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Geography in multiple sclerosis

Summary

Both mortality and morbidity data indicate quite clearly that multiple sclerosis is a geographically-related disease, and thus MS can be thought of as an acquired environmental (exogenous) illness. High frequency parts of the world for MS are Europe between 65° and 45° north latitude, northern United States and southern Canada, New Zealand, and southern Australia. These regions are bounded by medium frequency MS regions: in Europe to the north, east, and south; in America for southern U.S.; and the remainder of Australia. Latin America, Asia and Africa are essentially of low frequency from present data. Latitude is not a sufficient criterion: at 40° north latitude, MS is high in America, medium in Europe, and low in Asia.

All high and medium risk areas therefore are in Europe or European colonies; thus MS is the white man's burden spread from western Europe. Within the U.S., MS is less common among Negroes, Japanese, and possibly Amerindians than in whites regardless of geography. Migration studies among risk areas indicate that migrants keep much of the risk of their birthplace, but also that overall the risk is decreased by high-to-low migration, and probably increased by low-to-high. For the former, it seems that adolescence is the age critical for retention of birthplace risk. Some preliminary data on a possible epidemic of MS are also presented.

All the epidemiologic information would be most easily explained if MS were an infectious (?viral) illness with prolonged latency. The proof of this though must come from the laboratory.

Zusammenfassung

Die Daten über Mortalität und Vorkommen der Multiplen Sklerose zeigen eindeutig, daß es sich um eine Krankheit mit einer bestimmten geographischen Verbreitung handelt, und daß die Multiple Sklerose als eine erworbene, (exogene) umweltbedingte Krankheit angesehen werden muß. Gebiete mit hoher Frequenz der Multiplen Sklerose liegen in Europa zwischen dem 65. und 45. Breitengrad, in den nördlichen Vereinigten Staaten, Südkanada, Neuseeland und Südaustralien. An diese Regionen grenzen solche mit einer mittleren MS-Frequenz, in Europa nördlich, östlich und südlich, in Amerika gilt das für die südlichen Vereinigten Staaten und es gilt für den Rest von Australien. Lateinamerika, Asien und Afrika zeigen im wesentlichen nach den heutigen Untersuchungen eine niedrige Frequenz. Aber der Breitengrad ist nicht genug: auf dem 40. Breitengrad nördlich ist die Multiple Sklerose in Amerika sehr häufig, mittelhäufig in Europa und niedrig in Asien.

Alle Gebiete hohen und mittleren Risikos liegen deswegen in Europa oder in den europäischen Kolonien. Die Multiple Sklerose ist also die Bürde des weißen Mannes, die sich von Westeuropa aus ausgebreitet hat. Innerhalb der Vereinigten Staaten ist Multiple Sklerose seltener bei den Negern und Japanern und wahrscheinlich auch bei den amerikanischen Indianern als bei den Weißen, unabhängig von der Geographie. Untersuchungen des Einflusses der Wanderung von Risikogegenden aus zeigen, daß die Wanderer das Risiko ihrer Geburtsländer mit sich bringen, daß aber im großen und ganzen das Risiko abnimmt, wenn die Wanderung von risikoreichen zu risikoniedrigen Gebieten erfolgt ist, und daß das Risiko zunimmt, wenn die Wanderung in umgekehrter Richtung erfolgt. Bei der ersteren scheint es, daß die Adoleszenz das kritische Alter für die Beibehaltung des Risikos des Geburtslandes darstellt. Es werden vorläufige Daten einer möglichen MS-Epidemie vorgestellt. Alle epidemiologischen Unterlagen werden am leichtesten erklärbar, wenn die Multiple Sklerose eine infektiöse (Virus?) Krankheit mit langer Latenz wäre. Der Nachweis dafür muß allerdings durch Laboratoriumsuntersuchungen erbracht werden.

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Kurtzke, J.F. Geography in multiple sclerosis. J. Neurol. 215, 1–26 (1977). https://doi.org/10.1007/BF00312546

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Key words

  • Multiple sclerosis
  • Geographic distribution
  • Race
  • Migration
  • Clustering