Long-term health outcomes and medical effects of torture among US Navy prisoners of war in Vietnam

Abstract

Objective: To characterize incidence of illnesses and injuries from 1979 to 1993 in former naval aviator prisoners of war (POWs) from the Vietnam War and a comparison group of naval aviators from the same war.

Design: Cohort analytic study.

Setting: A US Navy primary care clinic.

Participants: Volunteer sample consisting of 70 former naval aviator POWs (white men, aged 47 to 69 years in 1993) and a comparison group of 55 naval aviators who served in Vietnam but were not POWs, matched on race, age, marital status, education, rank, year of entry into the navy, and pilot status. Subjects participated in an annual health screening program. This study reports data sampled on a biennial basis from subjects screening both in 1979 and 1993.

Main outcome measure: Medically diagnosed incidence of illness and injury based on a standard protocol.

Results: POWs had higher incidence rates than the comparison group did of disorders of the peripheral nervous system (relative risk [RR], 8.4; 95% confidence interval [CI], 2.7-25.9; P<.001), joints (RR, 1.5; 95% CI, 1.2-2.0; P<.006), and back RR, 1.8; 5% CI, 1.0-3.0; P<.037). These findings also were statistically significant according to Kaplan-Meier survival analyses that included 131 (95%) of 138 POWs and 115 (83%) of the 138 members of the comparison group. Survival analyses revealed that, in addition to these disorders, POWs had higher hazard rates of peptic ulcer (P<.01).

Conclusions: During captivity, ropes, ratchet handcuffs, leg irons, or stocks were used to put tightly constrictive pressure around the extremities of POWs as a means of torture, resulting in painful ischemia and subsequent neuropathies. Being a former POW was associated with increased cumulative incidence rates of chronic disorders of the peripheral nervous system, joints, and back and an increased hazard rate of peptic ulcer.