兰开夏郡和南坎布里亚郡运动神经元病患者居住地的地理流行病学
Geographical epidemiology of residence of patients with motor neuron disease in Lancashire and south Cumbria.
作者信息
Mitchell J D, Gatrell A C, Al-Hamad A, Davies R B, Batterby G
机构信息
Department of Neurology, Royal Preston Hospital, Fulwood, UK.
出版信息
J Neurol Neurosurg Psychiatry. 1998 Dec;65(6):842-7. doi: 10.1136/jnnp.65.6.842.
OBJECTIVES
To seek objective evidence for geographical clustering of places of residence of patients with motor neuron disease (MND).
METHODS
A complete residential history from birth to onset of disease was obtained from a cohort of 130 patients with MND from Lancashire and south Cumbria presenting to the Department of Neurology in Preston between 1 January 1989 and 31 December 1993. These data were compared with population based reference data from the 1991 UK Census.
RESULTS
Some areal units showed a greater, others a lesser, number of MND patient residences than expected. The results suggest that the background population incidence of MND is relatively low and that the overall incidence figures previously quoted have been skewed upwards by areas in which the incidence of MND is relatively increased. These findings were further tested by Poisson modelling. The Poisson model provided a poor fit for the data at postcode district and sector levels confirming that patients with MND were significantly more likely to have lived in some areas than others after allowing for variation in population of the different areal units and for variation in duration of residence.
CONCLUSIONS
These findings reinforce the results of previous work, much of which has been qualitative rather than quantitative. The results presented here suggest a low background incidence of MND in the context of generally quoted overall incidence figures. This low background incidence is, however, skewed upwards by some areal units with a relatively high incidence, thus achieving overall incidence rates comparable with generally quoted figures. We conclude that there is prima facie evidence of spatial patterns in the distribution of places of residence of patients with MND. Further examination of occupational and environmental factors in the lives of the patients with MND is required to obtain a better understanding of the importance of these findings.
目的
寻找运动神经元病（MND）患者居住地地理聚集的客观证据。
方法
从1989年1月1日至1993年12月31日期间就诊于普雷斯顿神经病学系的130例来自兰开夏郡和坎布里亚郡南部的MND患者队列中获取从出生到发病的完整居住史。将这些数据与1991年英国人口普查的基于人群的参考数据进行比较。
结果
一些区域单位显示MND患者居住数量多于预期，另一些则少于预期。结果表明，MND的背景人群发病率相对较低，之前引用的总体发病率数据因MND发病率相对较高的地区而向上偏斜。通过泊松模型对这些发现进行了进一步检验。泊松模型对邮政编码区和扇区层面的数据拟合不佳，证实了在考虑不同区域单位人口差异和居住时间差异后，MND患者在某些地区居住的可能性明显高于其他地区。
结论
这些发现强化了先前工作的结果，其中许多工作是定性而非定量的。此处呈现的结果表明，在普遍引用的总体发病率数据背景下，MND的背景发病率较低。然而，这种低背景发病率因一些发病率相对较高的区域单位而向上偏斜，从而使总体发病率与普遍引用的数字相当。我们得出结论，有初步证据表明MND患者居住地分布存在空间模式。需要进一步研究MND患者生活中的职业和环境因素，以更好地理解这些发现的重要性。
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