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The Canadian Persian Gulf Cohort Study

The Canadian Persian Gulf Cohort Study

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The Canadian Persian Gulf Cohort Study
The Canadian Persian Gulf Cohort Study

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Published by: Canadian_Veterans_Ad on Jan 05, 2012
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Canadian Gulf War Veterans 02/11/20051 
The Canadian Persian Gulf Cohort Study:
Detailed Report
Prepared by Statistics CanadaFor the Gulf War Veterans Cohort Study Advisory Committee
Canadian Gulf War Veterans 02/11/20052 
Statistics Canada wishes to acknowledge the work of Dr. Nicolas Birkett who was the mainconsultant on the project. Members of the Gulf War Veterans Cohort Study Advisory Committeeprovided valuable input into the study process and included representatives from the Gulf War Veterans Association, Veterans Affairs Canada, the Ombudsman’s office of the Department of National Defence and the Department of National Defence.To enquire about the concepts, methods and data quality please contact Client and TechnicalServices at 613-951-1746, Health Statistics Division, Statistics Canada. For all other enquiries,please contact the Department of National Defence, Canadian Forces Media Liaison Office at613-996-2353 or 613-996-2354.
Canadian Gulf War Veterans 02/11/20053
Executive Summary
The Gulf and Kuwait War of 1990/91 officially began with the invasion of Kuwait by Iraq onAugust 2, 1990. The Canadian military participated actively in the subsequent blockade and war initially contributing three ships committed on August 24, 1990. Between this date and February28, 1991 that marked the end of the war, Canada deployed 5,100 military personnel (soldiers,sailors and airmen). Canada’s contribution consisted of one headquarters, a naval task force, anair task group, a field hospital, two infantry companies and a platoon that provided security for thegroup of airmen, the hospital and the headquarters.Since the end of the war, concerns have been expressed about the health of veterans who weredeployed to the Persian Gulf. These concerns related partly to the general circumstances of deployment to a war zone and partly to the unique factors to which these veterans may havebeen exposed, including anti-chemical warfare substances, various immunizations and thepossibility of exposure to low-level chemical and biological warfare agents. In this study, the term“veterans” refers to retired and currently serving members of the Canadian military.In 1997, the Department of National Defence (DND) commissioned a survey on the health statusof Canadian Gulf and Kuwait War veterans (Gilroy, 1998). Results from the survey indicated that,when compared to the active Canadian Forces (CF) members who were not deployed to the Gulf,Gulf and Kuwait War veterans had a higher prevalence of self-reported health problems includingdiseases of bones and joints, digestive system, skin, and respiratory system. They also had ahigher prevalence of chronic fatigue symptoms, cognitive dysfunction, major depression, PostTraumatic Stress Disorder (PTSD), anxiety and fibromyalgia.The long-term health ramifications of deployment to a war zone have yet to be studied amongCanadian Gulf and Kuwait War veterans. Results from an American study (Kang & Bullman,1996) indicated that United States (US) Gulf War veterans had higher death rates from motor vehicle accidents, particularly in the first 2 to 3 years after they returned from the Persian Gulf.However, there was no evidence of an increased risk of diseases. Similar mortality patterns werefound in a mortality study of United Kingdom (UK) Gulf War Veterans (MacFarlane, Thomas &Cherry, 2000) A recent UK study of cancer incidence reported no evidence of an increase incancer incidence in UK military personnel deployed to the Persian Gulf (MacFarlane, Biggs,Maconochie et al., 2003).In 2000, the Gulf and Kuwait War Illness Advisory Committee commissioned a report to explorethe feasibility of undertaking a study on the mortality and cancer incidence of military personnelposted to the Persian Gulf based on record-linkage methodology (Birkett, 2000). It wasconcluded, in the feasibility report, that a cohort study using this methodological approach wasfeasible and warranted and that the statistical power of study was deemed sufficient to detectdifferences between military groups in the “overall” risk of death and “overall” risk of developingcancer over the proposed 9-year follow-up. The proposed study had an 80% power to detectaround a 60% increase in overall mortality (RR=1.63) and a 75% increase in overall cancer incidence (RR=1.75). The lower power for cancer outcomes reflects the shorter follow-up of 7years instead of 9 years.The main objective of this study, as was proposed in the feasibility report, was to determine if military personnel deployed to the Persian Gulf between August 24, 1990 and September 30,1991 were at a higher risk of death or of developing cancer after their return to Canada thaneither other members of the military who were not deployed to the Persian Gulf or the generalCanadian public. The availability, in Canada, of a national mortality database as well as a nationalcancer registry provided a unique opportunity to examine this cohort for higher than expectedrates of mortality and cancer incidence using record linkage methodology.This report describes the results of analyses, based on a nine-year follow-up (1991-1999), onmortality and cancer incidence among Canadian Gulf and Kuwait War veterans. Two cohortswere established. The final Deployed cohort consisted of 5,117 CF members sent to the Gulf between August 1990 and October 1991. The comparison cohort consisted of 6,093 members of the Canadian Forces who were eligible for deployment at the time of the 1990/91 Gulf and KuwaitWar but who were not deployed. The age-sex distribution of the Non-deployed cohort waschecked to ensure that it matched the distribution of the Deployed cohort. Record linkagemethodology was used to identify deaths and incident cases of cancer in the two cohorts. In total,

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