Mortality from multiple sclerosis in British military personnel.

Keith T Palmer,E Clare Harris,Vanessa Cox,John Osman,Andrew Darnton,David Coggon

doi:10.1093/occmed/kqx083

Abstract

While analysing trends in occupational mortality in England and Wales, we noticed an unexpectedly elevated proportion of deaths from multiple sclerosis (MS) among men in the armed forces. To document and explore possible explanations for the observed excess. We analysed data on underlying cause of death and last full-time occupation for 3,688,916 deaths among men aged 20-74 years in England and Wales during 1979-2010, calculating proportional mortality ratios (PMRs) standardised for age. We compared PMRs for MS in the armed forces with those for each main social class, and in selected other occupations. We also compared PMRs for MS with those for motor neurone disease (MND). The overall PMR for MS in the armed forces during 1979-2010 was 243 (95%CI 203-288). The excess was apparent in each of three separate decades of study (PMRs, ranging from 220 to 259), and across the entire age range. PMRs for MS were not elevated to the same extent in comparator occupations, nor in any of the main social classes. There was no parallel increase in PMRs for MND. These findings suggest that the high proportional mortality from MS in British military personnel is unlikely to have occurred by chance, or as an artefact of the method of investigation. However, the only military cohort study with published results on MS does not support an increased risk. It would be useful to analyse data on MS from other established military cohorts, to check for evidence of a hazard.

Highlights

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system with a prevalence in the UK of approximately 200 per 100,000 [1]
In the course of our most recent analysis [8], we noticed that proportional mortality ratios (PMRs) for multiple sclerosis (MS) in male members of the armed forces had been consistently elevated over three successive decades
Proportional mortality was highest in social classes 1 and 3 non-manual, but even in these groups, PMRs were much lower than those for the armed forces

Summary

Introduction

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system with a prevalence in the UK of approximately 200 per 100,000 [1]. In the course of our most recent analysis [8], we noticed that proportional mortality ratios (PMRs) for MS in male members of the armed forces had been consistently elevated over three successive decades. While analysing trends in occupational mortality in England and Wales, we noticed an unexpectedly elevated proportion of deaths from multiple sclerosis (MS) among men in the armed forces. Methods—We analysed data on underlying cause of death and last full-time occupation for 3,688,916 deaths among men aged 20-74 years in England and Wales during 1979-2010, calculating proportional mortality ratios (PMRs) standardised for age. We compared PMRs for MS in the armed forces with those for each main social class, and in selected other occupations. It would be useful to analyse data on MS from other established military cohorts, to check for evidence of a hazard

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Conclusion