LONG-TERM HEALTH OUTCOMES AND MEDICAL EFFECTS OF TORTURE AMONG US NAVY PRISONERS OF WAR IN VIETNAM

Objective.-To characterize incidence of illnesses and injuries from 19 79 to 1993 in former naval aviator prisoners of war (POWs) from the Vi etnam War and a comparison group of naval aviators from the same war. Design.-Cohort analytic study. Setting.-A US Navy primary care clinic. Participants.-Volunteer sample consisting of 70 former naval aviator POWs (white men, aged 47 to 69 years in 1993) and a comparison group o f 55 naval aviators who served in Vietnam but were not POWs, matched o n race, age, marital status, education, rank, year of entry into the n avy, and pilot status, Subjects participated in an annual health scree ning program. This study reports data sampled on a biennial basis from subjects screened both in 1979 and 1993. Main Outcome Measure.-Medica lly diagnosed incidence of illness and injury based on a standard prot ocol. Results.-POWs had higher incidence rates than the comparison gro up did of disorders of the peripheral nervous system (relative risk [R R], 8.4; 95% confidence interval [CI], 2.7-25.9: P<.001). joints (RR, 1.5, 95% CI, 1.2-2.0; P<.006), and back (RR, 1.8; 95% CI, 1.0-3.0; P<. 037). These findings also were statistically significant according to Kaplan-Meier survival analyses that included 131 (95%) of 138 POWs and 115 (83%) of the 138 members of the comparison group. Survival analys es revealed that, in addition to these disorders, POWs had higher haza rd rates of peptic ulcer (P<.01). Conclusions.-During captivity, ropes , ratchet handcuffs, leg irons, or stocks were used to put tightly con strictive pressure around the extremities of POWs as a means of tortur e, resulting in painful ischemia and subsequent neuropathies. Being a former POW was associated with increased cumulative incidence rates of chronic disorders of the peripheral nervous system. joints, and back and an increased hazard rate of peptic ulcer.