Abstract
A review of the United Kingdom (UK) multiple sclerosis (MS) literature suggests that over the last three decades prevalence and estimated incidence rates have increased, while mortality rates have been declining. UK mortality data over a 30 year period have been studied to examine temporal and geographical variations, to estimate changes in survival, and to examine the relationship between mortality and morbidity trends. The study has shown an overall decline in mortality throughout the UK of approximately 25% over the 30 year period ending in 1983, and a reduction in the mortality differential between Scotland, and England and Wales, but no positive correlation has been found between mortality and morbidity. The overall decline in death rate in females was 23% and in males 30% over the 30 years of the survey. The total number of deaths declined by 39% between the five year periods 1954-58 and 1979-83 in Scotland compared with a 10% decline for England and Wales. Estimated median age of death increased from 52 to 59 years and the improvement in survival over the period of study was similar for both countries and is unlikely to have contributed to the reduction in mortality differential. Within England and Wales regional mortality rates did not show a clear north-south gradient. The decline in the mortality differential between Scotland and England (if not artefactual) may provide an important aetiological clue in the search for the cause of multiple sclerosis, and the rate of decline suggests an environmental rather than a genetic aetiology.
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- ALLISON R. S., MILLAR J. H. Prevalence of disseminated sclerosis in Northern Ireland. Ulster Med J. 1954 Mar;23(Suppl 2):1–27. [PMC free article] [PubMed] [Google Scholar]
- Berry G. The analysis of mortality by the subject-years method. Biometrics. 1983 Mar;39(1):173–184. [PubMed] [Google Scholar]
- Fog M., Hyllested K. Prevalence of disseminated sclerosis in the Faroes, the Orkneys and Shetland. Acta Neurol Scand. 1966;42(Suppl):9–11. doi: 10.1111/j.1600-0404.1966.tb01996.x. [DOI] [PubMed] [Google Scholar]
- HARGREAVES E. R. Epidemiological studies in Cornwall. Proc R Soc Med. 1961 Mar;54:209–216. [PMC free article] [PubMed] [Google Scholar]
- Holford T. R. An alternative approach to statistical age-period-cohort analysis. J Chronic Dis. 1985;38(10):831–840. doi: 10.1016/0021-9681(85)90106-7. [DOI] [PubMed] [Google Scholar]
- Kupper L. L., Janis J. M., Karmous A., Greenberg B. G. Statistical age-period-cohort analysis: a review and critique. J Chronic Dis. 1985;38(10):811–830. doi: 10.1016/0021-9681(85)90105-5. [DOI] [PubMed] [Google Scholar]
- LIMBURG C. C. The geographic distribution of multiple sclerosis and its estimated prevalence in the United States. Res Publ Assoc Res Nerv Ment Dis. 1950;28:15–24. [PubMed] [Google Scholar]
- POSKANZER D. C., SCHAPIRA K., MILLER H. EPIDEMIOLOGY OF MULTIPLE SCLEROSIS IN THE COUNTIES OF NORTHUMBERLAND AND DURHAM. J Neurol Neurosurg Psychiatry. 1963 Aug;26:368–376. doi: 10.1136/jnnp.26.4.368. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Poskanzer D. C., Prenney L. B., Sheridan J. L., Kondy J. Y. Multiple sclerosis in the Orkney and Shetland Islands. I: Epidemiology, clinical factors, and methodology. J Epidemiol Community Health. 1980 Dec;34(4):229–239. doi: 10.1136/jech.34.4.229. [DOI] [PMC free article] [PubMed] [Google Scholar]
- SUTHERLAND J. M. Observations on the prevalence of multiple sclerosis in Northern Scotland. Brain. 1956 Dec;79(4):635–654. doi: 10.1093/brain/79.4.635. [DOI] [PubMed] [Google Scholar]
- Shepherd D. I., Downie A. W. A further prevalence study of multiple sclerosis in north-east Scotland. J Neurol Neurosurg Psychiatry. 1980 Apr;43(4):310–315. doi: 10.1136/jnnp.43.4.310. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shepherd D. I., Downie A. W. Prevalence of multiple sclerosis in north-east Scotland. Br Med J. 1978 Jul 29;2(6133):314–316. doi: 10.1136/bmj.2.6133.314. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Swingler R. J., Compston D. The distribution of multiple sclerosis in the United Kingdom. J Neurol Neurosurg Psychiatry. 1986 Oct;49(10):1115–1124. doi: 10.1136/jnnp.49.10.1115. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Williams E. S., McKeran R. O. Prevalence of multiple sclerosis in a south London borough. Br Med J (Clin Res Ed) 1986 Jul 26;293(6541):237–239. doi: 10.1136/bmj.293.6541.237. [DOI] [PMC free article] [PubMed] [Google Scholar]