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Research paper
Latitude continues to be significantly associated with the prevalence of multiple sclerosis: an updated meta-analysis
  1. Steve Simpson Jr.1,2,
  2. Wendy Wang3,4,
  3. Peter Otahal2,
  4. Leigh Blizzard2,
  5. Ingrid A F van der Mei2,
  6. Bruce V Taylor2
  1. 1 Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  2. 2 Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
  3. 3 Department of Neurology, Royal Hobart Hospital, Hobart, Tasmania, Australia
  4. 4 The Alfred Hospital, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Dr Steve Simpson, Jr., Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Victoria 3053, Australia; steve.simpson{at}; steve.simpson{at}


Objectives Previous studies have demonstrated a strong latitudinal gradient in multiple sclerosis (MS) prevalence. Herein, we present a meta-analysis of the latitudinal gradient of MS prevalence including studies published since our 2011 review, seeking to assess the latitudinal gradient and whether it has changed since our previous analysis.

Methods Studies published up to December 2018 were located via Embase, Web of Knowledge and PubMed, using standardised search terms; data were extracted from peer-reviewed studies and these studies added to those from our previous analysis. Where age-specific data were available, prevalence estimates were age-/sex-standardised to the 2009 European population. Prevalence estimates were adjusted for study prevalence year and ascertainment methods. The latitudinal association with MS prevalence was assessed by meta-regression.

Results A total of 94 studies met inclusion criteria, yielding 230 new prevalence points and 880 altogether with those from the prior study. There was a significant positive gradient in time-corrected MS prevalence with increasing latitude (5.27/100 000 per degree latitude), attenuating slightly to 4.34/100 000 on age-standardisation, these associations persisting on adjustment for ascertainment method. Of note, the age-standardised gradient was consistently significantly enhanced from our previous study, regardless of whether it was as-measured, time-corrected or adjusted for ascertainment methods. Certain areas, such as the Scandinavian and Atlantic Coast/Central Europe regions, showed changes in MS prevalence gradient over time, but other regional gradients were similar.

Conclusions This new meta-analysis confirms that MS prevalence is still strongly positively associated with increasing latitude and that the gradient is increasing, suggesting that potentially modifiable environmental factors, such as sun exposure, are still strongly associated with MS risk.

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  • Contributors This project was conceived of by SS. The literature review for the updated studies was conducted by WW and SS. Statistical analyses were conducted by SS, with assistance from LB and PO. Initial manuscript drafting was done by SS. All the authors have critically reviewed the manuscript and approve it for submission.

  • Funding This research has received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests No, there are no competing interests for any author.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.