Harris E Clare, Palmer Keith T, Cox Vanessa, Darnton Andrew, Osman John, Coggon David
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
Statistics and Epidemiology Unit, Science Directorate, Health and Safety Executive, UK.
Occup Med (Lond). 2017 Aug 1;67(6):448-452. doi: 10.1093/occmed/kqx083. Epub 2017 Jun 20.
While analysing trends in occupational mortality in England and Wales, we noticed an unexpectedly elevated proportion of deaths from multiple sclerosis (MS) among men in the armed forces.
To document and explore possible explanations for the observed excess.
We analysed data on underlying cause of death and last full-time occupation for 3,688,916 deaths among men aged 20-74 years in England and Wales during 1979-2010, calculating proportional mortality ratios (PMRs) standardised for age. We compared PMRs for MS in the armed forces with those for each main social class, and in selected other occupations. We also compared PMRs for MS with those for motor neurone disease (MND).
The overall PMR for MS in the armed forces during 1979-2010 was 243 (95%CI 203-288). The excess was apparent in each of three separate decades of study (PMRs, ranging from 220 to 259), and across the entire age range. PMRs for MS were not elevated to the same extent in comparator occupations, nor in any of the main social classes. There was no parallel increase in PMRs for MND.
These findings suggest that the high proportional mortality from MS in British military personnel is unlikely to have occurred by chance, or as an artefact of the method of investigation. However, the only military cohort study with published results on MS does not support an increased risk. It would be useful to analyse data on MS from other established military cohorts, to check for evidence of a hazard.
在分析英格兰和威尔士职业死亡率趋势时，我们注意到武装部队男性中死于多发性硬化症（MS）的比例意外升高。
记录并探讨观察到的超额死亡现象的可能原因。
我们分析了1979年至2010年期间英格兰和威尔士20至74岁男性的3,688,916例死亡的根本死因和最后全职职业数据，计算了年龄标准化的比例死亡率（PMR）。我们将武装部队中MS的PMR与每个主要社会阶层以及选定的其他职业的PMR进行了比较。我们还将MS的PMR与运动神经元病（MND）的PMR进行了比较。
1979年至2010年期间，武装部队中MS的总体PMR为243（95%CI 203 - 288）。在三个独立的研究十年中，超额死亡现象均很明显（PMR范围为220至259），且在整个年龄范围内都存在。在对照职业和任何主要社会阶层中，MS的PMR升高幅度均未达到相同程度。MND的PMR没有相应增加。
这些发现表明，英国军事人员中MS的高比例死亡率不太可能是偶然发生的，也不是调查方法造成的假象。然而，唯一一项已发表结果的军事队列研究并不支持风险增加的结论。分析其他既定军事队列中MS的数据以检查是否存在危害证据将是有用的。
