Health-Related Quality of Life by Gulf War Illness Case Status

Elizabeth J Gifford, Stephen H Boyle, Jacqueline Vahey, Kellie J Sims, Jimmy T Efird, Blair Chesnut, Crystal Stafford, Julie Upchurch, Christina D Williams, Drew A Helmer, Elizabeth R Hauser, Elizabeth J Gifford, Stephen H Boyle, Jacqueline Vahey, Kellie J Sims, Jimmy T Efird, Blair Chesnut, Crystal Stafford, Julie Upchurch, Christina D Williams, Drew A Helmer, Elizabeth R Hauser

Abstract

This study examines how health-related quality of life (HRQOL) and related indices vary by Gulf War illness (GWI) case status. The study population included veterans from the Gulf War Era Cohort and Biorepository (n = 1116). Outcomes were physical and mental health from the Veterans RAND 12 and depression, post-traumatic stress (PTSD), sleep disturbance, and pain. Kansas (KS) and Centers for Disease Control and Prevention (CDC) GWI definitions were used. Kansas GWI derived subtypes included GWI (met symptom criteria; no exclusionary conditions (KS GWI: Sym+/Dx−)) and those without GWI: KS noncase (1): Sym+/Dx+, KS noncase (2): Sym−/Dx+, and noncase (3): Sym−/Dx−. CDC-derived subtypes included CDC GWI severe, CDC GWI mild-to-moderate and CDC noncases. Case status and outcomes were examined using multivariable regression adjusted for sociodemographic and military-related characteristics. Logistic regression analysis was used to examine associations between GWI case status and binary measures for depression, PTSD, and severe pain. The KS GWI: Sym+/Dx− and KS noncase (1): Sym+/Dx+ groups had worse mental and physical HRQOL outcomes than veterans in the KS noncase (2): Sym−/Dx+ and KS noncase (3): Sym−/Dx− groups (ps < 0.001). Individuals who met the CDC GWI severe criteria had worse mental and physical HRQOL outcomes than those meeting the CDC GWI mild-to-moderate or CDC noncases (ps < 0.001). For other outcomes, results followed a similar pattern. Relative to the less symptomatic comparison subtypes, veterans who met the Kansas symptom criteria, regardless of exclusionary conditions, and those who met the CDC GWI severe criteria experienced lower HRQOL and higher rates of depression, PTSD, and severe pain.

Keywords: Gulf War illness; depression; health-related quality of life; pain; post-traumatic stress disorder; sleep disturbance.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Adjusted boxplots of Health-related Quality of Life measures by Gulf War illness case status. Note: Model adjusted for age (continuous), sex, race/ethnicity, education, income, deployment status, military component, and military branch (see Tables S4 and S5 for regression coefficients). Mean differences were compared across categories within the Kansas definition and alternatively across categories within the CDC definition. Comparisons were made to GWI for Kansas and for CDC GWI severe for CDC GWI categories. All differences were statistically significant (p < 0.001); sleep disturbance total score did not differ between KS GWI: Sym+/Dx− and KS noncase (1) Sym+/Dx+. GWI = Gulf War illness; PTSD = post-traumatic stress disorder; Sym = symptom criteria; Dx = Diagnoses.
Figure 2
Figure 2
Proportion of GWECB Veterans meeting depression, post-traumatic stress disorder, and severe pain cutpoints by GWI Case Status, adjusted for demographic and characteristics of military service. Note: All values were suppressed due to fewer than ≤10) people in cell sizes for (a) KS noncase (2) Sym−/Dx+, (b) KS noncase (3) Sym−/Dx−, and (c) CDC noncases.

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