Kurtzke J F, Page W F, Murphy F M, Norman J E
Neuroepidemiology Research Program, Department of Veterans Affairs Medical Center, Washington, D.C. 20422.
Neuroepidemiology. 1992;11(4-6):226-35. doi: 10.1159/000110935.
Age at onset of multiple sclerosis (MS) symptoms was ascertained for subsets of some 4,400 veterans of World War II who had been adjudged 'service-connected' for this condition. Average age at onset was 27.0 years for white men, 27.7 for white women, and 27.5 for black men. The unexpectedly older age for women is attributed to their older age at entry into service. When the coterminous United States was divided into three horizontal tiers of states, we found a strong effect of geography on age at onset. By state of residence at entry into active duty (EAD), white men had an average age at onset of 26.4 years in the northern tier, 27.3 years in the middle, and 28.8 years in the south. Trends were similar for white women and black men. Migrants, defined as those whose birth and EAD tiers differed, showed increasing ages at onset with southward moves. A statistical model used to discriminate between the influence of birth and EAD tiers on age at onset confirmed the significant effect of EAD alone. These data are compatible with the theses that the cause of MS is less common (or less efficient) in locations where the clinical disease is less common, and that its acquisition therefore occurs at an older age in those locales.
我们确定了约4400名二战退伍军人中被判定患有与服役相关多发性硬化症（MS）的部分人群出现MS症状的年龄。白人男性的平均发病年龄为27.0岁，白人女性为27.7岁，黑人男性为27.5岁。女性发病年龄意外偏大归因于她们入伍时年龄较大。当将美国本土划分为三个水平的州层时，我们发现地理位置对发病年龄有显著影响。按现役入伍时的居住州（EAD）划分，北方层的白人男性平均发病年龄为26.4岁，中间层为27.3岁，南方层为28.8岁。白人女性和黑人男性也有类似趋势。移民被定义为出生州层和EAD州层不同的人，他们发病年龄随向南迁移而增加。用于区分出生州层和EAD州层对发病年龄影响的统计模型证实，仅EAD有显著影响。这些数据与以下论点相符：MS病因在临床疾病较少见的地区不太常见（或效率较低），因此在这些地区发病年龄较大。
