Annual incidence, prevalence, and mortality of multiple sclerosis in white South-African-born and in white immigrants to South Africa.

Dean, Geoffrey

doi:10.1136/bmj.2.5554.724

Cited by 209 publications

(88 citation statements)

References 13 publications

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“…Previous studies on MS prevalence had shown that MS was more common among the English-speaking than among the Afrikaans-speaking white South African-born and perhaps this also occurred in MND. 10 To find out how frequently MND was noted on the death certificate, after it had been diagnosed during life, we obtained lists of patients diagnosed as having MND from the teaching hospitals of Groote Schuur and Belville, at the Cape, and at the General Hospital, Johannesburg. We ascertained from the Population Registrar which of these patients had died and how the death had been reported on the death certificate.…”

Section: Methodsmentioning

confidence: 99%

Motor neuron disease and multiple sclerosis mortality in Australia, New Zealand and South Africa compared with England and Wales.

Dean

Elian

1993

Journal of Neurology, Neurosurgery & Psychiatry

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There has been a marked increase in the reported mortality from motor neuron disease (MND) but not multiple sclerosis (MS) in England and Wales and in a number of other countries. A comparison has been made of the mortality from MND and from MS for two time periods in Australia, New Zealand and South Africa. An increase in MND mortality occurred in Australia and New Zealand between 1968-77 and 1978-87, greater than that which occurred in England and Wales, but there was no increase in MS mortality. Among the white population of South Africa, the MND mortality was half of that in England and Wales, Australia and New Zealand in both time periods. Both MND and MS mortality is higher in the English-speaking than in the Afrikaans-speaking white South African-born. The marked increase in MND mortality which has now been reported from many countries, is good evidence that an environmental factor is important in causing this disease. The large differences in MND mortality in different populations may be important clues to the environment factors causing the disease. (7 Neurol Neurosurg Psychiatry 1993;56:633-637) study, 1978-87 and also for the two subsequent years, 1988-89. A total of 94 4% of the MND and 89% of the MS death certificates were traced. Previous studies on MS prevalence had shown that MS was more common among the English-speaking than among the Afrikaans-speaking white South African-born and perhaps this also occurred in MND.10To find out how frequently MND was noted on the death certificate, after it had been diagnosed during life, we obtained lists of patients diagnosed as having MND from the teaching hospitals of Groote Schuur and Belville, at the Cape, and at the General Hospital, Johannesburg. We ascertained from the Population Registrar which of these patients had died and how the death had been reported on the death certificate. The death certificates of 126 white patients diagnosed as having MND at three teaching hospitals in South Africa were traced. Among them, MND was reported as the primary cause of death in 81 or 64-3%, and as a contributory cause of death in 16 or 12-7%, compared with 68-3% and 113% in England and Wales." Previous studies have shown that MS is reported on the death certificate as frequently, when diagnosed during life, in South Africa'0 as in England and Wales."Results were expressed as standardised mortality ratios (SMR) with rates from England and Wales taken as the standard. Confidence limits for SMRs were based on the exact method using the Poisson distribution. Statistical significance of an SMR was inferred if the relevant confidence interval (95% for p < 0-05; 99% for p < 0.01) did not include the null value of 100. Confidence intervals for the ratio of two SMRs in different groups was made using the binomial dis-633 on 10 May 2018 by guest. Protected by copyright.

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Section: Methodsmentioning

confidence: 99%

Motor neuron disease and multiple sclerosis mortality in Australia, New Zealand and South Africa compared with England and Wales.

Dean

Elian

1993

Journal of Neurology, Neurosurgery & Psychiatry

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“…A similar phenomenon was seen when people born in the United Kingdom (UK: a high MS country) migrated to South Africa (SA: a low MS country). Migration from the UK to SA was protective when the migrant was a child, whereas adult migrants retained their high UK prevalence of MS (Dean, 1967). Analysis of this and other studies suggests that the environmental factors that protect from or predispose to MS act during the first two decades of life (Gale and Martyn, 1995;Milo and Kahana, 2010).…”

Section: Immigrationmentioning

confidence: 98%

Hygiene and Other Early Childhood Influences on the Subsequent Function of the Immune System

Rook

2012

Immunity to Parasitic Infection

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Hygiene Depression a b s t r a c tThe immune system influences brain development and function. Hygiene and other early childhood influences impact the subsequent function of the immune system during adulthood, with consequences for vulnerability to neurodevelopmental and psychiatric disorders. Inflammatory events during pregnancy can act directly to cause developmental problems in the central nervous system (CNS) that have been implicated in schizophrenia and autism. The immune system also acts indirectly by "farming" the intestinal microbiota, which then influences brain development and function via the multiple pathways that constitute the gut-brain axis. The gut microbiota also regulates the immune system.Regulation of the immune system is crucial because inflammatory states in pregnancy need to be limited, and throughout life inflammation needs to be terminated completely when not required; for example, persistently raised levels of background inflammation during adulthood (in the presence or absence of a clinically apparent inflammatory stimulus) correlate with an increased risk of depression. A number of factors in the perinatal period, notably immigration from rural low-income to rich developed settings, caesarean delivery, breastfeeding and antibiotic abuse have profound effects on the microbiota and on immunoregulation during early life that persist into adulthood. Many aspects of the modern western environment deprive the infant of the immunoregulatory organisms with which humans co-evolved, while encouraging exposure to nonimmunoregulatory organisms, associated with more recently evolved "crowd" infections.

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“…The seminal work of McLeod and Kurtzke in the US Veteran's (VA) studies [2,3] quantitated the geography of MS, having been set in motion by Dean's work in South Africa [4]. There can be no question about the importance of early exposure from this work, materially supplemented by the differences in VA prevalence based on region of birthplace, enlistment, and residence [3].…”

mentioning

confidence: 99%

Editorial regarding “Explaining multiple sclerosis prevalence by ultraviolet exposure: a geospatial analysis,” by Beretich and Beretich

Ebers

2009

Mult Scler

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Annual incidence, prevalence, and mortality of multiple sclerosis in white South-African-born and in white immigrants to South Africa.

Cited by 209 publications

References 13 publications

Motor neuron disease and multiple sclerosis mortality in Australia, New Zealand and South Africa compared with England and Wales.

Motor neuron disease and multiple sclerosis mortality in Australia, New Zealand and South Africa compared with England and Wales.

Hygiene and Other Early Childhood Influences on the Subsequent Function of the Immune System

Editorial regarding “Explaining multiple sclerosis prevalence by ultraviolet exposure: a geospatial analysis,” by Beretich and Beretich

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