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Writer James V. et al. Comparative Mortality Among U.S. Military Personnel in the Persian Gulf Region and Worldwide During Operations Desert Shield and Desert Storm. JAMA 1996; 275:118-121.

Analyzed were all deaths among active duty military, including activated members of the reserve components, between 1 August 1990 and 31 July 1991 reported to the DoD Worldwide Casualty System. Worldwide there were 1769 deaths among active duty military. 372 deaths occurred among servicemembers in the Gulf region. 147 occurred as the direct result of combat, 194 resulted from injuries not incurred in battle, and 30 resulted from illness. Of the 30 illness deaths, none was from cancer, 1 was from infectious disease, 2 were from cardiovascular causes, 21were initially described as unexpected/undefined, and 6 others died from miscellaneous causes. Of the 21unexpected deaths, autopsies were performed on 18 of the deceased. Findings at autopsy were: 13 had serious heart disease; 1 had pulmonary embolism from venous thrombosis in the leg; 1 died of ethanol toxicity and aspiration pneumonia; 1 from unintentional drug overdose; 1from gangrene of the bowel due to mesenteric volvulus; and, 1from a ruptured cerebral aneurysm. There was no excess risk for unexpected /undefined death among the deployed. Deaths from unintentional injury among the deployed exceeded the number expected based upon rates that obtained for the non- deployed. Limitations of this study: The databases used are not intended for use in medical research; the accuracy of the personnel data to determine who deployed had not been validated; there was some imprecision in the dates of deployment for many of the servicemembers.

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