Spatial analysis of the etiology of amyotrophic lateral sclerosis among 1991 Gulf War veterans

Marie Lynn Miranda, M. Alicia Overstreet Galeano, Eric Tassone, Kelli D. Allen, Ronnie D. Horner

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


Background: Veterans of the 1991 Gulf War have an increased risk of amyotrophic lateral sclerosis (ALS), but the etiology is unknown. Objectives: This study sought to identify geographic areas with elevated risk for the later development of ALS among military personnel who served in the first Gulf War. Methods: A unified geographic information system (GIS) was constructed to allow analysis of secondary data on troop movements in the 1991 Gulf War theatre in the Persian Gulf region including Iraq, northern Saudi Arabia, and Kuwait. We fit Bayesian Poisson regression models to adjust for potential risk factors, including one relatively discrete environmental exposure, and to identify areas associated with elevated risk of ALS. Results: We found that service in particular locations of the Gulf was associated with an elevated risk for later developing ALS, both before and after adjustment for branch of service and potential of exposure to chemical warfare agents in and around Khamisiyah, Iraq. Conclusions: Specific geographic locations of troop units within the 1991 Gulf War theatre are associated with an increased risk for the subsequent development of ALS among members of those units. The identified spatial locations represent the logical starting points in the search for potential etiologic factors of ALS among Gulf War veterans. Of note, for locations where the relative odds of subsequently developing ALS are among the highest, specific risk factors, whether environmental or occupationally related, have not been identified. The results of spatial models can be used to subsequently look for risk factors that follow the spatial pattern of elevated risk.

Original languageEnglish (US)
Pages (from-to)964-970
Number of pages7
Issue number6
StatePublished - Nov 2008
Externally publishedYes


  • 1991 Gulf War
  • Amyotrophic lateral sclerosis
  • Environmental exposure
  • Geographic information systems
  • Spatial analysis

ASJC Scopus subject areas

  • General Neuroscience
  • Toxicology


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