ALS Prevalent Among Young Veterans Deployed in Post-9/11 U.S. Wars, Study Shows

ALS Prevalent Among Young Veterans Deployed in Post-9/11 U.S. Wars, Study Shows

Amyotrophic lateral sclerosis (ALS) is highly prevalent among young U.S. war veterans deployed post-9/11, particularly Air Force personnel, tactical operation officers, and health care workers, a recent study suggests.

The findings suggest that there is an early onset of ALS among deployed military service members, the researchers said.

Titled “Amyotrophic Lateral Sclerosis Among Veterans Deployed in Support of Post-9/11 U.S. Conflicts,” the study was published in the journal Military Medicine.

U.S. military service has long been recognized as a risk factor for the development of ALS, a progressive neurological disease. This increased risk was found in studies conducted among Gulf War veterans (GWV), as well as military veterans who had served in previous wars.

In fact, the average case rate of ALS among deployed GWV is 6.7 per million compared with 3.5 per million among individuals who were not deployed. The average annual cumulative incidence is 0.43 per 100,000 persons in the GWV population.

Most studies to date on the ALS risk have been limited to veterans who served in the Gulf War and include only a small sample of participants who served in post-9/11 U.S. wars in Iraq and Afghanistan.

Importantly, post-9/11 veterans differ from other war era veterans in regard to age, severity of injury, disability, and survival. These new veterans also have unique occupational exposures that may result in a higher risk for ALS.

However, there has been no research on the occurrence of — and risk factors associated with — ALS specific to post-9/11 deployed U.S. war veterans.

Now, a group of American researchers set out to identify the prevalence of ALS among these veterans. The team also sought to determine whether there were any certain patient characteristics, such as traumatic brain injury (TBI) or military branch or occupation, that were associated with a higher risk for ALS.

TBI has been considered a possible trigger for ALS, the researchers noted.

“Given the relatively high prevalence of TBI among Post-9/11 deployed U.S. war Veterans, it is important to examine the association of TBI with ALS in this population,” they said.

The researchers also adjusted the results for demographics and concurrent conditions previously associated with ALS, specifically metabolic disorders such as diabetes and dyslipidemia, cancer, and cardiac and cerebrovascular diseases. The results also were adjusted for other concurrent conditions common among veterans such as post-traumatic stress disorder (PTSD), depression, and anxiety.

The study included veterans deployed in support of post-9/11 conflicts who received care in the Veterans Health Administration (VHA) during the fiscal years of 2002–2015. Inpatient and outpatient data, pharmacy records, and Veterans Benefits Administration were reviewed for a total of 1,149,620 veterans. Definite ALS was found in 139 veterans, with a median age of 39.7 years.

The results indicated that the prevalence of ALS was 19.7 per 100,000 over 14 years.

This rate is significantly higher compared with the ALS prevalence reported among deployed GWV, which was 5.8 per 100,000 over 10 years after the Gulf War.

The new findings also indicate a higher estimated prevalence than that reported by the Agency for Toxic Substances and Disease Registry (ATSDR). Using the National ALS Registry, that agency demonstrated that the rate of ALS in people under the age of 60 was 11.5 per 100,000 persons in 2015. However, “our findings may not be comparable due to methodological and cohort characteristics,” the researchers said.

Interestingly, both the prevalence and cumulative incidence of definite ALS were significantly higher among Air Force personnel, tactical operation officers, and health care workers compared with general officers and administrators.

“This suggests the need for evaluating the role of occupational exposures these personnel are exposed to, such as ionizing radiation, electromagnetic fields, ozone, jet emissions, noise etc., in the pathogenesis of ALS,” the researchers said.

Such evaluation is particularly important since electromagnetic fields, high-intensity radar waves, diesel exhaustion, and electric shock have previously been reported to be risk factors for ALS.

Consistent with previous studies, there was a lower prevalence rate of ALS among Marines.

Neither TBI nor younger age, defined as younger than 45 years old, were associated with ALS. On the other hand, also consistent with previous literature, the researchers found an elevated risk for men and Caucasians.

