respiratory diseases, the authors reported increases in asthma, but no data were shown. The study is antecedent to a more detailed study of respiratory hospitalizations in relation to exposure to smoke from oil-well fires (Smith et al. 2002). The authors also found increased rates of hospitalization for the category “injury and poisoning” in DOD (PMR 1.03, 95% CI 1.01-1.05) and California hospitals (PMR 1.11, 95% CI 1.04-1.18). Each finding is discussed in the relevant section of this chapter.

Other hospitalization studies are reviewed in this chapter and address specific causes of hospitalizations, for example, in relation to exposure to oil-well fires and respiratory outcomes (Smith et al. 2002) or exposure to nerve agents and specific hospitalizations (Gray et al. 1999b; Smith et al. 2003). For the most part, the studies did not find increased hospitalization in relation to the exposures. A study that did find an increase in hospitalizations for acute psychiatric disorders (Dlugosz et al. 1999) is discussed in the psychiatric section. Table 5.22 summarizes the results of the all-cause hospitalization studies.

Summary and Conclusion

The all-cause hospitalization studies provide some reassurance that excess hospitalizations did not occur among veterans of the Gulf War who remained on active duty through 1994. The studies, however, have several limitations, including that they were largely of active-duty personnel and cannot be generalized to the entire cohort of Gulf War veterans, inasmuch as it been noted that Gulf War veterans who left the military reported worse health outcomes than those who remained (Ismail et al. 2000). As is the case for mortality studies, it is too soon to capture hospitalizations from illnesses that might have longer latency, such as some cancers. In addition, hospitalization data might be incomplete on people separated from the military and admitted to nonmilitary (VA and civilian) hospitals. The studies did not measure the use of outpatient treatment and thus detected only illnesses that required hospitalization.

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