Multiple Sclerosis in US Veterans of the Vietnam Era and Later Military Service: Race, Sex, and Geography

Department of Veterans Affairs Medical Center, Georgetown University Medical School, Washington, DC, USA.
Annals of Neurology (Impact Factor: 9.98). 01/2004; 55(1):65-71. DOI: 10.1002/ana.10788
Source: PubMed


We identified 5345 cases of multiple sclerosis (MS) among US veterans who first entered military service between 1960 and 1994, and who were "service-connected" for MS by the Department of Veterans Affairs (VA). Two controls per case were matched on age, date of service entry, and branch of service. Available for service and VA files were demographic and military data for 4951 cases and 9378 controls. Versus white men, relative risk of MS was significantly higher for all women, at 2.99 for whites, 2.86 for blacks, and 3.51 for those of other races. This was a significant increase from our prior series of veterans of World War II and the Korean Conflict, where white women had a relative risk of 1.79. Risk for black men was higher now (0.67 vs 0.44), while other men remained low (0.30 vs 0.22). Residence at service entry in the northern tier of states had a relative risk of 2.02 versus the southern tier, which was significantly less than the 2.64 for the earlier series. Residence by individual state at birth and service entry for white men further supported this decreasing geographic differential. Such marked changes in geography, sex, and race in such a short interval strongly imply a primary environmental factor in the cause or precipitation of this disease.

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Available from: John F Kurtzke, Mar 09, 2015
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    • "The Gulf War era multiple sclerosis cohort was assembled similarly to the World War II–Korean Conflict series and the Vietnam and later series (Kurtzke et al., 1979; Wallin et al., 2004). With the assistance of Veterans Benefits Administration, Department of Veterans Affairs databases and Department of Defense data, we identified all veterans who had applied and were evaluated for a service-connection for multiple sclerosis by the Department of Veterans Affairs, and who had active duty service between 1990 and 2007. "
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    ABSTRACT: We characterize here a new nationwide incident cohort of multiple sclerosis from the US military-veteran population. This cohort provides an update to the only other US nationwide incidence study of multiple sclerosis performed during the 1970s. Medical records and data from the Department of Defense and Department of Veterans Affairs for cases of multiple sclerosis who served in the military between 1990, the start of the Gulf War era, and 2007 and who were service-connected for this disorder by the Department of Veterans Affairs from 1990 on, were reviewed. A total of 2691 patients were confirmed as having multiple sclerosis: 2288 definite, 190 possible, 207 clinically isolated syndrome and six neuromyelitis optica. Overall racial categories were White, Black and other, which included all Hispanics. There were 1278 White males and 556 females; 360 Black males and 296 females; and 200 others, 153 (77%) of whom were Hispanic. Mean age at onset of 30.7 years did not differ significantly by race or sex. Age at onset was 17-50 years in 99%, the same age range as 99% of the military. Average annual age specific (age 17-50 years) incidence rates per 100 000 for the entire series were 9.6 with 95% confidence interval of 9.3-10.0. Rates for Blacks were highest at 12.1 with confidence interval 11.2-13.1, Whites were 9.3 (interval 8.9-9.8) and others 6.9 (interval 6.0-7.9). For 83 Hispanics defined for 2000-07, the rate was 8.2 (interval 6.5-10.1). Much smaller numbers gave rates of 3.3 for Asian/Pacific Islanders and 3.1 for native Americans. Rates by sex for Whites were 7.3 and 25.8 male and female, respectively, for Blacks 8.4 and 26.3, and for Hispanics 6.6 and 17.0. Rates by service were high for Air Force (10.9) and Army (10.6), medium for Navy (9.1) and Coast Guard (7.9), and low for Marines (5.3). Relative risk of multiple sclerosis was 3.39 female:male and 1.27 Black:White. These new findings indicate that females of all races now have incidence rates for multiple sclerosis some three times those of their male counterparts and that among these groups, Blacks have the highest and others (probably including Hispanics) the lowest incidence rates regardless of sex or service. The low rate for Marines is unexplained. This Gulf War era multiple sclerosis cohort provides a unique resource for further study.
    Brain 06/2012; 135(Pt 6):1778-85. DOI:10.1093/brain/aws099 · 9.20 Impact Factor
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    • "They concluded, '. . . such marked changes in geography, sex, and race in such a short interval strongly imply a primary environmental factor in the cause or precipitation of multiple sclerosis' (Wallin et al., 2004). "
    Brain 06/2012; 135(Pt 6):1663-5. DOI:10.1093/brain/aws135 · 9.20 Impact Factor
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    • "The disease has a peak onset between ages 20 and 40 years [1]; however it may also develop in children and in addition has been reported in individuals aged above 60 years. MS affects women approximately twice as often as men [2] [3] [4] [5]. MS results in a plethora of neurological manifestations and is a leading cause of nontraumatic disability among young adults and has great socioeconomic impact in developed countries [6]. "
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    ABSTRACT: Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS) with varied clinical presentations and heterogeneous histopathological features. The underlying immunological abnormalities in MS lead to various neurological and autoimmune manifestations. There is strong evidence that MS is, at least in part, an immune-mediated disease. There is less evidence that MS is a classical autoimmune disease, even though many authors state this in the description of the disease. We show the evidence that both supports and refutes the autoimmune hypothesis. In addition, we present an alternate hypothesis based on virus infection to explain the pathogenesis of MS.
    05/2012; 2012(1):969657. DOI:10.1155/2012/969657
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