMR 1.11, 95% CI 1.04-1.18), but not in VA hospitals. Table 5.20 summarizes the results of the primary mortality studies.

Secondary Studies

A mortality study of US active-duty military personnel focused exclusively on the Gulf War period of Operations Desert Storm and Desert Shield (1990-1991). It compared noncombat mortality among troops stationed in the Gulf War and troops on active duty elsewhere. There was no excess noncombat mortality in deployed veterans except for unintentional injury due to vehicle accidents and other causes (Writer et al. 1996). A similar study of noncombat injuries in navy and marine personnel during the Gulf War found that most patient visits were for injuries and poisonings21 (Shaw et al. 1991).

A post-Gulf War population-based study of Iowa veterans (1995-1996) found that self-reported traumatic injuries were more likely in deployed than in nondeployed veterans (Zwerling et al. 2000). However, in a large UK study, self-reported “accidental injuries” were lower in Gulf War veterans than in nondeployed veterans, but the category was very broad (Simmons et al. 2004); the authors interpreted this unexpected result as due to inclusion of both major and minor injuries and to the possibility that Gulf War veterans are more inclined to report illnesses than injuries because of the belief that illnesses are associated with deployment.

Gackstetter et al. (2002) performed a nested case-control study of the large Gulf War-deployed and nondeployed population assembled by Kang and colleagues (1996). Deployed veterans who died in motor-vehicle accidents through 1995 (n = 1,343) were more likely to be male, younger, less educated, and never married than nondeployed controls (10 controls/case). They were also more likely to be enlisted, have combat occupations, and be in the National Guard or reserves and not in the Air Force. One of the datasets used by Gackstetter et al. (2002) examined prior morbidity patterns to determine underlying physical and mental health among 980 deployed veterans and nondeployed veterans who died in motor-vehicle accidents. After adjustment for demographic factors and military characteristics, the authors found that prior treatment for mental-health problems, particularly drug or alcohol abuse was strongly associated with such deaths, particularly among nondeployed veterans. The only predictor of motor-vehicle deaths among deployed veterans was prior motor-vehicle injury.

Summary and Conclusion

The committee found that various studies have looked at mortality in Gulf War veterans but have numerous limitations. The principal limitation is the short duration of their followup


As noted earlier, poisoning is one of the standard codes used on death certificates under “other external causes of accidental injury”. The category includes falls, drowning, and poisoning.

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