Multiple sclerosis in US veterans of the Vietnam era and later military service: Race, sex, and geography

Abstract

We identified 5345 cases of multiple sclerosis (MS) among US veterans who first entered military service between 1960 and 1994, and who were "service-connected" for MS by the Department of Veterans Affairs (VA). Two controls per case were matched on age, date of service entry, and branch of service. Available for service and VA files were demographic and military data for 4951 cases and 9378 controls. Versus white men, relative risk of MS was significantly higher for all women, at 2.99 for whites, 2.86 for blacks, and 3.51 for those of other races. This was a significant increase from our prior series of veterans of World War II and the Korean Conflict, where white women had a relative risk of 1.79. Risk for black men was higher now (0.67 vs 0.44), while other men remained low (0.30 vs 0.22). Residence at service entry in the northern tier of states had a relative risk of 2.02 versus the southern tier, which was significantly less than the 2.64 for the earlier series. Residence by individual state at birth and service entry for white men further supported this decreasing geographic differential. Such marked changes in geography, sex, and race in such a short interval strongly imply a primary environmental factor in the cause or precipitation of this disease.

Veterans Health Administration multiple sclerosis surveillance registry: The problem of case-finding from administrative databases

“…Additionally, we queried Veterans Benefits Administration (VBA) databases. Specifically, we used the VBA Compensation and Pension Mini-Master File to identify veterans who were service-connected for MS. Service-connection for MS requires definitive evidence of clinical MS signs upon examination during or within 7 years of active military service [10]. Finally, we examined VHA Pharmacy Benefits Management (Chicago, Illinois) data to identify veterans who had been prescribed an MS-specific DMA from FY1998 to FY2002.…”

Multiple sclerosis genetics

“…This increased susceptibility might be due to genetic differences between ethnic groups. For example, some studies have shown that MS is approximately 50% less common in African Americans compared to whites (Kurtzke et al, 1977;Wallin et al, 2004). In addition, MS is still less common in both native Japanese and Japanese Americans (5 per 100 000) compared to northern European populations (100-150 per 100 000) (Detels et al, 1977).…”

Multiple sclerosis genetics: leaving no stone unturned

“…Positive selection for this allele appears to have occurred in Europeans but not in Africans, and although the factors that drove this selection, presumably some infectious pathogen, are unknown, one possible consequence was a heightened susceptibility to MS in Europe, a disorder almost nonexistent in Africa. Compared to Europeans-Americans, African-Americans are at lowrisk for MS, 5,44 supporting the presence of genetic risk factors that occur at higher frequency in Europeans. As the sections of the genome in African-Americans inherited from their European or African ancestors have only had an average of six generations of recombination, extended LD is present, and non-MHC disease genes are potentially amenable to identification through admixture mapping using reasonable numbers of ancestry informative genetic markers that are readily available.…”