Mortality among UK Gulf War veterans

Summary

Background

Armed forces personnel who served in the Gulf War report more current ill-health than those who were not deployed. There has been concern expressed that they may also experience higher mortality rates.

Methods

A retrospective cohort study was done including all 53 462 UK Gulf War veterans (Gulf cohort) and a comparison group equivalent in size of personnel who were not deployed but matched for age, sex, rank, service, and level of fitness (Era cohort). Individuals were identified on central registers of the Office for National Statistics and information on death among cohort subjects, including cause of death, obtained. Follow-up extended from April 1, 1991 (the end of the Gulf War) until March 31, 1999.

Findings

There were 395 deaths among the Gulf cohort and 378 deaths amongst the Era cohort (mortality rate ratio [MRR] 1·05, 95% CI 0·91–1·21). Mortality from “external” causes was higher in the Gulf cohort (Gulf 254, Era 216; MRR 1·18 [0·98–1·42] while mortality from “disease-related” causes was lower (Gulf 122, Era 141; 0·87 [0·67–1·11]). The higher mortality rate from “external” causes in the Gulf cohort was principally due to higher mortality rates from accidents. There was, however, no excess of deaths recorded as suicide in the Gulf cohort.

Interpretation

This follow-up of veterans of the Gulf war has shown, 8 years after the end of the conflict, that although they have experienced higher mortality rates than a comparison cohort, the excess mortality rate is very small and does not approach statistical significance. The excess is related mainly to accidents rather than disease, a pattern that is consistent both with US veterans of the Gulf war and veterans from other conflicts.

Introduction

There has been concern that armed forces personnel who served in the Gulf War during 1990-91 are currently experiencing an excess of ill-health. Studies among UK forces who served in the Gulf show that they do report more current ill-health than veterans who were not deployed.¹ The excess of ill-health spans a wide range of symptoms. Studies are on-going to find out whether deployment is associated with adverse reproductive outcomes and ill health among offspring.

During deployment in the Gulf, troops from the UK encountered a variety of environmental and physical exposures including smoke from oil-well fires, pesticides, nerve agent prophylaxis, and multiple inoculations.¹ In addition, adverse psychological experiences such as seeing maimed soldiers and dismembered bodies, and the threat of chemical attack have also been reported as common.¹ There is concern that not only may veterans be experiencing more ill-health as a result of such exposures but that they may also have higher mortality rates.

This study documents the mortality experience of 53 462 UK Gulf War veterans in the 8 years since the end of the war.