Cousens S, Smith P G, Ward H, Everington D, Knight R S, Zeidler M, Stewart G, Smith-Bathgate E A, Macleod M A, Mackenzie J, Will R G
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK.
Lancet. 2001 Mar 31;357(9261):1002-7. doi: 10.1016/s0140-6736(00)04236-7.
Geographical variation in the distribution of variant Creutzfeldt-Jakob disease (vCJD) might indicate the transmission route of the infectious agent to man. We investigated whether regional incidences of vCJD were correlated with regional dietary data.
The National CJD Surveillance Unit prospectively identified 84 people with vCJD up to Nov 10, 2000, in Great Britain. Their lifetime residential histories were obtained by interviews with a close relative. Cumulative incidences of vCJD by standard region were calculated. Grid references for places of residence in 1991 were identified and evidence of geographical clusters were sought. Data on diet in the 1980s were analysed for regional correlations with vCJD incidence. The socioeconomic status of the places of residence of people with vCJD was compared with that of the general population.
vCJD incidence was higher in the north of Great Britain than the south. The rate ratio (north vs south) was 1.94 (95% CI 1.27-2.98). The mean Carstairs' deprivation score for areas of residence of people with vCJD was -0.09 (-0.73 to 0.55), which is close to the national average of zero. Regional rates of vCJD were correlated with consumption of other meat or meat products as classified and recorded by the Household Food Consumption and Expenditure Survey (r=0.72), but not with data from the Dietary and Nutritional Survey of British Adults. Five people with vCJD in Leicestershire formed a cluster (p=0.004).
Regional differences in vCJD incidence are unlikely to be due to ascertainment bias. We had difficulty determining whether regional variations in diet might cause these differences, since the results of dietary analyses were inconsistent.
变异型克雅氏病（vCJD）分布的地理差异可能表明感染源向人类的传播途径。我们调查了vCJD的地区发病率是否与地区饮食数据相关。
国家克雅氏病监测单位前瞻性地确定了截至2000年11月10日在英国的84例vCJD患者。通过与近亲访谈获取他们的终生居住史。计算了标准地区vCJD的累积发病率。确定了1991年居住地的网格参考，并寻找地理聚集的证据。分析了20世纪80年代的饮食数据与vCJD发病率的地区相关性。将vCJD患者居住地的社会经济状况与一般人群进行了比较。
英国北部的vCJD发病率高于南部。率比（北部对南部）为1.94（95%CI 1.27 - 2.98）。vCJD患者居住地区的平均卡斯尔斯贫困得分是 -0.09（-0.73至0.55），接近全国平均水平零。家庭食物消费和支出调查分类并记录的其他肉类或肉类产品的消费量与vCJD的地区发病率相关（r = 0.72），但与英国成年人饮食与营养调查的数据无关。莱斯特郡的5例vCJD患者形成了一个聚集区（p = 0.004）。
vCJD发病率的地区差异不太可能是由于确诊偏倚。由于饮食分析结果不一致，我们难以确定饮食的地区差异是否可能导致这些差异。
