National Academies Press: OpenBook
« Previous: B-- VA AND DOD REPORTS
Suggested Citation:"C-- SUMMARY TABLE." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×

C


SUMMARY TABLE

This appendix includes a summary table of selected reports and studies that describe the burden of illness in the 1990-1991 Gulf War and OEF/OIF/OND veteran populations.

Suggested Citation:"C-- SUMMARY TABLE." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×

Summary of Selected Studies on Disease Burden

REPORTS/STUDY VA UTILIZATION REPORTS IN 1990-1991 GULF WAR VETERANS (MS, migraine, PD, brain cancer) VA UTILIZATION REPORTS IN OEF/OIF/OND VETERANS MS, migraine, PD, brain cancer) SPECIFIC OUTCOMERELATED STUDIES (MS) SPECIFIC OUTCOMERELATED STUDIES (headache and migraine) SPECIFIC OUTCOMERELATED STUDIES (headache disorders) SPECIFIC OUTCOMERELATED STUDIES (headache) SPECIFIC OUTCOMERELATED STUDIES (cancer, including brain cancer)
Authors Department of Veterans Affairs (VA) Department of Veterans Affairs (VA) Wallin et al. (2014) Kang et al. (2000) Jankosky et al. (2011) Theeler et al. (2012) Young et al. (2010)
Study Description

Utilization reports of pre 9/11 veterans using the VA health system. Report based on ICD-9 codes for MS, migraine, PD, and malignant neoplasms of the brain.

Provides counts for each diagnosis.

Based on visits between October 1, 2001, and September 30, 2013.

Utilization reports of post 9/11 veterans using the VA health system. Report based on ICD-9 codes for MS, migraine, PD, malignant neoplasms of the brain.

Provides counts for each diagnosis.

Based on visits between October 1, 2001, and September 30, 2014.

Evaluated the risk of developing MS and other central nervous system demyelinating diseases (ODDs) in 1990-1991 Gulf War veterans.

Cases of MS and ODD were matched to a DOD database of all active-duty personnel.

All cases evaluated for service connection.

Survey data used to report outcomes related to headaches and migraines in veterans of the 1990-1991 Gulf War.

Self-reported responses were used to calculate weighted estimates of population rates for the conditions.

Examined headache disorder in a large population-based US military cohort (using the Millennium Cohort)—a 21-year longitudinal study. Began in 2001 prior to OEF and OIF. Designed to determine prevalence, characteristics, and factors associated with chronic daily headache.

Studied cancer diagnoses in Gulf War era veterans.

Using files from the DMDC and linked with 28 state cancer registries and the VA cancer registry.

Suggested Citation:"C-- SUMMARY TABLE." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
REPORTS/STUDY VA UTILIZATION REPORTS IN 1990-1991 GULF WAR VETERANS (MS, migraine, PD, brain cancer) VA UTILIZATION REPORTS IN OEF/OIF/OND VETERANS MS, migraine, PD, brain cancer) SPECIFIC OUTCOMERELATED STUDIES (MS) SPECIFIC OUTCOMERELATED STUDIES (headache and migraine) SPECIFIC OUTCOMERELATED STUDIES (headache disorders) SPECIFIC OUTCOMERELATED STUDIES (headache) SPECIFIC OUTCOMERELATED STUDIES (cancer, including brain cancer)
Number of Subjects 286,995 deployed veterans 1,126,173 OEF/OIF/OND veterans 696,118 deployed Gulf War veterans 15,000 Gulf War veterans 38,361 combat deployed 978 US Army 621,902 deployed and 746,248 era Gulf War veterans
Comparison Group 269,635 nondeployed using VA health care services None 1,786,215 nondeployed veterans 15,000 era veterans Non-combat deployed US population Gulf War veterans and Gulf War era veterans
Data Collection Methods Provide counts for selected health care diagnoses for veterans using VA health care. Provide counts for selected health care diagnoses for veterans using VA health care.

An incident cohort of MS and ODD was assembled from Gulf War era veterans (1990-2007).

Cases of MS and ODD were matched to a database of all active-duty personnel from DOD.

Phase 1: 16-page structured questionnaire sent to each of the 30,000 veterans.

Phase 2: telephone interviews on the nonrespondents.

Baseline cohort: A random sample of 256,400 service members of the 2.2 million total serving as of October 1, 2000.

Approximately 77,000 completed the baseline questionnaire; those with missing outcome data were excluded.

Self-administered questionnaire Review of DMDC, state cancer registries, and VA cancer registry
Suggested Citation:"C-- SUMMARY TABLE." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
REPORTS/STUDY VA UTILIZATION REPORTS IN 1990-1991 GULF WAR VETERANS (MS, migraine, PD, brain cancer) VA UTILIZATION REPORTS IN OEF/OIF/OND VETERANS MS, migraine, PD, brain cancer) SPECIFIC OUTCOMERELATED STUDIES (MS) SPECIFIC OUTCOMERELATED STUDIES (headache and migraine) SPECIFIC OUTCOMERELATED STUDIES (headache disorders) SPECIFIC OUTCOMERELATED STUDIES (headache) SPECIFIC OUTCOMERELATED STUDIES (cancer, including brain cancer)
Findings

MS (ICD-9 340): deployed 1,040; nondeployed 1,089

Migraine (ICD-9 346): deployed 16,327; nondeployed 14,115

PD (IDC-9 332.0): deployed 403; nondeployed 487

Malignant neoplasm of the brain (ICD-9 191): deployed 342; nondeployed 332

MS (ICD-9 340): 1,529 deployed

Migraine (ICD-9 346): 58,045 deployed

PD (IDC-9 332.0): 322 deployed

Malignant neoplasm of the brain (ICD-9 191): 458 deployed

There are no data on the nondeployed

For 1990-1991 Gulf War veterans:

