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Epidemiology of multiple sclerosis in US veterans: VII. Risk factors for MS
1Neurology Service, Veterans Affairs Medical Center, Washington, DC 20422, USA.
Abstract:
In previous papers of this series, we explored the epidemiology of MS, examining the effects of race, sex, geography, latitude and climate, migration, age at onset, population ancestry, and individual ethnicity on the risk of MS, using an unusually large cohort of MS cases and pre-illness matched controls comprising US veterans of World War II (WWII) and the Korean Conflict (KC). In this paper, we examine primarily the effect of other factors on the risk of MS in this cohort and their relation to those previously studied. We found here that latitude tier of residence at entry into active duty (EAD), years of education, and socioeconomic class (coded from occupation) were similarly associated with MS risk among white men, black men, and white women. Higher levels of each factor showed increased MS risk. Multivariate analyses indicated that for white male WWII subjects an urban address, 9 or more years of education, uncorrected visual acuity less than 20/20 at EAD, a more northern latitude, and a higher proportion of the subject's EAD state population reporting Swedish ancestry each significantly increased the risk of MS. White male KC subjects showed roughly the same patterns, except that uncorrected visual acuity less than 20/20 was associated with lower MS risk (ancestry/ethnicity was not studied). For black male WWII and KC subjects combined, a similar analysis (omitting ancestry/ethnicity) showed that only latitude at EAD and 9 or more years of education were independently associated with a significantly higher MS risk, and for WWII plus KC white women (also without ancestry/ethnicity), only latitude was a significant risk factor in these multivariate analyses. The smaller number of subjects, especially in these last two groups, limited the power to detect statistically significant risks in these last analyses. Similarities to white men of WWII in univariate analyses for all other groups suggest that findings for the former would otherwise apply to the latter. Although the interpretations of these associations may be obscure, in addition to geography, age, sex, and race, per se, higher socioeconomic status is significantly associated with higher MS risk in black and white men and in white women in the United States.
Insights
Higher socioeconomic status, more education, and northern latitude are linked to increased multiple sclerosis (MS) risk in US veterans. These factors, alongside urban living, appear to elevate MS risk across diverse demographic groups.
Area of Science:
- Epidemiology
- Neurology
Background:
- Previous studies explored multiple sclerosis (MS) risk factors including race, sex, geography, and ancestry in US veterans.
- This study investigates additional factors influencing MS risk within the same cohort.
Purpose of the Study:
- To examine the impact of education, socioeconomic class, and latitude on MS risk.
- To analyze the relationship between these factors and previously studied variables in a large cohort of US veterans.
Main Methods:
- Analysis of a large cohort of US veterans from World War II and the Korean Conflict.
- Multivariate analyses to identify significant risk factors for MS, including education, socioeconomic status, and latitude at entry into active duty.
Main Results:
- Higher education, northern latitude, and higher socioeconomic status were associated with increased MS risk across white men, black men, and white women.
- For white male veterans of WWII, urban address, 9+ years of education, northern latitude, and Swedish ancestry were significant risk factors.
- For black male and white female veterans, latitude and education (for black men) were significant independent risk factors.
Conclusions:
- Socioeconomic status, education, and geographic latitude are significant factors associated with increased MS risk in US veterans.
- These findings contribute to understanding the complex epidemiology of MS, highlighting the interplay of environmental and socioeconomic determinants.