Examining the current health of Gulf War veterans with the veterans affairs frailty index

Introduction: Gulf War Illness (GWI) is a chronic, multisymptom (e.g., fatigue, muscle/joint pain, memory and concentration difficulties) condition estimated to affect 25-32% of Gulf War (GW) veterans. Longitudinal studies suggest that few veterans with GWI have recovered over time and that deployed GW veterans may be at increased risks for age-related conditions. Methods: We performed a retrospective cohort study to examine the current health status of 703 GW veterans who participated in research studies at the San Francisco VA Health Care System (SFVAHCS) between 2002 and 2018. We used the Veterans Affairs Frailty Index (VA-FI) as a proxy measure of current health and compared the VA-FIs of GW veterans to a group of randomly selected ageand sex-matched, non-GW veterans. We also examined GW veterans' VA-FIs as a function of different GWI case definitions and in relationship to deploymentrelated experiences and exposures. Results: Compared to matched, non-GW veterans, GW veterans had lower VA-FIs (0.10 +/- 0.10 vs. 0.12 +/- 0.11, p < 0.01). However, the subset of GW veterans who met criteria for severe Chronic Multisymptom Illness (CMI) at the time of the SFVAHCS studies had the highest VA-FI (0.13 +/- 0.10, p < 0.001). GW veterans who had Kansas GWI exclusionary conditions had higher VA-FI (0.12 +/- 0.12, p < 0.05) than veterans who were Kansas GWI cases (0.08 +/- 0.08) and controls (i.e., veterans with little or no symptoms, 0.04 +/- 0.06) at the time of the SFVAHCS research studies. The VA-FI was positively correlated with several GW deployment-related exposures, including the frequency of wearing flea collars. Discussion: Although GW veterans, as a group, were less frail than non-GW veterans, the subset of GW veterans who met criteria for severe CDC CMI and/ or who had Kansas GWI exclusionary conditions at the time of the SFVAHCS research studies were frailest at index date. This suggests that many ongoing studies of GWI that use the Kansas GWI criteria may not be capturing the group of GW veterans who are most at risk for adverse chronic health outcomes.

Automated summary

This study aimed to analyze the health status of Gulf War veterans who participated in research studies at the San Francisco VA Health Care System. The study found that veterans with Gulf War Illness had poorer health status, and those with Kansas GWI exclusionary conditions had the poorest health status. Furthermore, factors related to deployment experiences and exposures were also associated with veterans' health status.