Health symptom trajectories and neurotoxicant exposures in Gulf War veterans: the Ft. Devens cohort

Background Thirty years ago, Gulf War (GW) veterans returned home with numerous health symptoms that have been associated with neurotoxicant exposures experienced during deployment. The health effects from these exposures have been termed toxic wounds. Most GW exposure-outcome studies utilize group analyses and thus individual fluctuations in symptoms may have been masked. This study investigates health symptom trajectories in the same veterans over 25 years. Methods Veterans were categorized into 5 a priori trajectory groups for each health symptom and Chronic Multisymptom Illness (CMI) clinical case status. Multinomial logistic regression models were used to investigate associations between these trajectories and neurotoxicant exposures. Results Results indicate that more than 21 Pyridostigmine Bromide (PB) pill exposure was associated with consistent reporting of fatigue, pain, and cognitive/mood symptoms as well as the development of six additional symptoms over time. Chemical weapons exposure was associated with both consistent reporting and development of neurological symptoms over time. Reported exposure to tent heater exhaust was associated with later development of gastrointestinal and pulmonary symptoms. Veterans reporting exposure to more than 21 PB pills were more than 8 times as likely to consistently meet the criteria for CMI over time. Conclusion This study highlights the importance of the continued documentation of the health impacts experienced by GW veterans', their resulting chronic health symptoms, and the importance of exposure-outcome relationships in these veterans now 30 years post-deployment.

Automated summary

This study examines the health symptom trajectories of Gulf War veterans over a 25-year period. The findings suggest that exposure to Pyridostigmine Bromide (PB) pills and chemical weapons is associated with consistent reporting and development of various symptoms over time. Furthermore, exposure to tent heater exhaust is related to the later development of gastrointestinal and pulmonary symptoms. Veterans who reported exposure to more than 21 PB pills were significantly more likely to consistently meet the criteria for Chronic Multisymptom Illness (CMI).