Cohort/Reference Study






New Orleans Reservists/Sutker et al., 1995

Volume 4

Brailey et al., 1998

Prevalence of psychiatric disorders


Sutker et al., 1995

Prevalence of psychologic disorders




Department of Veterans Affairs Study

Volume 4 described seven derivative studies of the National Health Survey of Gulf War Veterans and Their Families, conducted by the VA (Kang et al., 2000). The Update committee identified six additional derivative studies of this cohort that examine specific health outcomes or conducted a follow-up survey and analysis.

Reference Study

A major population-based study of US veterans was mandated by PL 103-446, with the purpose of estimating the prevalence of symptoms and other health outcomes (including reproductive outcomes in spouses and birth defects in children) in Gulf War deployed versus nondeployed veterans. This three-phase retrospective study, the National Health Survey of Gulf War Veterans and Their Families, was designed to be representative of the nearly 700,000 US veterans sent to the Persian Gulf and 800,680 veterans who were not deployed but who were in the military between September 1990 and May 1991.

In the first phase, begun in 1995, the VA mailed questionnaires to a stratified random sample of 15,000 Gulf War and 15,000 veterans not deployed to the Gulf War identified by the Defense Manpower Data Center (DMDC) (Kang et al., 2000). Women and those serving in the National Guard and reserves were oversampled, resulting in a study population that was approximately 20% women, 25% National Guard, and 33% reservists. The controls were stratified by gender, unit, and branch of service to mirror the population of deployed veterans. The self-administered structured health questionnaire contained a 48-symptom inventory (somatic and psychological symptoms) and questions about chronic medical conditions, functional limitations, use of medical services, and environmental exposures (for example, immunizations, use of the prophylactic antinerve agent pyridostigmine bromide [PB], smoke from oil-well fires, pesticides, and insecticides).

Phase II used telephone interview software in an attempt to capture those who did not respond to the mailed questionnaire. In addition, medical records were obtained for a random sample of 4200 respondents (either phase I or II) to validate self-reports of clinic visits or hospitalizations within the last year. Of the 2233 veterans with at least one clinic visit, 43.2% provided medical record release consent; of the 310 with at least one hospitalization, 45.2% provided medical record release consent. A total of 11,441 (75%) deployed and 9476 (64%) nondeployed veterans participated in the study; 15,817 veterans responded to phase I, and 5100 responded to the telephone portion of phase II (Kang and Bullman, 2001; Kang et al., 2000). Gulf War veterans reported significantly higher rates of functional impairment (27.8% vs 14.2%), limitations of employment (17.2% vs 11.6%), and health-care use as assessed by clinic visits (50.8% vs 40.5%) or hospitalizations (7.8% vs 6.4%) compared with nondeployed

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