title: Sunshine, Sea, and Season of Birth: MS Incidence in Wales.
abstract: Maternal sun exposure in gestation and throughout the lifetime is necessary for vitamin D synthesis, and living near the sea is a population level index of seafood consumption. The aim of this study was to estimate the incidence rate of multiple sclerosis (MS) in Wales and examine its association with sun exposure, coastal living, and latitude. The study used a database of MS hospital visits and admissions in Wales between 2002 and 2013. For the 1,909 lower layer super output areas (LSOAs) in Wales, coastal status, population, longitude/latitude, and average sunshine hours per day were obtained. Age-specific and age-standardised MS incidence were calculated and modelled using Poisson regression. The distribution of births by month was compared between MS cases and the combined England and Wales population. There were 3,557 new MS cases between 2002 and 2013, with an average annual incidence of 8.14 (95% CI: 7.69-8.59) among males and 12.97 (95% CI: 12.44-13.50) among females per 100,000 population. The female-to-male ratio was 1.86:1. For both sexes combined, the average annual incidence rate was 9.10 (95% CI: 8.80-9.40). All figures are age-standardized to the 1976 European standard population. Compared to the combined England and Wales population, more people with MS were born in April, observed-to-expected ratio: 1.21 (95% CI: 1.08-1.36). MS incidence varied directly with latitude and inversely with sunshine hours. Proximity to the coast was associated with lower MS incidence only in easterly areas. This study shows that MS incidence rate in Wales is comparable to the rate in Scotland and is associated with environmental factors that probably represent levels of vitamin D.
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Lloyd D
authors.initials: LD
authors.lastname: Balbuena
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Rod M
authors.initials: RM
authors.lastname: Middleton
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Katie
authors.initials: K
authors.lastname: Tuite-Dalton
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Theodora
authors.initials: T
authors.lastname: Pouliou
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Kate Elizabeth
authors.initials: KE
authors.lastname: Williams
authors.affiliation: Swansea University Medical School, Swansea, Wales, United Kingdom.
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Noble
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000209:etiology*; D036801:Parturition; D010343:Patient Admission; D011159:Population Surveillance; D012621:Seasons; D012623:Seawater; D013472:Sunlight; D014852:Wales / Q000453:epidemiology; D055815:Young Adult