Kurtzke J F, Page W F
Neurology Service, Veterans Affairs Medical Center, Washington, DC 20422, USA.
Neurology. 1997 Jan;48(1):204-13. doi: 10.1212/wnl.48.1.204.
In previous papers of this series, we explored the epidemiology of MS, examining the effects of race, sex, geography, latitude and climate, migration, age at onset, population ancestry, and individual ethnicity on the risk of MS, using an unusually large cohort of MS cases and pre-illness matched controls comprising US veterans of World War II (WWII) and the Korean Conflict (KC). In this paper, we examine primarily the effect of other factors on the risk of MS in this cohort and their relation to those previously studied. We found here that latitude tier of residence at entry into active duty (EAD), years of education, and socioeconomic class (coded from occupation) were similarly associated with MS risk among white men, black men, and white women. Higher levels of each factor showed increased MS risk. Multivariate analyses indicated that for white male WWII subjects an urban address, 9 or more years of education, uncorrected visual acuity less than 20/20 at EAD, a more northern latitude, and a higher proportion of the subject's EAD state population reporting Swedish ancestry each significantly increased the risk of MS. White male KC subjects showed roughly the same patterns, except that uncorrected visual acuity less than 20/20 was associated with lower MS risk (ancestry/ethnicity was not studied). For black male WWII and KC subjects combined, a similar analysis (omitting ancestry/ethnicity) showed that only latitude at EAD and 9 or more years of education were independently associated with a significantly higher MS risk, and for WWII plus KC white women (also without ancestry/ethnicity), only latitude was a significant risk factor in these multivariate analyses. The smaller number of subjects, especially in these last two groups, limited the power to detect statistically significant risks in these last analyses. Similarities to white men of WWII in univariate analyses for all other groups suggest that findings for the former would otherwise apply to the latter. Although the interpretations of these associations may be obscure, in addition to geography, age, sex, and race, per se, higher socioeconomic status is significantly associated with higher MS risk in black and white men and in white women in the United States.
在本系列之前的论文中，我们探讨了多发性硬化症（MS）的流行病学，利用一个异常庞大的MS病例队列以及病前匹配的对照人群（包括二战（WWII）和朝鲜战争（KC）的美国退伍军人），研究了种族、性别、地理位置、纬度和气候、移民、发病年龄、人群血统以及个体种族对MS风险的影响。在本文中，我们主要研究该队列中其他因素对MS风险的影响及其与先前研究因素的关系。我们发现，对于白人男性、黑人男性和白人女性而言，入伍时的居住纬度层级、受教育年限以及社会经济阶层（根据职业编码）与MS风险的关联方式相似。每个因素水平越高，MS风险越高。多变量分析表明，对于二战时期的白人男性受试者，城市住址、9年或更长时间的教育、入伍时未矫正视力低于20/20、更靠北的纬度以及受试者入伍所在州报告有瑞典血统的人口比例更高，均显著增加了MS风险。朝鲜战争时期的白人男性受试者呈现大致相同的模式，只是未矫正视力低于20/20与较低的MS风险相关（未研究血统/种族）。对于合并的二战和朝鲜战争时期的黑人男性受试者，类似分析（省略血统/种族）表明，只有入伍时的纬度和9年或更长时间的教育与显著更高的MS风险独立相关，而对于二战加朝鲜战争时期的白人女性（同样省略血统/种族），在这些多变量分析中只有纬度是显著的风险因素。受试者数量较少，尤其是后两组，限制了在这些最后分析中检测具有统计学显著意义风险的能力。所有其他组在单变量分析中与二战白人男性的相似性表明，否则前者的研究结果将适用于后者。尽管这些关联的解释可能并不明确，但除了地理、年龄、性别和种族本身之外，在美国，较高的社会经济地位与黑人和白人男性以及白人女性中较高的MS风险显著相关。
