Li, Bo, Mahan, Clare M, Kang, Han K et al. · American journal of epidemiology · 2011 · DOI
This study followed US veterans from the 1991 Gulf War for 10 years (1995–2005) to see how their health changed over time. Deployed veterans reported more ongoing health problems, including chronic fatigue syndrome-like illness, than veterans who were not deployed. By 2005, deployed veterans were also more likely to develop new health problems compared to nondeployed veterans.
This study is important because it provides long-term evidence that Gulf War-related illnesses, including chronic fatigue syndrome-like illness, persist and worsen over time in deployed populations. For ME/CFS research, it demonstrates how environmental or occupational exposures can trigger sustained, progressive health decline in specific cohorts, offering insights into disease trajectory and the importance of longitudinal follow-up.
This study does not prove what caused the health problems in deployed veterans—only that deployed veterans experienced worse outcomes than nondeployed veterans. It does not establish whether chronic fatigue syndrome-like illness is the same as ME/CFS as clinically defined today, nor does it prove causation from specific Gulf War exposures. The observational design means other unmeasured factors could explain some of the health differences.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Li, Bo, Mahan, Clare M, Kang, Han K, Eisen, Seth A, & Engel, Charles C (2011). Longitudinal health study of US 1991 Gulf War veterans: changes in health status at 10-year follow-up.. American journal of epidemiology. https://doi.org/10.1093/aje/kwr154
BibTeX
@article{mecfsatlas-li-2011-longitudinal-health,
author = {Li, Bo and Mahan, Clare M and Kang, Han K and Eisen, Seth A and Engel, Charles C},
title = {Longitudinal health study of US 1991 Gulf War veterans: changes in health status at 10-year follow-up.},
journal = {American journal of epidemiology},
year = {2011},
doi = {10.1093/aje/kwr154},
note = {PubMed: 21795757},
url = {https://www.mecfsatlas.com/evidence/li-2011-longitudinal-health},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/li-2011-longitudinal-health
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