Neurology 2003;61:742-749
© 2003 American Academy of Neurology
Occurrence of amyotrophic lateral sclerosis among Gulf War veterans
R.D. Horner, PhD,
K.G. Kamins, PhD,
J.R. Feussner, MD MPH,
S.C. Grambow, PhD,
J. Hoff-Lindquist, MStat,
Y. Harati, MD,
H. Mitsumoto, MD DSci,
R. Pascuzzi, MD,
P.S. Spencer, PhD,
R. Tim, MD,
D. Howard, MSPH,
T.C. Smith, MS,
M.A.K. Ryan, MD MPH,
C.J. Coffman, PhD and
E.J. Kasarskis, MD PhD
From the National Institute of Neurological Disorders and Stroke (Dr. Horner), Bethesda, MD; National Institute for Environmental Health Sciences (Dr. Kamins), Research Triangle, NC; Department of Medicine (Dr. Feussner), Medical University of South Carolina, Charleston, SC; VA Epidemiologic Research & Information Center (Dr. Grambow and D. Howard) and VA Center for Health Service Research in Primary Care (Drs. Grambow and Coffman, and J. Hoff-Lindquist), Durham, NC; Department of Biostatistics and Bioinformatics (Drs. Grambow and Coffman), Duke University Medical Center, Durham, NC; Houston VA Medical Center and Baylor College of Medicine (Dr. Harati), Houston, TX; Columbia Presbyterian Medical Center (Dr. Mitsumoto), New York, NY; Indiana University Medical Center (Dr. Pascuzzi), Indianapolis; Oregon Health and Science University (Dr. Spencer), Portland, OR; Durham VA Medical Center (Dr. Tim), NC; Naval Health Research Center (T.C. Smith and Dr. Ryan), San Diego, CA; and Lexington VA Medical Center and University of Kentucky (Dr. Kasarskis), Lexington, KY.
Address correspondence and reprint requests to Dr. Ronnie D. Horner, National Institute of Neurological Disorders and Stroke, NSC Building–Room 2149, 6001 Executive Blvd., Bethesda, MD 20852; e-mail: rh266m{at}nih.gov
Background: In response to Gulf War veterans’ concerns of high rates of ALS, this investigation sought to determine if Gulf War veterans have an elevated rate of ALS.
Methods: A nationwide epidemiologic case ascertainment study design was used to ascertain all occurrences of ALS for the 10-year period since August 1990 among active duty military and mobilized Reserves, including National Guard, who served during the Gulf War (August 2, 1990, through July 31, 1991). The diagnosis of ALS was confirmed by medical record review. Risk was assessed by the age-adjusted, average, annual 10-year cumulative incidence rate.
Results: Among approximately 2.5 million eligible military personnel, 107 confirmed cases of ALS were identified for an overall occurrence of 0.43 per 100,000 persons per year. A significant elevated risk of ALS occurred among all deployed personnel (RR = 1.92; 95% CL = 1.29, 2.84), deployed active duty military (RR = 2.15, 95% CL = 1.38, 3.36), deployed Air Force (RR = 2.68, 95% CL = 1.24, 5.78), and deployed Army (RR = 2.04; 95% CL = 1.10, 3.77) personnel. Elevated, but nonsignificant, risks were observed for deployed Reserves and National Guard (RR = 2.50; 95% CL = 0.88, 7.07), deployed Navy (RR = 1.48, 95% CL = 0.62, 3.57), and deployed Marine Corps (RR = 1.13; 95% CL = 0.27, 4.79) personnel. Overall, the attributable risk associated with deployment was 18% (95% CL = 4.9%, 29.4%).
Conclusions: Military personnel who were deployed to the Gulf Region during the Gulf War period experienced a greater post-war risk of ALS than those who were deployed to the Gulf.
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