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    • TABLE 4-2 Diseases of the Blood and Blood-Forming Organs

    Study

    Design

    Population

    Outcomes

    Results

    Adjustments

    Comments

    Gray et al., 1996 (Update)

    Retrospective cohort, hospitalizations from August 1991 through September 1993

    547,076 active-duty GWVs, 618,335 NDVs

    Hospital-discharge diagnoses of blood disease in DoD hospital system

    Exact values not given 1991: OR about 0.9 (95% CI 0.8-1.05);

    1992: OR about 1.1 (95% CI 1.0-1.2)

    1993, OR about 1.05 (95% CI 0.9-1.15)

    Prewar hospitalization, sex, age, race, service branch, marital status, rank, length of service, salary, occupation

    Short follow-up period; no outpatient data; restriction to DoD hospitals and thus to persons remaining on active duty after the war; no adjustment for other potential confounders

    Gray et al., 2000 (Update)

    Retrospective cohort, hospitalizations from August 1991 through December 1994

    652,979 GWVs, 652,922 randomly selected NDVs 182,164 DoD hospitalizations; 16,030 VA hospitalizations; 5185 COSHPD hospitalizations

    Hospital-discharge diagnoses of blood disease in DoD, VA, and COSHPD hospital systems

    DoD PMR 1.08 (95% CI 0.97-1.19)

    VA PMR 0.77 (95% CI 0.54-1.01)

    COSHPD PMR 1.09 (95% CI 0.22-1.96)

    Age, sex, race (only for DoD PMR)

    Able to assess only illnesses that resulted in hospitalization; possible undetected confounders; PMR has lower sensitivity than a comparison of hospitalization rates would have

    Smith et al., 2006 (Update)

    Retrospective cohort study (cohort data from DMDC)

    Active-duty personnel with a single deployment to: Gulf War theatre (n = 455,465); Southwest Asia peacekeeping

    mission, 1991-1998 (n = 249,047);

    Bosnia, 1995-1998 (n = 44,341)

    Postdeployment hospitalization events (1991-2000) for an ICD-9-CM diagnosis of a disease of the blood (280-289)

    Compared to GW veterans, veterans of Bosnia showed similar risk (HR 0.93, 95% CI 0.80-1.07), as did veterans of Southwest Asia (HR 0.93, 95% CI 0.75-1.15)

    Sex, age, marital status, pay grade, race/ethnicity, service branch, occupation, and predeployment hospitalization; time-dependent covariate to account for changing hospitalization methods, diagnostic criteria, and procedures

    Limitations: active-duty personnel only; hospitalizations at DoD facilities only


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