MS and ODD: 1,841 incident cases: 387 cases among the 696,118 deployed and 1,454 cases among the 1,786,215 nondeployed

RR for MS 0.69 (95% CI: 0.61-0.78)

Migraines: 16.5% of the deployed and 9.3% of the era veterans

Recurring headaches 32.6% of deployed and 14.9% of the era veterans

Combat deployed had statistically significantly higher adjusted odds of new-onset headache disorder than nondeployed (OR = 1.72, 95% CI 1.55-1.90 for men and OR = 1.84, 95% CI 1.55-2.18 for women).

Those deployed without combat did not have statistically significantly different adjusted odds of new onset headaches compared to the nondeployed (OR = 1.07, 95% CI 0.95-1.21 for men; OR = 0.96, 95% CI 0.80-1.14 for women).

Findings indicate that the prevalence of chronic daily headache is four to five times higher in OEF and OIF than the US population.

Chronic daily headache following concussion often resembles chronic migraine and is associated with onset of headaches within the first week after concussion.

Brain cancer: 278 in deployed and 410 in era Gulf War veterans.

The PIR, comparing Gulf War deployed and era veterans: 0.86% (95% CI: 0.73-1.01).

Suggested Citation:"C-- SUMMARY TABLE." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
REPORTS/STUDY VA UTILIZATION REPORTS IN 1990-1991 GULF WAR VETERANS (MS, migraine, PD, brain cancer) VA UTILIZATION REPORTS IN OEF/OIF/OND VETERANS MS, migraine, PD, brain cancer) SPECIFIC OUTCOMERELATED STUDIES (MS) SPECIFIC OUTCOMERELATED STUDIES (headache and migraine) SPECIFIC OUTCOMERELATED STUDIES (headache disorders) SPECIFIC OUTCOMERELATED STUDIES (headache) SPECIFIC OUTCOMERELATED STUDIES (cancer, including brain cancer)
Strengths/Limitations

Limited to those veterans using VA health care services.

Captures approximately 46% of deployed, 36% of nondeployed.

Based solely on a single entry of an ICD code for the disease of interest.

Limited to those veterans using VA health care services.

Captures approximately 60% of deployed.

Based solely on a single entry of an ICD code for the disease of interest.

Strengths include prospective study design, use of incident MS cases within the entire 1990-1991 Gulf War active-duty population; adequate power; and follow-up time to detect significant changes in MS risk in deployed troops.

Limitations of the study: the possibility of missing some MS cases that may have had their first symptom outside the active-duty period and 7 years thereafter.

A strength is the large number of subjects who were randomly selected.

Limitations of this study include exposure and outcomes data are based on the selfreported data that may be subject to recall bias. The differential participation rate between Gulf War veterans and era veterans could contribute to a biased prevalence estimate.

Strengths include the ability to estimate headache prevalence at baseline and new onset headache disorders at followup.

Limitations include long postdeployment time frame; possible combat exposure misclassification; types of headaches not distinguished; inability to assess the lifetime prevalence of headache disorders at follow-up.

Limitations include retrospective reporting of headaches, recall errors in reporting headache frequency, blast exposures, and symptoms of concussion. Screening for preexisting headaches was not performed. The study may not be representative of all US service members with a deployment-related concussion as it was conducted at a single US Army installation.

Strengths include associating cancer incidence outcomes with the entire Gulf War veteran population; included a large and representative sample of era veterans. Outcome assessment based on cancer registry data rather than mortality, hospitalization, or self-reports.

Limitations include lack of data from all 50 states and use of different registries may have resulted in slightly different match rates.

NOTE: CI = confidence interval; DMDC = Defense Manpower Data Center; DOD = Department of Defense; ICD = International Classification of Diseases; MS = multiple sclerosis; ODD = other demyelinating disease; OEF = Operation Enduring Freedom; OIF = Operation Iraqi Freedom; OR = odds ratio; PD = Parkinson’s disease; PIR = Proportional Incidence Ratio; RR = relative risk; VA = Department of Veterans Affairs.

Suggested Citation:"C-- SUMMARY TABLE." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×

This page intentionally left blank.

Suggested Citation:"C-- SUMMARY TABLE." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
Page 29
Suggested Citation:"C-- SUMMARY TABLE." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
Page 30
Suggested Citation:"C-- SUMMARY TABLE." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
Page 31
Suggested Citation:"C-- SUMMARY TABLE." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
Page 32
Suggested Citation:"C-- SUMMARY TABLE." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
Page 33
Suggested Citation:"C-- SUMMARY TABLE." National Academies of Sciences, Engineering, and Medicine. 2015. Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans. Washington, DC: The National Academies Press. doi: 10.17226/21870.
×
Page 34
Next: REFERENCES »
Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans Get This Book
×
Buy Ebook | $9.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

In January 2015, the Institute of Medicine conducted a study to determine the incidence and prevalence, as well as the risk of developing multiple sclerosis (MS) and other neurologic diseases as a result of service in the 1990-1991 Persian Gulf and post 9/11 Global Operations theaters. The other neurologic diseases to be considered include: Parkinson’s disease, and brain cancers, as well as central nervous system abnormalities that are difficult to precisely diagnose. This report presents the committee’s data collection and findings.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!