Skip to main content

Advertisement

SpringerLink
Log in

Sex ratio of multiple sclerosis in persons born from 1930 to 1979 and its relation to latitude in Norway

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

A remarkable increase in female to male ratio of multiple sclerosis (MS) is recognised in high incidence areas. Norway is a high-risk area for MS, spanning latitudes 58–71°N. We studied whether the sex ratio has changed over time and whether it differs by clinical phenotype or by latitude. Population-based epidemiological data and data from the Norwegian MS Registry on patients born from 1930 to 1979 were combined in this study. Place of birth was retrieved from the Norwegian Population Registry and information on clinical subtypes was obtained from the Norwegian MS Registry. The female to male ratio ranged from 1.7 to 2.7 (median 2.0) in 5,469 patients born in Norway, and increased slightly by 5-year blocks of year of birth (p = 0.043). The sex ratio was 2.6:1 in 825 patients born 1970–1979, which is significantly higher than in those born 1930–1969 (p < 0.001). In patients with relapsing remitting onset, the sex ratio was 2.4:1, while it was 1.1:1 in those with primary progressive disease. The sex ratio did not differ between the south, the middle and the north of the country. The overall sex ratio of MS is strongly determined by cases with relapsing remitting onset. We did not observe the remarkable increase in sex ratios of MS reported from other high-risk areas. The high sex ratio in the youngest birth cohorts may change as an increasing proportion of cases in this age group is being diagnosed. Sex ratio was not associated with latitude.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ahlgren C, Oden A, Lycke J (2011) High nationwide prevalence of multiple sclerosis in Sweden. Mult Scler 17:901–908

    Article  PubMed  CAS  Google Scholar 

  2. Alonso A, Hernan MA (2008) Temporal trends in the incidence of multiple sclerosis: a systematic review. Neurology 71:129–135

    Article  PubMed  Google Scholar 

  3. Alonso A, Jick SS, Olek MJ, Hernan MA (2007) Incidence of multiple sclerosis in the United Kingdom: findings from a population-based cohort. J Neurol 254:1736–1741

    Article  PubMed  CAS  Google Scholar 

  4. Alstadhaug KB, Olavsen J, Salvesen R (2005) Occurrence of multiple sclerosis in Nordland, 1970–1999. Tidsskr Nor Laegeforen 125:431–433

    PubMed  Google Scholar 

  5. Bentzen J, Flachs EM, Stenager E, Bronnum-Hansen H, Koch-Henriksen N (2010) Prevalence of multiple sclerosis in Denmark 1950–2005. Mult Scler 16:520–525

    Article  PubMed  Google Scholar 

  6. Beretich B, Beretich T (2009) Explaining multiple sclerosis prevalence by ultraviolet exposure: a geospatial analysis. Mult Scler 15:891–898

    Article  PubMed  CAS  Google Scholar 

  7. Bostrom I, Stawiarz L, Landtblom AM (2012) Sex ratio of multiple sclerosis in the National Swedish MS Register (SMSreg). Mult Scler. doi:10.1177/1352458512446169

    PubMed  Google Scholar 

  8. Celius EG, Smestad C (2009) Change in sex ratio, disease course and age at diagnosis in Oslo MS patients through seven decades. Acta Neurol Scand Suppl 189:27–29

    Article  PubMed  Google Scholar 

  9. Dahl OP, Aarseth JH, Myhr KM, Nyland H, Midgard R (2004) Multiple sclerosis in Nord-Trondelag County, Norway: a prevalence and incidence study. Acta Neurol Scand 109:378–384

    Article  PubMed  CAS  Google Scholar 

  10. Edvardsen K, Veierod MB, Brustad M, Braaten T, Engelsen O, Lund E (2011) Vitamin D-effective solar UV radiation, dietary vitamin D and breast cancer risk. Int J Cancer 128:1425–1433

    Article  PubMed  CAS  Google Scholar 

  11. Freisling H, Fahey MT, Moskal A, Ocke MC, Ferrari P, Jenab M, Norat T, Naska A, Welch AA, Navarro C, Schulz M, Wirfalt E, Casagrande C, Amiano P, Ardanaz E, Parr C, Engeset D, Grioni S, Sera F, Bueno-de-Mesquita B, van der Schouw YT, Touvier M, Boutron-Ruault MC, Halkjaer J, Dahm CC, Khaw KT, Crowe F, Linseisen J, Kroger J, Huybrechts I, Deharveng G, Manjer J, Agren A, Trichopoulou A, Tsiotas K, Riboli E, Bingham S, Slimani N (2010) Region-specific nutrient intake patterns exhibit a geographical gradient within and between European countries. J Nutr 140:1280–1286

    Article  PubMed  CAS  Google Scholar 

  12. Greer JM, McCombe PA (2011) Role of gender in multiple sclerosis: clinical effects and potential molecular mechanisms. J Neuroimmunol 234:7–18

