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Migration and multiple sclerosis in Alaskan military veterans
Mitchell T Wallin1, William F Page, John F Kurtzke
1Neuroepidemiology Section, Neurology Service, Veterans Affairs Medical Center and MS Center of Excellence-East, NW, Washington, DC 20422, USA. mitchell.wallin@va.gov
Abstract:
The objective is to provide the first estimates of the prevalence of multiple sclerosis (MS) in Alaskan white males including those migrant to and from the state. A case-control cohort design was utilized with a nationwide series of United States (US) veterans service-connected for MS and matched to pre-illness controls who had entered military service between 1960 and 1994. Among 3,758 white male MS cases and their 7,426 controls were 7 MS and 28 controls resident in Alaska at service entry, who provided an adjusted case/control (C/C) risk ratio for developing MS of 0.47 and an estimated prevalence rate of 22/100,000 population, but only 1 of the 7 had also been born in Alaska, for an estimated prevalence rate of 3.2 per 100,000 (95% confidence interval (CI): 0.08-17.80). The other 6 MS patients and their 26 controls, who migrated from another state to Alaska before onset, had an adjusted C/C ratio of 0.44 for a prevalence rate of 20.6 (95% CI: 7.56-44.90), significantly lower than the reported rate of 45.23 per 100,000 for all US white males in 1976. Another 9 MS patients and 7 controls born in Alaska, who had migrated to another state before entering service, provided an adjusted C/C risk ratio for developing MS of 2.44, with a highly significant elevated prevalence rate of 115 per 100,000 (95% CI: 52.6-218.1). In conclusion, these data suggest that Alaska is not a high-risk area for MS and indicate that migration before onset to Alaska from the high-risk coterminous US decreases the risk of MS and the opposite migration increases it. A formal prevalence survey of MS in Alaska is needed to support or refute these findings.
Insights
This study suggests Alaska is not a high-risk area for multiple sclerosis (MS). Migration to Alaska before MS onset appears to decrease risk, while migrating away increases it.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Multiple sclerosis (MS) prevalence varies geographically.
- Understanding MS risk factors, including migration, is crucial for public health.
- Previous studies have not specifically estimated MS prevalence in Alaskan white males, considering migration patterns.
Purpose of the Study:
- To provide the first estimates of multiple sclerosis (MS) prevalence in Alaskan white males.
- To investigate the impact of migration to and from Alaska on MS risk.
- To compare MS prevalence in Alaska with the broader United States population.
Main Methods:
- A case-control cohort study design was used.
- Data were collected from United States (US) veterans service-connected for MS and matched controls.
- Military service entry between 1960 and 1994 was used as the baseline for analysis.
Main Results:
- The estimated prevalence of MS in white males residing in Alaska at service entry was 22/100,000, with a lower rate of 3.2/100,000 for those born in Alaska.
- Individuals migrating from other states to Alaska before MS onset showed a significantly lower prevalence rate (20.6/100,000) compared to US white males.
- Conversely, those born in Alaska but migrating away before service exhibited a significantly elevated prevalence rate of 115/100,000.
Conclusions:
- Alaska does not appear to be a high-risk area for multiple sclerosis (MS).
- Migration to Alaska before MS onset is associated with a decreased risk.
- Migration away from Alaska before MS onset is associated with an increased risk, suggesting environmental or genetic factors influenced by location.
