Health of UK servicemen who served in Persian Gulf War

Background Various symptoms in military personnel in the Persian Gulf War 1 990-91 have caused international speculation and concern. We investigated U K servicemen. Methods We did a cross-sectional postal survey on a random sample of Gulf W ar veterans (Gulf War cohort, n=4248) and, stratified for age and rank, ser vicemen deployed to the Bosnia conflict (Bosnia cohort, n=4250) and those s erving during the Gulf War but not deployed there (Era cohort, n=4246). We asked about deployment, exposures, symptoms, and illnesses. We analysed men only. Our outcome measures were physical health, functional capacity (SF-3 6), the general health questionnaire, the Centers for Disease Control and P revention (CDC) multisymptom criteria for Gulf war illness, and post-trauma tic stress reactions. Findings There were 8195 (65.1%) valid responses. The Gulf War cohort repor ted symptoms and disorders significantly more frequently than those in the Bosnia and Era cohorts, which were similar. Perception of physical health a nd ability were significantly worse in the Gulf War cohort than in the othe r cohorts, even after adjustment for confounders. Gulf War veterans were mo re likely than the Bosnia cohort to have substantial fatigue (odds ratio 22 [95% CI 1.9-2.6]), symptoms of post-traumatic stress (2.6 [1.9-3.4]), and psychological distress (1.6 [1/.4-1.8]), and were nearly twice as likely to reach the CDC case definition (25 [2.2-2.8]). In the Gulf War, Bosnia, and Era cohorts, respectively, 61.9%, 36.8%, and 36.4% met the CDC criteria, w hich fell to 25.3%, 11.8%, and 12.2% for severe symptoms. Potentially harmf ul exposures were reported most frequently by the Gulf War cohort. All expo sures showed associations with all of the outcome measures in the three coh orts. Exposures specific to the Gulf were associated with all outcomes. Vac cination against biological warfare and multiple routine vaccinations were associated with the CDC multisymptom syndrome in the Gulf War cohort. Interpretation Service in the Gulf War was associated with various health p roblems over and above those associated with deployment to an unfamiliar ho stile environment. Since associations of ill health with adverse events and exposures were found in all cohorts, however, they may not be unique and c ausally implicated in Gulf-War-related illness. A specific mechanism may li nk vaccination against biological warfare agents and later ill health, but the risks of illness must be considered against the protection of serviceme n.