    Article  PubMed  CAS  Google Scholar 

  13. Grytten N, Glad SB, Aarseth JH, Nyland H, Midgard R, Myhr KM (2006) A 50-year follow-up of the incidence of multiple sclerosis in Hordaland County, Norway. Neurology 66:182–186

    Article  PubMed  CAS  Google Scholar 

  14. Harbo HF, Utsi E, Lorentzen AR, Kampman MT, Celius EG, Myhr KM, Lie BA, Mellgren SI, Thorsby E (2007) Low frequency of the disease-associated DRB1*15-DQB1*06 haplotype may contribute to the low prevalence of multiple sclerosis in Sami. Tissue Antigens 69:299–304

    Article  PubMed  CAS  Google Scholar 

  15. Hirst C, Ingram G, Pickersgill T, Swingler R, Compston DA, Robertson NP (2009) Increasing prevalence and incidence of multiple sclerosis in South East Wales. J Neurol Neurosurg Psychiatry 80:386–391

    Article  PubMed  CAS  Google Scholar 

  16. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281

    Article  PubMed  CAS  Google Scholar 

  17. Islam T, Gauderman WJ, Cozen W, Mack TM (2007) Childhood sun exposure influences risk of MS in monozygotic twins. Neurology 69:381–388

    Article  PubMed  Google Scholar 

  18. Kampman MT, Brustad M (2008) Vitamin D: a Candidate for the Environmental Effect in Multiple Sclerosis—Observations from Norway. Neuroepidemiology 30:140–146

    Article  PubMed  Google Scholar 

  19. Kampman MT, Wilsgaard T, Mellgren SI (2007) Outdoor activities and diet in childhood and adolescence relate to MS risk above the Arctic Circle. J Neurol 254:471–477

    Article  PubMed  CAS  Google Scholar 

  20. Koch-Henriksen N, Sorensen PS (2010) The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol 9:520–532

    Article  PubMed  Google Scholar 

  21. 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 78:1728–1735

    Article  PubMed  CAS  Google Scholar 

  22. McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den NS, Weinshenker BY, Wolinsky JS (2001) Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127

    Article  PubMed  CAS  Google Scholar 

  23. Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A (2006) Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA 296:2832–2838

    Article  PubMed  CAS  Google Scholar 

  24. Orton SM, Herrera BM, Yee IM, Valdar W, Ramagopalan SV, Sadovnick AD, Ebers GC (2006) Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurol 5:932–936

    Article  PubMed  Google Scholar 

  25. Orton SM, Wald L, Confavreux C, Vukusic S, Krohn JP, Ramagopalan SV, Herrera BM, Sadovnick AD, Ebers GC (2011) Association of UV radiation with multiple sclerosis prevalence and sex ratio in France. Neurology 76:425–431

    Article  PubMed  Google Scholar 

  26. Palacios N, Alonso A, Bronnum-Hansen H, Ascherio A (2011) Smoking and increased risk of multiple sclerosis: parallel trends in the sex ratio reinforce the evidence. Ann Epidemiol 21:536–542

    Article  PubMed  Google Scholar 

  27. Ponsonby AL, Lucas RM, van der Mei IA, Dear K, Valery PC, Pender MP, Taylor BV, Kilpatrick TJ, Coulthard A, Chapman C, Williams D, McMichael AJ, Dwyer T (2012) Offspring number, pregnancy, and risk of a first clinical demyelinating event: the AusImmune Study. Neurology 78:867–874

    Article  PubMed  Google Scholar 

  28. Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231

    Article  PubMed  CAS  Google Scholar 

  29. Ramagopalan SV, Byrnes JK, Orton SM, Dyment DA, Guimond C, Yee IM, Ebers GC, Sadovnick AD (2010) Sex ratio of multiple sclerosis and clinical phenotype. Eur J Neurol 17:634–637

    Article  PubMed  CAS  Google Scholar 

  30. Ramagopalan SV, Handel AE, Giovannoni G, Rutherford SS, Ebers GC, Chaplin G (2011) Relationship of UV exposure to prevalence of multiple sclerosis in England. Neurology 76:1410–1414

    Article  PubMed  CAS  Google Scholar 

  31. Risberg G, Aarseth JH, Nyland H, Lauer K, Myhr KM, Midgard R (2010) Prevalence and incidence of multiple sclerosis in Oppland County—a cross-sectional population-based study in a landlocked county of Eastern Norway. Acta Neurol Scand 124:250–257

    Article  PubMed  Google Scholar 

  32. Salzer J, Hallmans G, Nystrom M, Stenlund H, Wadell G, Sundstrom P (2012) Vitamin D as a protective factor in multiple sclerosis. Neurology 79:2140–2145

