—To identify risk factors of factor analysis-derived Gulf War-related syndromes.
—A cross-sectional survey.
—A total of 249 Gulf War veterans from the Twenty-fourth Reserve Naval Mobile Construction Battalion.
—Participants completed standardized booklets measuring self-reported wartime exposures and present symptoms.
Main Outcome Measures.
—Associations of factor analysis—derived syndromes with risk factors for chemical interactions that inhibit butyrylcholinesterase and neuropathy target esterase.
—Risk of syndrome 1 ("impaired cognition") was greater in veterans who reported wearing flea collars during the war (5 of 20,25%) than in those who never wore them (7 of 229, 3%; relative risk [RR], 8.7; 95% confidence interval [CI], 3.024.7; P<.001). Risk of syndrome 2 ("confusion-ataxia") increased with a scale of advanced adverse effects from pyridostigmine bromide (χ for trend, P<.001), was greater among veterans who believed they had been involved in chemical weapons exposure (18 of 108, 17%) than in those who did not (3 of 141, 2%; RR, 7.8; 95% CI, 2.3-25.9; P<.001), and was increased in veterans who had been in a sector of far northeastern Saudi Arabia on the fourth day of the air war (6 of 21, 29%) than in those who had not been (15 of 228,7%; RR, 4.3; 95% CI, 1.9-10.0.0; P=.004). Effects of perceived chemical weapons exposure and advanced adverse effects from pyridostigmine were synergistic (Rothman S, 5.3; 95% CI, 1.04-26.7). Risk of syndrome 3 ("arthro-myo-neuropathy") increased with an index of frequency and amount of government-issued insect repellent containing 75% DEET (N,N-diethylm-toluamide) in ethanol applied during the war (χ2 for trend, P<.001) and with advanced adverse effects from pyridostigmine (χ2 for trend, P<.001).
—Some Gulf War veterans may have delayed, chronic neurotoxic syndromes from wartime exposure to combinations of chemicals that inhibit butyrylcholinesterase and neuropathy target esterase.
Haley RW, Kurt TL. Self-reported Exposure to Neurotoxic Chemical Combinations in the Gulf War: A Cross-sectional Epidemiologic Study. JAMA. 1997;277(3):231–237. doi:10.1001/jama.1997.03540270057027
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