title: The epidemiology of multiple sclerosis in Scotland: inferences from hospital admissions.
abstract: BACKGROUND
  Multiple sclerosis (MS) is a neurological disorder with a highly characteristic disease distribution. Prevalence and incidence in general increase with increasing distance from the equator. Similarly the female to male sex ratio increases with increasing latitude. Multiple possible risk factors have been hypothesised for this epidemiological trend, including human leukocyte antigen allele frequencies, ultraviolet exposure and subsequent vitamin D levels, smoking and Epstein-Barr virus. In this study we undertook a study of medical records across Scotland on an NHS health board level of resolution to examine the epidemiology of MS in this region.
  
  
  RESULTS
  We calculated the number and rate of patient-linked hospital admissions throughout Scotland between 1997 and 2009 from the Scottish Morbidity Records. We used weighted-regression to examine correlations between these measures of MS, and latitude and smoking prevalence. We found a highly significant relationship between MS patient-linked admissions and latitude (r weighted by standard error (r(sw)) = 0.75, p = 0.002). There was no significant relationship between smoking prevalence and MS patient-linked admissions.
  
  
  CONCLUSIONS
  There is a definite latitudinal effect on MS risk across Scotland, arising primarily from an excess of female MS patients at more Northerly latitudes. Whether this is a true gradient or whether a threshold effect may apply at particular latitude will be revealed only by further research. A number of genetic and environmental factors may underlie this effect.
authors.affiliation: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom.
authors.forename: Adam E
authors.initials: AE
authors.lastname: Handel
authors.forename: Lynne
authors.initials: L
authors.lastname: Jarvis
authors.forename: Ryan
authors.initials: R
authors.lastname: McLaughlin
authors.forename: Anastasia
authors.initials: A
authors.lastname: Fries
authors.forename: George C
authors.initials: GC
authors.lastname: Ebers
authors.forename: Sreeram V
authors.initials: SV
authors.lastname: Ramagopalan
mesh_terms: D003625:Data Collection; D004777:Environment; D005260:Female; D004854:Herpesvirus 4, Human; D006760:Hospitalization; D006801:Humans; D008297:Male; D008499:Medical Records; D009103:Multiple Sclerosis / Q000453:epidemiology*; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012744:Sex Ratio; D019371:Topography, Medical