Amyotrophic lateral sclerosis among 1991 Gulf War veterans: Evidence for a time-limited outbreak

Ronnie D. Horner, Steven C. Grambow, Cynthia J. Coffman, Jennifer H. Lindquist, Eugene Z. Oddone, Kelli D. Allen, Edward J. Kasarskis

Research output: Contribution to journalArticlepeer-review

79 Scopus citations


Background: In follow-up to recent reports of an elevated risk of amyotrophic lateral sclerosis (ALS) among 1991 Gulf War veterans, we analyzed the distribution of disease onset times to determine whether the excess risk was time limited. Methods: This secondary analysis used data from a population-based series of ALS cases identified between 1991 and 2001 among the 2.5 million military personnel who were on active duty during the 1991 Gulf War. Annual standardized incidence ratios (SIR) were calculated for all cases and for those with disease onset before age 45 years. Results: Forty-eight of 124 cases occurred among those deployed to the Persian Gulf region during the war. The annual SIR for deployed military personnel did not demonstrate a monotonically increasing trend for either all cases (χ2 = 0.11, d.f. = 1, p = 0.74) or for cases under 45 years of age at onset (χ2 = 2.41, d.f. = 1, p = 0.12). The highest risk was observed in 1996, declining thereafter. Among military personnel who were not deployed to the Gulf region, the level of risk remained fairly constant during the 11-year period. Conclusions: The excess risk of ALS among 1991 Gulf War veterans was limited to the decade following the war.

Original languageEnglish
Pages (from-to)28-32
Number of pages5
Issue number1
StatePublished - Jul 2008

Bibliographical note

Funding Information:
It is a pleasure to thank Jenny Greene, Hung-Jin Huang, Cameron Liang, Michael Rauch and Mark Voit for helpful discussions on the interpretations of our main findings. We thank an anonymous referee for constructive comments that helped improve the presentation of the paper. HWC acknowledges the Aspen Center for Physics, which is supported by National Science Foundation grant PHY-1066293, and the organizers of the workshop on the Physics of Accretion and Feedback in the Circumgalactic Medium for a productive visit in 2015 June, during which components of the work presented were accomplished. We are grateful to the SDSS collaboration for producing and maintaining the SDSS public data archive. Funding for SDSS-III has been provided by the Alfred P. Sloan Foundation, the participating institutions, the National Science Foundation and the US Department of Energy Office of Science. The SDSS-III website is SDSS-III is managed by the Astrophysical Research Consortium for the participating institutions of the SDSS-III Collaboration including the University of Arizona, the Brazilian Participation Group, Brookhaven National Laboratory, Carnegie Mellon University, University of Florida, the French Participation Group, the German Participation Group, Harvard University, the Instituto de Astrofisica de Canarias, the Michigan State/Notre Dame/JINA Participation Group, Johns Hopkins University, Lawrence Berkeley National Laboratory, Max Planck Institute for Astrophysics, Max Planck Institute for Extraterrestrial Physics, New Mexico State University, New York University, Ohio State University, Pennsylvania State University, University of Portsmouth, Princeton University, the Spanish Participation Group, University of Tokyo, University of Utah, Vanderbilt University, University of Virginia, University of Washington and Yale University.


  • Amyotrophic lateral sclerosis
  • Gulf War
  • Motor neuron disease
  • Veterans

ASJC Scopus subject areas

  • Epidemiology
  • Clinical Neurology


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