Kang H K, Bullman T A
Department of Veterans Affairs, Environmental Epidemiology Service, Washington, DC 20036-3406, USA.
N Engl J Med. 1996 Nov 14;335(20):1498-504. doi: 10.1056/NEJM199611143352006.
Since the 1990-1991 Persian Gulf War, there has been persistent concern that U.S. war veterans may have had adverse health consequences, including higher-than-normal mortality.
We conducted a retrospective cohort study of postwar mortality according to cause among 695,516 Gulf War veterans and 746,291 other veterans. The follow-up continued through September 1993. A stratified, multivariate analysis (with Cox proportional-hazards models) controlled for branch of service, type of unit, age, sex, and race in comparing the two groups. We used standardized mortality ratios to compare the groups of veterans with the general population of the United States.
Among the Gulf War veterans, there was a small but significant excess of deaths as compared with the veterans who did not serve in the Persian Gulf (adjusted rate ratio, 1.09; 95 percent confidence interval, 1.01 to 1.16). The excess deaths were mainly caused by accidents (1.25; 1.13 to 1.39) rather than disease (0.88; 0.77 to 1.02). The corresponding rate ratios among 49,919 female veterans of the Gulf War were 1.32 (0.95 to 1.83) for death from all causes, 1.83 (1.02 to 3.28) for accidental death, and 0.89 (0.45 to 1.78) for death from disease. In both groups of veterans the mortality rates were significantly lower overall than those in the general population. The adjusted standardized mortality ratios were 0.44 (95 percent confidence interval, 0.42 to 0.47) for Gulf War veterans and 0.38 (0.36 to 0.40) for other veterans.
Among veterans of the Persian Gulf War, there was a significantly higher mortality rate than among veterans deployed elsewhere, but most of the increase was due to accidents rather than disease, a finding consistent with patterns of postwar mortality among veterans of previous wars.
自1990 - 1991年海湾战争以来，人们一直担心美国退伍军人可能会出现不良健康后果，包括死亡率高于正常水平。
我们对695,516名海湾战争退伍军人和746,291名其他退伍军人按死因进行了战后死亡率的回顾性队列研究。随访持续到1993年9月。在比较两组时，采用分层多变量分析（Cox比例风险模型）控制军种、部队类型、年龄、性别和种族。我们使用标准化死亡比来比较退伍军人组与美国普通人群。
与未在波斯湾服役的退伍军人相比，海湾战争退伍军人的死亡人数虽少但有显著增加（调整后的率比为1.09；95%置信区间为1.01至1.16）。死亡人数增加主要是由事故（1.25；1.13至1.39）而非疾病（0.88；0.77至1.02）导致。49,919名海湾战争女性退伍军人中，所有原因导致的死亡的相应率比为1.32（0.95至1.83），意外死亡为1.83（1.02至3.28），疾病死亡为0.89（0.45至1.78）。两组退伍军人的总体死亡率均显著低于普通人群。海湾战争退伍军人调整后的标准化死亡比为0.44（95%置信区间为0.42至0.47），其他退伍军人为0.38（0.36至0.40）。
在波斯湾战争退伍军人中，死亡率显著高于部署在其他地方的退伍军人，但增加的部分大多是由事故而非疾病导致，这一发现与以往战争退伍军人战后死亡率模式一致。
