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Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature
agents, and they have been used by many previous IOM committees.
CONCLUSION
The committee identified one high-quality cohort study3 that adequately controlled for confounding factors and reported a relationship between serving in the military and later development of ALS. Results of three other studies supported the association. One of the three4 was generally well conducted, but it was limited by the potential for underascertainment of cases in the comparison group. The other two5 had several methodologic limitations that made them less valuable for the committee’s evaluation. Another study6 did not report an association between military service and ALS; it also had methodologic limitations.
On the basis of its evaluation of the literature, thecommittee concludes that there is limited andsuggestive evidence of an association between militaryservice and later development of ALS.
3
Weisskopf MG, O’Reilly EJ, McCullough ML, Calle EE, Thun MJ, Cudkowicz M, Ascherio A. 2005. Prospective study of military service and mortality from ALS. Neurology 64(1):32–37.
4
Horner RD, Kamins KG, Feussner JR, Grambow SC, Hoff-Lindquist J, Harati Y, Mitsumoto H, Pascuzzi R, Spencer PS, Tim R, Howard D, Smith TC, Ryan MA, Coffman CJ, Kasarskis EJ. 2003. Occurrence of amyotrophic lateral sclerosis among Gulf War veterans. Neurology 61(6):742–749; Coffman CJ, Horner RD, Grambow SC, Lindquist J. 2005. Estimating the occurrence of amyotrophic lateral sclerosis among Gulf War (1990–1991) veterans using capture-recapture methods. Neuroepidemiology 24(3):141–150.
5
Haley RW. 2003. Excess incidence of ALS in young Gulf War veterans. Neurology 61(6):750–756; Smith TC, Gray GC, Knoke JD. 2000. Is systemic lupus erythematosus, amyotrophic lateral sclerosis, or fibromyalgia associated with Persian Gulf War service? An examination of Department of Defense hospitalization data. American Journal ofEpidemiology 151(11):1053–1059.
6
Kang HK, Bullman TA. 2001. Mortality among US veterans of the Persian Gulf War: 7-year follow-up. American Journal of Epidemiology 154(5):399–405.
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