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Multisymptom Illness in Gulf War Veterans: A Systematic Review and Meta-Analysis

Gwini, Stella M. MSc; Forbes, Andrew B. PhD; Sim, Malcolm R. PhD; Kelsall, Helen L. PhD

Journal of Occupational and Environmental Medicine: July 2016 - Volume 58 - Issue 7 - p 659–667
doi: 10.1097/JOM.0000000000000755

Objective: The aim of this study was to conduct a systematic review and meta-analysis of multisymptom illness (MSI) in 1990 to 1991 Gulf/Afghanistan/Iraq War veterans.

Methods: Electronic databases were searched from January 1990, June 2014 for studies on MSI prevalence in Gulf/Afghanistan/Iraq War veterans, based on the Centers for Disease Control and Prevention MSI case definition, and which included a military comparison group.

Results: Seven studies were identified among US, UK, and Australian Gulf War veterans; no studies were identified in Afghanistan/Iraq War veterans. MSI prevalence in Gulf War veterans and comparison groups ranged from 26 to 65% and from 12 to 37%, respectively. More recent studies were larger, with improved designs. The pooled odds ratio comparing Gulf War veterans to other military groups was 2.74 (95% confidence interval 2.15 to 3.51).

Conclusion: The systematic review showed that MSI was most prevalent in Gulf War veterans, emphasizing the health burden of MSI in this veteran population.

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Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia.

Address correspondence to: Stella M. Gwini, MSc, Monash University, Department of Epidemiology and Preventive Medicine, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia (

This study was funded by Australian Department of Veterans’ Affairs (grant ARP1122) and an Australian Postgraduate Award (grant 120636).

While this journal article has been produced using funding provided by the Australian Government Department of Veterans’ Affairs, the views expressed do not necessarily represent the views of the Minister for Veterans’ Affairs or the Department of Veterans’ Affairs. The Commonwealth does not give any warranty nor accept any liability in relation to the contents of this work.

Authors Gwini, Forbes, Sim, and Kelsall have no relationships/conditions/circumstances that present potential conflict of interest.

The JOEM editorial board and planners have no financial interest related to this research.

(C) Commonwealth of Australia 2016. This work is copyright. Apart from any use as permitted under the Copyright Act 1968 (Cth), no part may be reproduced without prior written permission. Requests and enquiries concerning reproduction and rights should be directed in the first instance to Wolters Kluwer Health Inc., the American College of Occupational and Environmental Medicine or to the Australian Department of Veterans’ Affairs.

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Copyright © 2016 by the American College of Occupational and Environmental Medicine