Williams E S, Jones D R, McKeran R O
Department of Public Health Medicine, Croydon General Hospital, UK.
J Neurol Neurosurg Psychiatry. 1991 Feb;54(2):104-9. doi: 10.1136/jnnp.54.2.104.
A review of the United Kingdom (UK) multiple sclerosis (MS) literature suggests that over the last three decades prevalence and estimated incidence rates have increased, while mortality rates have been declining. UK mortality data over a 30 year period have been studied to examine temporal and geographical variations, to estimate changes in survival, and to examine the relationship between mortality and morbidity trends. The study has shown an overall decline in mortality throughout the UK of approximately 25% over the 30 year period ending in 1983, and a reduction in the mortality differential between Scotland, and England and Wales, but no positive correlation has been found between mortality and morbidity. The overall decline in death rate in females was 23% and in males 30% over the 30 years of the survey. The total number of deaths declined by 39% between the five year periods 1954-58 and 1979-83 in Scotland compared with a 10% decline for England and Wales. Estimated median age of death increased from 52 to 59 years and the improvement in survival over the period of study was similar for both countries and is unlikely to have contributed to the reduction in mortality differential. Within England and Wales regional mortality rates did not show a clear north-south gradient. The decline in the mortality differential between Scotland and England (if not artefactual) may provide an important aetiological clue in the search for the cause of multiple sclerosis, and the rate of decline suggests an environmental rather than a genetic aetiology.
对英国多发性硬化症（MS）文献的综述表明，在过去三十年中，患病率和估计发病率有所上升，而死亡率则在下降。对英国30年期间的死亡率数据进行了研究，以考察时间和地理差异，估计生存率的变化，并研究死亡率与发病率趋势之间的关系。该研究表明，在截至1983年的30年期间，英国的总体死亡率下降了约25%，苏格兰与英格兰和威尔士之间的死亡率差异有所缩小，但未发现死亡率与发病率之间存在正相关。在调查的30年中，女性的死亡率总体下降了23%，男性下降了30%。与英格兰和威尔士下降10%相比，苏格兰1954 - 58年至1979 - 83年这两个五年期之间的死亡总数下降了39%。估计的死亡年龄中位数从52岁增加到59岁，在研究期间两个国家的生存率改善情况相似，而且这一情况不太可能是导致死亡率差异缩小的原因。在英格兰和威尔士内部，地区死亡率并未呈现明显的南北梯度。苏格兰与英格兰之间死亡率差异的缩小（如果不是人为造成的）可能为寻找多发性硬化症病因提供重要的病因线索，而且下降速度表明其病因是环境因素而非遗传因素。