Depression, cardiac disease, cerebrovascular disease, high blood pressure, and obstructive sleep apnea were found to be significantly associated with ALS in this population of veterans.

“This study among a cohort of relatively young Veterans showed a high ALS prevalence, suggesting an early onset of ALS among deployed military service members,” the researchers said.

“Research examining military risk factors and occupational exposures that lead to early onset of ALS is needed to determine if occupational safety approaches can reduce risk for this terminal disease,” they added.

“Furthermore, there is a need for future ALS surveillance measures in this population as more cases of ALS may develop with the aging of this cohort,” the researchers said.

Iqra holds a MSc in Cellular and Molecular Medicine from the University of Ottawa in Ottawa, Canada. She also holds a BSc in Life Sciences from Queen’s University in Kingston, Canada. Currently, she is completing a PhD in Laboratory Medicine and Pathobiology from the University of Toronto in Toronto, Canada. Her research has ranged from across various disease areas including Alzheimer’s disease, myelodysplastic syndrome, bleeding disorders and rare pediatric brain tumors.
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Margarida graduated with a BS in Health Sciences from the University of Lisbon and a MSc in Biotechnology from Instituto Superior Técnico (IST-UL). She worked as a molecular biologist research associate at a Cambridge UK-based biotech company that discovers and develops therapeutic, fully human monoclonal antibodies.
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Iqra holds a MSc in Cellular and Molecular Medicine from the University of Ottawa in Ottawa, Canada. She also holds a BSc in Life Sciences from Queen’s University in Kingston, Canada. Currently, she is completing a PhD in Laboratory Medicine and Pathobiology from the University of Toronto in Toronto, Canada. Her research has ranged from across various disease areas including Alzheimer’s disease, myelodysplastic syndrome, bleeding disorders and rare pediatric brain tumors.
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6 comments

  1. Dave Reckonin says:

    Did Vets from WW2 show a higher prevalence of ALS ? Or Vets returning from Vietnam ?

    Post 9/11 Vets are an interesting group.
    I wonder why the toxic adjuvents in innoculations given to combat troops and support staff going to Iraq, Afghanistan etc are not being looked at.
    Gulf War Syndrome is a problem area and has neurological implications.
    Adjuvents in non-military persons receiving anti-viral inoculations should be looked at and cleared of suspicion…. or …..otherwise evaluated.
    You see where I’m going with this.

  2. Howard Lubow,RN says:

    Interesting thought.MDs in France were curing polio,late ’40s,early’50s, w/Magnesium chloride in water.See ‘polio/pesticides’dating to intro of arsenical compounds in late 19th century.

  3. Donald Brooks says:

    I was Air Force. I am ALS but the questions remain. Why?
    Jobs that involve adrenaline rushes over period of time. In the Middle East the commanders sent convoy after convoy down the same road only to blasted off the highway by devices planted overnight. Dummer than dumb. (But leaders of Vietnam War sent B-52 after B-52 into heavy AA fire along the same path at the same altitude as prior attacks, after heavy losses they changed) adrenaline had to be pounding away day after day. Fear or strong concern does trigger things of the mind.

  4. Debbie Chalk says:

    My husband died of ALS 2 years ago at 64. He was shot in the head when he was 16 in a hunting accident. He would get terrible cramps in his leg at night for years. No one knows what causes cancer, but they are finding cures. Please find a cure for A L S. These are old percents for how many people have ALS. Many are unreported.

  5. EricALS says:

    Men are more likely to get ALS. I feel like the attention and funding this disease deserves doesn’t get the necessary funding. Im happy to see certain diseases like breast cancer make big progress, but it seems it’s in the media attention and full support for decades now. While the only big event for ALS awareness was the bucket challenge many years ago. I want to see more progress for ALS

  6. My brother is a Viet Nam Marine Corp vet and has end stage ALS. He was involved in active combat, exposed to Agent Orange and was diagnosed over two years ago. He has just turned 71 and is in a VA nursing home in Missouri at this time. Up to now he has been very healthy and has not suffered any serious conditions of any kind. At the end of his military tour he was injured by explosives and has shrapnel buried throughout his body. There are over 200 veterans residing at this facility and he is the only one there currently with ALS.

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