Surprises in MS Incidence Study Among Gulf War Era Veterans

WASHINGTON – How common is multiple sclerosis among U.S. military personnel and veterans from the Gulf War era?

A study led by researchers from the Washington, DC, VAMC and the VA Multiple Sclerosis Centers of Excellence in Baltimore sought to quantify that.

Their report, published last year in the journal Brain, was the first update since an MS incidence study in the 1970s.1

Researchers reviewed medical records and data from the DoD and VA for cases of MS in patients who served in the military between 1990, the start of the Gulf War era, and 2007, as well as those who were service-connected for this disorder by VA from 1990 on.

A total of 2,691 patients were confirmed as having multiple sclerosis: 2,288 definite, 190 possible, 207 clinically isolated syndrome and 6 neuromyelitis optica.

Of those, 1,278 were white males and 556 were white females; 360 were black males and 296 were black females. Of the 200 in the other category, 153 (77%) were Hispanic.

The mean age at onset – 30.7 years – did not differ significantly by race or sex.

Disease rates measured by race were highest for blacks at 12.1 per 100,000 person years, followed by whites at 9.3 and others 6.9. For 83 Hispanics defined for 2000- 07, the rate was 8.2. Using much smaller numbers, rates were determined to be 3.3 for Asian/Pacific Islanders and 3.1 for Native Americans.

Interestingly, many earlier studies had found the highest rates among whites of northern European backgrounds.

Despite race, women had much higher incidence rates than men – 25.8 compared with 7.3 for whites; 26.3 compared with 8.4 for blacks and 17 compared with 6.6 for Hispanics.

The Air Force and Army had the highest rates of MS, 10.9 and 10.6, respectively. The rate per 100,000 person years for the Navy was 9.1, with 7.9 for the Coast Guard. The rate among Marines was an extremely low 5.3.

Noting that relative risk of multiple sclerosis was found to be 3.39 female: male and 1.27 black: white, the authors noted, “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.”

1. Wallin MT, Culpepper WJ, Coffman P, Pulaski S, et al. Veterans Affairs Multiple Sclerosis Centers of Excellence Epidemiology Group. The Gulf War era multiple sclerosis cohort: age and incidence rates by race, sex and service. Brain. 2012 Jun;135(Pt 6):1778-85. doi: 10.1093/brain/aws099. PubMed PMID: 22628389.

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