Wallin Mitchell T, Page William F, Kurtzke John F
Department of Veterans Affairs Medical Center, Georgetown University Medical School, Washington, DC, USA.
Ann Neurol. 2004 Jan;55(1):65-71. doi: 10.1002/ana.10788.
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.
我们在美国退伍军人中识别出5345例多发性硬化症（MS）病例，这些退伍军人于1960年至1994年首次入伍，并被美国退伍军人事务部（VA）认定为与MS“有关联服役”。每例病例匹配两名对照，匹配因素为年龄、入伍日期和军种。可获取4951例病例和9378名对照的服役及VA档案中的人口统计学和军事数据。与白人男性相比，所有女性患MS的相对风险显著更高，白人女性为2.99，黑人女性为2.86，其他种族女性为3.51。这相较于我们之前对二战和朝鲜战争退伍军人的系列研究有显著增加，当时白人女性的相对风险为1.79。黑人男性的风险现在更高（0.67对0.44），而其他男性仍然较低（0.30对0.22）。入伍时居住在北部各州相比于南部各州的相对风险为2.02，这显著低于早期系列研究中的2.64。白人男性出生和入伍时按各州划分的居住地进一步支持了这种地理差异的减小。在如此短的时间间隔内，地理、性别和种族方面的这种显著变化强烈暗示了该疾病病因或发病中有一个主要环境因素。
