title: Latitudinal variation in incidence and type of first central nervous system demyelinating events.
abstract: Increasing prevalence and variable geographic patterns of occurrence of multiple sclerosis suggest an environmental role in causation. There are few descriptive, population-level, data on whether such variability applies to first demyelinating events (FDEs). We recruited 216 adults (18-59 years), with a FDE between 1 November 2003 and 31 December 2006 in a multi-center incident case-control study in four locations on the south-eastern and eastern seaboard of Australia, spanning latitudes 27 degrees south to 43 degrees south. Population denominators were obtained from the Australian Bureau of Statistics censuses of 2001 and 2006. Age and sex adjusted FDE incidence rates increased by 9.55% (95% confidence interval (CI) 7.37-11.78, p < 0.001) per higher degree of latitude. The incidence rate gradient per higher degree of latitude varied by gender (male: 14.69% (95% CI 9.68-19.94, p < 0.001); female 8.13% (95% CI 5.69-10.62, p < 0.001)); and also by the presenting FDE type: optic neuritis 11.39% (95% CI 7.15-15.80, p < 0.001); brainstem/cerebellar syndrome 9.47% (95% CI 5.18-13.93, p < 0.001); and spinal cord syndrome 5.36% (95% CI 1.78-9.06, p = 0.003). Differences in incidence rate gradients were statistically significant between males and females (p = 0.02) and between optic neuritis and spinal cord syndrome (p = 0.04). The male to female ratio varied from 1 : 6.7 at 27 degrees south to 1 : 2.5 at 43 degrees south. The study establishes a positive latitudinal gradient of FDE incidence in Australia. The latitude-related factor(s) influences FDE incidence variably according to subtype and gender, with the strongest influence on optic neuritis presentations and for males. These descriptive case analyses show intriguing patterns that could be important for understanding the etiology of multiple sclerosis.
authors.affiliation: Menzies Research Institute, University of Tasmania, Hobart, Australia. bruce.taylor@utas.edu.au
authors.forename: Bruce V
authors.initials: BV
authors.lastname: Taylor
authors.forename: Robyn M
authors.initials: RM
authors.lastname: Lucas
authors.forename: Keith
authors.initials: K
authors.lastname: Dear
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Kilpatrick
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pender
authors.forename: Ingrid A F
authors.initials: IA
authors.lastname: van der Mei
authors.forename: Caron
authors.initials: C
authors.lastname: Chapman
authors.forename: Alan
authors.initials: A
authors.lastname: Coulthard
authors.forename: Terence
authors.initials: T
authors.lastname: Dwyer
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: McMichael
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Valery
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.forename: Anne-Louise
authors.initials: AL
authors.lastname: Ponsonby
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D016022:Case-Control Studies; D002493:Central Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology; D002526:Cerebellar Diseases / Q000453:epidemiology; D003711:Demyelinating Diseases / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000453:epidemiology* / Q000209:etiology; D009902:Optic Neuritis / Q000453:epidemiology; D012111:Residence Characteristics; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013118:Spinal Cord Diseases / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult