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Rising incidence of multiple sclerosis in females associated with urbanization.

Abstract

OBJECTIVE

To design and perform a case-control study of multiple sclerosis (MS) in Crete, an island of 0.6 million people, that has experienced profound socioeconomic changes in recent decades.

METHODS

All MS cases occurring on Crete from 1980 to 2008 were ascertained. To search for putative risk factors, a structured questionnaire of 71 variables was employed, with patients with MS (n = 657) being compared to random controls (n = 593) matched for age, gender, and current place of residence.

RESULTS

MS incidence rose markedly on Crete over the past 3 decades. This increase was associated with a major shift in MS distribution among genders (1980: F/M = 0.9; 2008: F/M = 2.1), with females living in towns or having relocated at a young age from the countryside to urban centers being mainly affected. In rural Crete, MS showed lesser increases and gender preference. Of the major changes that accompanied urbanization, smoking among women with MS increased dramatically, while imported pasteurized cow milk virtually replaced fresh goat milk produced locally. Compared to controls, female patients with MS more often used contraceptives and were older at first childbirth. Besides smoking, alcohol drinking and vitamin intake was more common among female patients with MS. Also, the distribution of childhood diseases and chronic medical conditions differed significantly between patients with MS and controls.

CONCLUSIONS

MS incidence rose markedly over 3 decades in a genetically stable population in tandem with a transition from rural to urban living, thus possibly implicating environmental factors introduced by urbanization.

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  • Authors+Show Affiliations

    ,

    Department of Neurology, School of Medicine, University of Crete, Heraklion, Greece.

    , , , , ,

    Source

    Neurology 78:22 2012 May 29 pg 1728-35

    MeSH

    Adult
    Age Factors
    Alcohol Drinking
    Case-Control Studies
    Communicable Diseases
    Comorbidity
    Contraceptive Agents, Female
    Dairy Products
    Family Characteristics
    Feeding Behavior
    Female
    Greece
    Humans
    Incidence
    Middle Aged
    Multiple Sclerosis
    Occupations
    Odds Ratio
    Parturition
    Prevalence
    Risk Factors
    Rural Population
    Smoking
    Social Change
    Social Environment
    Socioeconomic Factors
    Sunlight
    Surveys and Questionnaires
    Urbanization
    Vitamins

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22592376

    Citation

    Kotzamani, D, et al. "Rising Incidence of Multiple Sclerosis in Females Associated With Urbanization." Neurology, vol. 78, no. 22, 2012, pp. 1728-35.
    Kotzamani D, Panou T, Mastorodemos V, et al. Rising incidence of multiple sclerosis in females associated with urbanization. Neurology. 2012;78(22):1728-35.
    Kotzamani, D., Panou, T., Mastorodemos, V., Tzagournissakis, M., Nikolakaki, H., Spanaki, C., & Plaitakis, A. (2012). Rising incidence of multiple sclerosis in females associated with urbanization. Neurology, 78(22), pp. 1728-35. doi:10.1212/WNL.0b013e31825830a9.
    Kotzamani D, et al. Rising Incidence of Multiple Sclerosis in Females Associated With Urbanization. Neurology. 2012 May 29;78(22):1728-35. PubMed PMID: 22592376.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Rising incidence of multiple sclerosis in females associated with urbanization. AU - Kotzamani,D, AU - Panou,T, AU - Mastorodemos,V, AU - Tzagournissakis,M, AU - Nikolakaki,H, AU - Spanaki,C, AU - Plaitakis,A, Y1 - 2012/05/16/ PY - 2012/5/18/entrez PY - 2012/5/18/pubmed PY - 2012/7/31/medline SP - 1728 EP - 35 JF - Neurology JO - Neurology VL - 78 IS - 22 N2 - OBJECTIVE: To design and perform a case-control study of multiple sclerosis (MS) in Crete, an island of 0.6 million people, that has experienced profound socioeconomic changes in recent decades. METHODS: All MS cases occurring on Crete from 1980 to 2008 were ascertained. To search for putative risk factors, a structured questionnaire of 71 variables was employed, with patients with MS (n = 657) being compared to random controls (n = 593) matched for age, gender, and current place of residence. RESULTS: MS incidence rose markedly on Crete over the past 3 decades. This increase was associated with a major shift in MS distribution among genders (1980: F/M = 0.9; 2008: F/M = 2.1), with females living in towns or having relocated at a young age from the countryside to urban centers being mainly affected. In rural Crete, MS showed lesser increases and gender preference. Of the major changes that accompanied urbanization, smoking among women with MS increased dramatically, while imported pasteurized cow milk virtually replaced fresh goat milk produced locally. Compared to controls, female patients with MS more often used contraceptives and were older at first childbirth. Besides smoking, alcohol drinking and vitamin intake was more common among female patients with MS. Also, the distribution of childhood diseases and chronic medical conditions differed significantly between patients with MS and controls. CONCLUSIONS: MS incidence rose markedly over 3 decades in a genetically stable population in tandem with a transition from rural to urban living, thus possibly implicating environmental factors introduced by urbanization. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/22592376/full_citation L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=22592376 DB - PRIME DP - Unbound Medicine ER -