Neurology 2003;61:750-756
© 2003 American Academy of Neurology
Excess incidence of ALS in young Gulf War veterans
Robert W. Haley, MD
From the Epidemiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Address correspondence and reprint requests to Dr. Robert Haley, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8874; e-mail: Robert.Haley{at}UTSouthwestern.edu
Background: Reported cases of ALS in young veterans of the 1991 Gulf War have suggested excess incidence.
Objective: To compare observed and expected incidence of ALS in Gulf War veterans diagnosed before age 45 years (young veterans).
Methods: Cases of ALS diagnosed from 1991 through 1998 were collected from military registries and a publicity campaign in late 1998. Diagnoses were established from neurologists’ medical records using El Escorial criteria. Expected incidence was estimated from the age distribution of the Gulf War veteran population, weighted by age-specific death rates of the US population. Secular changes in nationwide ALS rates were assessed using calculations of the age-specific US population death rates from vital statistics data of 1979 to 1998.
Results: During 8 postwar years, 20 ALS cases were confirmed in approximately 690,000 Gulf War veterans, and 17 were diagnosed before age 45 years. All developed bulbar and spinal involvement, and 11 have died. In young veterans, the expected incidence increased from 0.93 cases/year in 1991 to 1.57 cases/year in 1998, but the observed incidence increased from 1 to 5 cases/year. The observed incidence was 0.94 (95% CI, 0.26 to 2.41) times that expected in the baseline period from 1991 to 1994 (4 vs 4.25 cases; p = 0.6); it increased to 2.27 (95% CI, 1.27 to 3.88) times that expected during the 4-year period from 1995 to 1998 (13 vs 5.72 cases; p = 0.006); and it peaked at 3.19 (95% CI, 1.03 to 7.43) times that expected in 1998 (5 vs 1.57 cases; p = 0.02). The magnitude of the excess of ALS cases over the expected incidence increased during the 8-year period (Poisson trend test, p = 0.05), and the increase was not explained by a change in the interval from onset to diagnosis or by a change in the US population death rate of ALS in those aged <45 years.
Conclusions: The observed incidence of ALS in young Gulf War veterans exceeded the expected, suggesting a war-related environmental trigger.
This article has been cited by other articles:
|
|
|
|
 
B. A. Golomb
Correction for Golomb, "Reply to Blazer et al.: Flawed challenges to 'Acetylcholinesterase inhibitors and Gulf War illnesses',"
PNAS,
November 25, 2008;
105(47):
E94 - E94.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Golomb
Reply to Blazer et al.: Flawed challenges to "Acetylcholinesterase inhibitors and Gulf War illnesses"
PNAS,
August 19, 2008;
105(33):
E53 - E53.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. N. Valdmanis, E. Kabashi, A. Dyck, P. Hince, J. Lee, P. Dion, M. D'Amour, F. Souchon, J. -P. Bouchard, F. Salachas, et al.
Association of paraoxonase gene cluster polymorphisms with ALS in France, Quebec, and Sweden
Neurology,
August 12, 2008;
71(7):
514 - 520.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Golomb
Acetylcholinesterase inhibitors and Gulf War illnesses
PNAS,
March 18, 2008;
105(11):
4295 - 4300.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. A. Sutedja, J. H. Veldink, K. Fischer, H. Kromhout, J.H.J. Wokke, M. H.B. Huisman, D. J.J. Heederik, and L. H. Van den Berg
Lifetime occupation, education, smoking, and risk of ALS
Neurology,
October 9, 2007;
69(15):
1508 - 1514.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Abhinav, A. Al-Chalabi, T. Hortobagyi, and P N. Leigh
Electrical injury and amyotrophic lateral sclerosis: a systematic review of the literature
J. Neurol. Neurosurg. Psychiatry,
May 1, 2007;
78(5):
450 - 453.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Slowik, B. Tomik, P. P. Wolkow, D. Partyka, W. Turaj, M. T. Malecki, J. Pera, T. Dziedzic, A. Szczudlik, and D. A. Figlewicz
Paraoxonase gene polymorphisms and sporadic ALS
Neurology,
September 12, 2006;
67(5):
766 - 770.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Saeed, N. Siddique, W. Y. Hung, E. Usacheva, E. Liu, R. L. Sufit, S. L. Heller, J. L. Haines, M. Pericak-Vance, and T. Siddique
Paraoxonase cluster polymorphisms are associated with sporadic ALS
Neurology,
September 12, 2006;
67(5):
771 - 776.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. C Gray and H. K Kang
Healthcare utilization and mortality among veterans of the Gulf War
Phil Trans R Soc B,
April 29, 2006;
361(1468):
553 - 569.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R Rose and K. A. Brix
Neurological disorders in Gulf War veterans
Phil Trans R Soc B,
April 29, 2006;
361(1468):
605 - 618.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Sim and H. Kelsall
Gulf War illness: a view from Australia
Phil Trans R Soc B,
April 29, 2006;
361(1468):
619 - 626.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Kelsall, R. Macdonell, M. Sim, A. Forbes, D. McKenzie, D. Glass, J. Ikin, and P. Ittak
Neurological status of Australian veterans of the 1991 Gulf War and the effect of medical and chemical exposures
Int. J. Epidemiol.,
August 1, 2005;
34(4):
810 - 819.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Al-Chalabi and P. N. Leigh
Trouble on the pitch: are professional football players at increased risk of developing amyotrophic lateral sclerosis?
Brain,
March 1, 2005;
128(3):
451 - 453.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Beghi and K. E. Morrison
ALS and military service
Neurology,
January 11, 2005;
64(1):
6 - 7.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. G. Weisskopf, E. J. O'Reilly, M. L. McCullough, E. E. Calle, M. J. Thun, M. Cudkowicz, and A. Ascherio
Prospective study of military service and mortality from ALS
Neurology,
January 11, 2005;
64(1):
32 - 37.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Armon and R. W. Haley
Excess incidence of ALS in young Gulf War veterans
Neurology,
November 23, 2004;
63(10):
1986 - 1987.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. Rose, M. K. Sharief, J. Priddin, V. Nikolaou, L. Hull, C. Unwin, R. Ajmal-Ali, R. A. Sherwood, A. Spellman, A. David, et al.
Evaluation of neuromuscular symptoms in UK Gulf War veterans: A controlled study
Neurology,
November 9, 2004;
63(9):
1681 - 1687.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
ALS in Gulf War Veterans: More Data, but Questions Remain
Journal Watch Neurology,
December 12, 2003;
2003(1212):
5 - 5.
[Full Text]
|
|
|
|
|
|
|
Are Gulf War Veterans at Increased Risk for ALS?
Journal Watch (General),
October 14, 2003;
2003(1014):
3 - 3.
[Full Text]
|
|
|
|
|
|
|
M. R. Rose
Gulf War service is an uncertain trigger for ALS
Neurology,
September 23, 2003;
61(6):
730 - 731.
[Full Text]
[PDF]
|
|
|
Correspondence:
Read all Correspondence
- Excess incidence of ALS in young Gulf War veterans
- Carmel Armon, et al.
- Neurology Online, 19 Jun 2004
[Full text]
- Reply to Dr. Armon
- Robert W. Haley
- Neurology Online, 19 Jun 2004
[Full text]
|
