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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
Copyright:Attribution Non-commercial


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One of the major limitations of the present study is the small sample size and the young age of
the participants. These two factors led to a low number of events that may have reduced the
power of the study to detect group differences in cause-specific mortality and in specific types of
cancer incidence. The sample size was also a factor in the analysis with the early and late period.
However, the power of the study was sufficient to detect differences between the cohorts on
overall mortality and cancer incidence and, in general, the results are consistent with those of
other, much larger cohort studies from the US and the UK.
The entire follow-up period may have been too short to detect certain cancers and certain cause
specific mortality such as deaths attributed to cardiovascular disease. The late follow-up period
was probably too close to the final reference date for some long-term risk effects to be manifest.
It is possible that the deployed cohort was healthier than the comparison cohort because of the
pre-deployment screening process. In contrast, the inclusion of subjects who were medically unfit
for deployment may have introduced some noise in the comparison. While, the amount of error
would be small, it might have pulled the estimates towards the null value, leading to an under-
estimation of the effect of deployment on health.
There was a paucity of exposure information available for analysis. Less than half of the
Deployed cohort was present in the Gulf War during the period of actual fighting but it was not
possible to identify the military personnel who were there during that time. The analyses did not
control for command or element (e.g., air force, navy or army) or MOC that differed between the
study groups. Therefore, the comparability in terms of risk of the Deployed and Non-deployed
cohort may have been compromised.
Likewise deployment history and number of deployments were not considered in the analyses.
Therefore, information on physical exposures (e.g., chemicals, immunization) or stress could not
be inferred. All members of the Deployed cohort would have had moderate exposure to
psychological stresses as evidenced by the higher rates of PTSD in military personnel having had
multiple deployments (Statistics Canada, 2003). It is likely that the Non-deployed cohort would
have had similar exposure due to other deployments. This may have compromised the
comparability of the two cohorts, reduced the effect of deployment to the Persian Gulf, or masked
between cohort differences in mortality and cancer incidence.

Canadian Gulf War Veterans



The mortality and cancer incidence results could not be adjusted for individual behaviours such
as smoking, heavy drinking or drug use. Hence, it is possible that the overall negative results
might be masking a deployment risk differential if the two cohorts differed on health-related
behaviours. However, according to the GG survey, which used the same study group, self-
reported smoking and alcohol intake did not differ between the Deployed and Non-deployed
In addition to the lack of information on individual behaviours, one major limitation in interpreting
the cancer incidence data is the lack of information on occupational exposure to specific potential
carcinogens. Moreover, it is possible that the members of the two cohorts differed on their
degree of cancer risk.
At the same time, comparisons between military and civilian population within a country are
subject to the healthy worker effect. Similarly, it is possible that either of the cohorts might exhibit
risk behaviours that differ from those of the general Canadian population (e.g. differential smoking
prevalence). This would compromise the interpretation of the SIR as well.
Although the power of the study was estimated to be sufficient to detect some outcomes, it may
have been overestimated in the cancer incidence component as the follow-up period is
comparatively short. There can be a substantial lag between exposure and the development of
cancer. In many cases (e.g., cigarette smoking and lung cancer), this lag is partly due to the
need to accumulate sufficient exposure to produce the DNA damage required for malignant
transformation. Once a malignant clone has become established, time is required for the tumour
to develop blood supply and grow to a detectable size. Leukemia and lymphoma frequently have
the shortest lag time between exposure and onset. However, even following major radiation
exposures, a five-year lag is common.
On the one hand, the number of tests that were done does not permit one to rule out that the
significant findings of this study are the result of chance. On the other hand, the present study
has the potential for failing to find significant differences because the number of events was
small, especially when cause specific outcomes were analyzed. The 95% confidence intervals
provide an empirical estimate of the size of difference that might have been missed by the study.
In many cases, these confidence intervals were large, suggesting that it is possible that the study
might have missed a large impact on mortality or cancer incidence. However, the differences in
overall mortality and cancer incidence between the deployed and non-deployed cohorts were
estimated with a sufficient number of events to rule out a large impact of deployment on these
two indicators.

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