Scott Kirsten M, Abhinav Kumar, Stanton Biba R, Johnston Clare, Turner Martin R, Ampong Mary-Ann, Sakel Mohamed, Orrell Richard W, Howard Robin, Shaw Christopher E, Leigh P Nigel, Al-Chalabi Ammar
King's College Medical School at Guy's, King's College and St. Thomas's Hospitals, London, UK.
Neuroepidemiology. 2009;32(2):81-8. doi: 10.1159/000177032. Epub 2008 Nov 27.
Amyotrophic lateral sclerosis (ALS) is a degenerative disease of motor neurons that causes progressive paralysis and eventually results in death from respiratory failure. Environmental factors that trigger ALS might result in a pattern of geographical clustering of cases. We tested this hypothesis using the South-East England ALS population register, which covers south-east London, Kent and parts of neighbouring counties.
The register's catchment area was divided into postcode districts and sectors. The expected rates of ALS (adjusted for age and sex) were compared with the observed rates using a standardised residuals method and the SaTScan programme.
There were 406 cases of ALS identified in the catchment area during the study period. Four of the 126 postcode districts, all in Greater London, had residuals >2.5 SDs from the mean. Similarly, there were 15 postcode sectors (out of 420) that had residuals >1.96 SDs from the mean. Nine of these were in Greater London. SaTScan identified an area that had a 5.61-km radius in which the relative risk of ALS was 1.70 (p = 0.012). This area overlapped with the postcode districts and some of the sectors identified using the residuals method.
These findings suggest an excess of ALS cases in some postcode districts in south-east England.
肌萎缩侧索硬化症（ALS）是一种运动神经元退行性疾病，可导致进行性瘫痪，最终因呼吸衰竭而死亡。引发ALS的环境因素可能导致病例出现地理聚集模式。我们使用英格兰东南部ALS人群登记册对这一假设进行了检验，该登记册涵盖伦敦东南部、肯特郡及邻近郡县的部分地区。
将登记册的服务区域划分为邮政编码区和分区。使用标准化残差法和SaTScan程序将ALS的预期发病率（根据年龄和性别调整）与观察到的发病率进行比较。
在研究期间，服务区域内共确诊406例ALS病例。126个邮政编码区中有4个，均位于大伦敦地区，其残差与平均值的偏差>2.5个标准差。同样，在420个邮政编码分区中有15个的残差与平均值的偏差>1.96个标准差。其中9个位于大伦敦地区。SaTScan识别出一个半径为5.61公里的区域，该区域内ALS的相对风险为1.70（p = 0.012）。该区域与使用残差法确定的邮政编码区和部分分区重叠。
这些发现表明英格兰东南部的一些邮政编码区内ALS病例过多。