    Article  PubMed  CAS  Google Scholar 

  33. Sellner J, Kraus J, Awad A, Milo R, Hemmer B, Stuve O (2011) The increasing incidence and prevalence of female multiple sclerosis–a critical analysis of potential environmental factors. Autoimmun Rev 10:495–502

    Article  PubMed  Google Scholar 

  34. Simpson S Jr, Blizzard L, Otahal P, van dM I, Taylor B (2011) Latitude is significantly associated with the prevalence of multiple sclerosis: a meta-analysis. J Neurol Neurosurg Psychiatry 82:1132–1141

    Article  PubMed  Google Scholar 

  35. Simpson S Jr, Pittas F, van dM I, Blizzard L, Ponsonby AL, Taylor B (2011) Trends in the epidemiology of multiple sclerosis in Greater Hobart, Tasmania: 1951 to 2009. J Neurol Neurosurg Psychiatry 82:180–187

    Article  PubMed  Google Scholar 

  36. Sloka JS, Pryse-Phillips WE, Stefanelli M (2008) The relation of ultraviolet radiation and multiple sclerosis in Newfoundland. Can J Neurol Sci 35:69–74

    PubMed  CAS  Google Scholar 

  37. Swank RL, Lerstad O, Strom A, Backer J (1952) Multiple sclerosis in rural Norway its geographic and occupational incidence in relation to nutrition. N Engl J Med 246:722–728

    Article  PubMed  CAS  Google Scholar 

  38. van der Mei IAF, Ponsonby AL, Blizzard L, Dwyer T (2001) Regional variation in multiple sclerosis prevalence in Australia and its association with ambient ultraviolet radiation. Neuroepidemiology 20:168–174

    Article  PubMed  Google Scholar 

  39. van der Mei IAF, Ponsonby AL, Dwyer T, Blizzard L, Simmons R, Taylor BV, Butzkueven H, Kilpatrick T (2003) Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study. BMJ 327:316–321

    Article  PubMed  Google Scholar 

  40. Vatne A, Mygland A, Ljostad U (2011) Multiple sclerosis in Vest-Agder county, Norway. Acta Neurol Scand 123:396–399

    Article  PubMed  CAS  Google Scholar 

  41. Warren SA, Svenson LW, Warren KG (2008) Contribution of incidence to increasing prevalence of multiple sclerosis in Alberta, Canada. Mult Scler 14:872–879

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Cathrine Smestad for data collection from the Oslo MS registry. This work was financially supported by the Neuromuscular Diseases Research Group at the University of Tromsø.

Conflicts of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Centre for Clinical Research and Education, University Hospital of North Norway, 9038, Tromsø, Norway

    Margitta T. Kampman

  2. Department of Clinical Medicine, University of Tromsø, Tromso, Norway

    Margitta T. Kampman

  3. Department of Neurology, Norwegian Multiple Sclerosis Competence Centre, Haukeland University Hospital, Bergen, Norway

    Jan Harald Aarseth, Nina Grytten, Kjell-Morten Myhr & Øivind Torkildsen

  4. Department of Neurology, Nordland Hospital, Bodø, Norway

    Espen Benjaminsen

  5. Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway

    Elisabeth Gulowsen Celius

  6. Department of Neurology, Namsos Hospital, Namsos, Norway

    Ole Petter Dahl

  7. Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway

    Trygve Holmøy

  8. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Trygve Holmøy

  9. Department of Neurology, Innlandet Hospital Trust, Lillehammer, Norway

    Kristin Løken-Amsrud

  10. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Kristin Løken-Amsrud

  11. Department of Neurology, Molde Hospital, Molde, Norway

    Rune Midgard

  12. Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway

    Rune Midgard

  13. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Kjell-Morten Myhr

  14. KG Jebsen Centre for MS-research, Bergen, Norway

    Nina Grytten, Kjell-Morten Myhr & Øivind Torkildsen

  15. Department of Rehabilitation, Innlandet Hospital Trust, Gjovik, Norway

    Geir Risberg

  16. Department of Neurology, Sørlandet Hospital SSK, Kristiansand, Norway

    Anita Vatne

Authors
  1. Margitta T. Kampman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan Harald Aarseth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nina Grytten
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Espen Benjaminsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elisabeth Gulowsen Celius
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ole Petter Dahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Trygve Holmøy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kristin Løken-Amsrud
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rune Midgard
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kjell-Morten Myhr
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Geir Risberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Anita Vatne
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Øivind Torkildsen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Margitta T. Kampman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kampman, M.T., Aarseth, J.H., Grytten, N. et al. Sex ratio of multiple sclerosis in persons born from 1930 to 1979 and its relation to latitude in Norway. J Neurol 260, 1481–1488 (2013). https://doi.org/10.1007/s00415-012-6814-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-012-6814-x

Keywords

Search

Navigation