Spatial Analysis of 1991 Gulf War Troop Locations in Relationship with Postwar Health Symptom Reports Using GIS Techniques

Spatial autocorrelation analysis was used to identify spatial patterns of 1991 Gulf War (GW) troop locations in relationship to subsequent postwar diagnosis of chronic multisymptom illness (CMI). Criteria for the diagnosis of CMI include reporting from at least two of three symptom clusters: fatigue, musculoskeletal pain, and mood and cognition. A GIS-based methodology was used to examine associations between potential hazardous exposures or deployment situations and postwar health outcomes using troop location data as a surrogate. GW veterans from the Devens Cohort Study were queried about specific symptoms approximately four years after the 1991 deployment to the Persian Gulf. Global and local statistics were calculated using the Moran's I and G statistics for six selected date periods chosen a priori to mark important GW-service events or exposure scenarios among 173 members of the cohort. Global Moran's I statistics did not detect global spatial patterns at any of the six specified data periods, thus, indicating there is no significant spatial autocorrelation of locations over the entire Gulf region for veterans meeting criteria for severe postwar CMI. However, when applying local G* and local Moran's I statistics, significant spatial clusters (primarily in the coastal Dammam/Dharhan and the central inland areas of Saudi Arabia) were identified for several of the selected time periods. Further study using GIS techniques, coupled with epidemiological methods, to examine spatial and temporal patterns with larger sample sizes of GW veterans is warranted to ascertain if the observed spatial patterns can be confirmed.