Mortality of Multiple Sclerosis in Spain: Demonstration of a North-South Gradient

Llorca, Javier; Guerrero, Paula Barba; Prieto-Salceda, Dolores; Dierssen-Sotos, Trinidad

doi:10.1159/000083296

Cited by 15 publications

(5 citation statements)

References 27 publications

(10 reference statements)

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“…One study only reported mortality rates for age groups 12. No SMR was reported in two studies 13 14. One study was excluded due to reports of SMR for suicide only but not overall SMR 15.…”

Section: Resultsmentioning

confidence: 99%

Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios

Manouchehrinia

Tanasescu

Tench

et al. 2015

J Neurol Neurosurg Psychiatry

101

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“…One study only reported mortality rates for age groups 12. No SMR was reported in two studies 13 14. One study was excluded due to reports of SMR for suicide only but not overall SMR 15.…”

Section: Resultsmentioning

confidence: 99%

Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios

Manouchehrinia

Tanasescu

Tench

et al. 2015

J Neurol Neurosurg Psychiatry

101

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“…One of the most striking features of the epidemiology of multiple sclerosis (MS) is a positive latitudinal gradient in incidence, 1,2 prevalence 3 and mortality. 4 That is, MS becomes more common with increasing latitude, in both the northern and southern hemispheres. This pattern is thought to be largely due to genetic and environmental factors acting at the population level.…”

Section: Introductionmentioning

confidence: 99%

Latitudinal variation in incidence and type of first central nervous system demyelinating events

et al. 2010

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Increasing prevalence and variable geographic patterns of occurrence of multiple sclerosis suggest an environmental role in causation. There are few descriptive, population-level, data on whether such variability applies to first demyelinating events (FDEs). We recruited 216 adults (18-59 years), with a FDE between 1 November 2003 and 31 December 2006 in a multi-center incident case-control study in four locations on the south-eastern and eastern seaboard of Australia, spanning latitudes 27 degrees south to 43 degrees south. Population denominators were obtained from the Australian Bureau of Statistics censuses of 2001 and 2006. Age and sex adjusted FDE incidence rates increased by 9.55% (95% confidence interval (CI) 7.37-11.78, p < 0.001) per higher degree of latitude. The incidence rate gradient per higher degree of latitude varied by gender (male: 14.69% (95% CI 9.68-19.94, p < 0.001); female 8.13% (95% CI 5.69-10.62, p < 0.001)); and also by the presenting FDE type: optic neuritis 11.39% (95% CI 7.15-15.80, p < 0.001); brainstem/cerebellar syndrome 9.47% (95% CI 5.18-13.93, p < 0.001); and spinal cord syndrome 5.36% (95% CI 1.78-9.06, p = 0.003). Differences in incidence rate gradients were statistically significant between males and females (p = 0.02) and between optic neuritis and spinal cord syndrome (p = 0.04). The male to female ratio varied from 1 : 6.7 at 27 degrees south to 1 : 2.5 at 43 degrees south. The study establishes a positive latitudinal gradient of FDE incidence in Australia. The latitude-related factor(s) influences FDE incidence variably according to subtype and gender, with the strongest influence on optic neuritis presentations and for males. These descriptive case analyses show intriguing patterns that could be important for understanding the etiology of multiple sclerosis.

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“…The prevalence of MS has been shown to follow a north south gradient in its geographical distribution in several countries such as the USA (Wallin et al, 2004), Australia (van der Mei et al, 2001) and some European countries including France (Vukusic et al, 2007) and Spain (Llorca et al, 2005). In these countries, the prevalence of MS increased with latitude with lower prevalence rates in the more equatorial regions, however, there are exceptions, notably Norway (Kampman and Brustad, 2008).…”

Section: Discussionmentioning

confidence: 99%