Amyotrophic Lateral Sclerosis in Veterans Review of the Scientific Literature (2006) / Chapter Skim
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2 Evidence Regarding Amyotrophic Lateral Sclerosis in Veterans
2 Evidence Regarding Amyotrophic Lateral Sclerosis in Veterans
Pages 19-36
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From page 19... ...
STUDIES ON AMYOTROPHIC LATERAL SCLEROSIS IN THE VETERAN POPULATION In this section, the committee evaluates the studies on ALS in the veteran population that it considered to be the primary studies on which it based its conclusion. The studies are presented chronologically by year of publication.
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; 1,478,704 military Gulf War-era August records hazards adjusted for (12) personnel who veterans 1991-July analysis age served during 1997 the Gulf War (August 8, 1990 July 31, 1991)
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; the Gulf War adjusted for (August 1990- age April 1991) and were less than 45 years old Horner et All active, gulf- Non-gulf- 696,118 (40)
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Analysis Intervals) Population Population Design Methods including telephone mobilized enrollment; reserves and internet notices; National Guard mass mailings to neurologists, VA centers, and veteran service organizations
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; the ACS Cancer with self- 1989-1998 National Death hazards adjusted for 126,414 (63) Prevention report of no Index analysis age, smoking, Study II cohort military education, who had self- service at alcohol intake, reported military enrollment self-reported service exposure to pesticides and herbicides, and main occupation as farmer, electrical or welding work, or food preparation NOTE: ACS = American Cancer Society; DOD = Department of Defense; ICD-9 = International Classification of Diseases, 23 ninth revision; NA = not available; SMR = standardized mortality ratio; VA = Department of Veterans Affairs.
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al. 2003 era veterans Gulf War-deployed military 40 1.92 personnel (1990-1991)
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Service branch No military service 63 1.0 (ref) Army and National Guard 97 1.54 (1.09-2.17)
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(2000) relied on hospitalization records and reported an imprecisely estimated increase in relative risk of ALS
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performed a study to investigate causes of death of Gulf War veterans compared with concurrently serving veterans who were not deployed. Vital status and cause of death were determined from a variety of databases for 621,902 veterans who served in the Persian Gulf before the termination of hostilities and for 746,248 non-gulf-deployed Gulf War-era veterans, stratified by branch of service.
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found an excess incidence of ALS among deployed Gulf War veterans in comparison with the expected incidence based on US vital statistics. The study population was defined as the approximately 695,000 members of the Army, Navy, Air Force, Marines, and Coast Guard who served in the Southwest Asia Theater of Operations from August 1990-April 1991.
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. Military personnel were considered deployed if they were in the gulf region or received hazardous duty pay during the Gulf War.
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formally assessed the potential impact of such a bias by using three statistical modeling methods known as capture-recapture methods: log-linear modeling, the sample coverage approach, and ecologic modeling. On the basis of the three modeling approaches, the investigators concluded that a modest underascertainment of cases among nondeployed military personnel might have occurred, whereas little or no underascertainment was apparent in deployed personnel.
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estimated rates for nondeployed personnel were lower than the age-adjusted rates reported in a high-quality populationbased study of ALS conducted in Washington state by McGuire et al.
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To ascertain ALS mortality, the CPS II cohort records were linked to the National Death Index and death certificates were obtained. The CPS II cohort was established in 1982, but ALS deaths were not coded separately on death certificates before 1989.
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However, given the inevitable progression of ALS, it is unlikely that a large number of cases would be miscoded on death certificates. Even if some miscoding occurred, it probably was not related to military service inasmuch as the data were recorded before the putative link between service in the Gulf War and ALS had been widely reported.
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The study by Weisskopf et al. is the first to suggest a relationship between military service before the Gulf War and ALS mortality.
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2004b. Occurrence of amyotrophic lateral sclerosis among Gulf War veterans.
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2000. Is systemic lupus erythematosus, amyotrophic lateral sclerosis, or fibromyalgia associated with Persian Gulf War service?
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