Sex ratio of multiple sclerosis in Canada: a longitudinal study
Sex ratio of multiple sclerosis in Canada: a longitudinal study
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DOI：
10.1016/s1474-4422(06)70581-6
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发表时间：
2006-11-01
期刊：
影响因子：
48
通讯作者：
Ebers, George C.
中科院分区：
文献类型：
--
作者：
Orton, Sarah-Michelle;Herrera, Blanca M.;Ebers, George C.
背景 人们认为多发性硬化症的发病率正在增加，但这一观点很难得到证实。在三十多年来获得的多发性硬化症患者的基于人群的纵向数据集中，我们没有显示出性别诊断时间的差异。我们推断，如果发病率发生了性别特异性变化，那么女性与男性的性别比将作为发病率变化的替代指标。方法由于环境风险因素似乎在生命早期起作用，我们计算了 27 074 名加拿大多发性硬化症患者的出生年份的性别比，这些患者被确定为基于人口的纵向数据集的一部分。结果 按出生年份计算的女性与男性的性别比已经增加了至少 50 年，目前在加拿大已超过 3(.)2:1。出生年份是性别比的重要预测因素（p < 0(.)0001，chi(2)=124(.)4；等级相关性 r=0(.)84）。 解释 加拿大女性与男性性别比的大幅增加似乎是由于女性多发性硬化症发病率不成比例的增加所致。这种快速变化必须有环境根源，即使它与基因-环境相互作用有关，并且意味着很大一部分多发性硬化症病例可能是可以原位预防的。尽管该疾病发病率上升的原因尚不清楚，但它对医疗保健提供具有重大影响，因为在英国，多发性硬化症的终生成本超过每例 100 万英镑。
Background Incidence of multiple sclerosis is thought to be increasing, but this notion has been difficult to substantiate. In a longitudinal population-based dataset of patients with multiple sclerosis obtained over more than three decades, We did not show a difference in time to diagnosis by sex. We reasoned that if a sex-specific change in incidence was occurring, the female to male sex ratio would serve as a surrogate of incidence change.Methods Since environmental risk factors seem to act early in life, we calculated sex ratios by birth year in 27 074 Canadian patients with multiple sclerosis identified as part of a longitudinal population-based dataset.Findings The female to male sex ratio by year of birth has been increasing for at least 50 years and now exceeds 3(.)2:1 in Canada. Year of birth was a significant predictor for sex ratio (p < 0(.)0001, chi(2)=124(.)4; rank correlation r=0(.)84).Interpretation The substantial increase in the female to male sex ratio in Canada seems to result from a disproportional increase in incidence of multiple sclerosis in women. This rapid change must have environmental origins even if it is associated with a gene-environment interaction, and implies that a large proportion of multiple sclerosis cases may be preventable in situ. Although the reasons why incidence of the disease is increasing are unknown, there are major implications for health-care provision because lifetime costs of multiple sclerosis exceed 1 million pounds per case in the UK.