Determining Multiple Sclerosis Prevalence in Granite County, Montana

1
Determining Multiple Sclerosis Prevalence In
Granite County, Montana
Kristie Scheel, M.S
2
In partial fulfillment of requirements for a
Master in Public Health from the University of
Montana
Dr. Craig Molgaard, PhD, MPH Practicum Academic
Mentor MPH PROGRAM FACULTY, UNIVERSITY OF
MONTANA Michele Sare, MSN, RN - LPHO Practicum
Site Mentor GRANITE COUNTY PUBLIC HEALTH
DEPARTMENT Dr. Amanda Golbeck, PhD Practicum
Committee Member MPH PROGRAM FACULTY, UNIVERSITY
OF MONTANA
3
I. Background II. Study Description III.
Results IV. Discussion V. Personal Assessment
4
I. Background
5
Is there a cluster of multiple sclerosis in
Granite County, Montana?
6
To identify environmental risks in the area
To determine if there is an increased prevalence
of multiple sclerosis (MS) in Granite County,
Montana
7

• Study objectives are based on the following
  principles
• The confirmation of an excess of disease is the
  first step in any investigation of a cluster

• The estimate of excess disease
• burden in a population may also
• drive the decision to pursue an
• etiologic study of the cluster

8
What is Multiple Sclerosis?
9
Weakness and exhaustion in limbs
Tremors
Lack of Muscle Coordination
Symptoms of MS
Blurred Vision
Numbness and Tingling
Incontinence
10
(No Transcript)
11
Family History
Female
MS
Residing in Northern Latitude
Risk Factors
20-40 years of age
Northern European Ancestry
Caucasian
12
Latitudinal Variations in MS Prevalence
13
What Causes MS?
Infectious Agent
Genetics
Environment
14
(No Transcript)
15
Granite County, Montana
(Drummond, Hall, Philipsburg)
Established 1893
Population 2830
16
(No Transcript)
17
Tailings Sites
Dissolved Metals
Human Exposure to Heavy Metals
Runoff
Contamination Of Water Sources
18
High Priority Mining sites in Montana identified
by the Montana Department of Environmental
Quality
19
Prioritized List for Reclamation of Mining Sites
in Montana (2006)
20
II. Study Description
21
Methods
Case Confirmation
Case-Finding
Data Collection
Case Eligibility
Recommended Neurologist Diagnosis Verification

• In-person
• Interview
• Questionnaire
• Medical record
• consent
• Consent to be
• study subject

• Community-
• Based
• Key informant
• Focus group
• Collaboration
• with GCMC
• and MT. MS
• Society

• Resident of
• Granite Co.
• Aged 18 up
• Diagnosed
• between
• 1980 and
• present

22
III. Results
23
Demographics of total cases (n 6) in Granite
County, Montana
24
Crude MS prevalence estimate in Granite County,
Montana per 100,000 population
25

• 2002 National Health
• Interview Survey
• 85 per 100,000
• Most recent, broad-based
• U.S estimate
• Age-, sex-, and region-
• specific
• Same case definition
• Cases are self-reported
• Limitation no clear
• latitudinal adjustments

• 2003 Olmsted County,
• Minnesota Study
• 177 per 100,000
• Updated, county-wide
• Age-, sex-, and latitude-
• specific
• Cases are medically
• verified
• Limitation utilized old
• case definition

26
Granite County, Montana prevalence estimate
comparison per 100,000
27
Philipsburg, Montana prevalence estimate
comparison per 100,000
28

• RESULTS
• NHIS Comparison
• 2.5-fold increase in crude MS prevalence rate
  (2.4 expected cases,
• 6.0 observed)
• 3-fold increase in female-specific prevalence
  rate
• 5-fold increase in crude comparison to
  Philipsburg
• (0.11 expected cases, 4 observed)

• Olmstead County Comparison
• Crude rate indicates 5.0 expected, 6.0 observed
• 1.5-fold increase in female-specific prevalence
  rate
• Almost 2-fold increase in age-specific category
  of 45-54
• 2.5-fold increase in crude comparison to
  Philipsburg
• (0.54 expected cases, 4 observed)

29
Standardized morbidity ratios (SMRs) for the
Granite County study group using the Olmsted
County data for comparison
a non-statistically significant finding
30
Map of Granite County area showing approximate
locations of MS cases identified (numbered
01-06) in relation to Granite Mountain Mine
31
IV. Discussion
32
Study Limitations
33
CONCLUSIONS

• Although crude prevalence estimates are
  compelling
• in comparison to the NHIS U.S. data
• The results indicate a
• non-statistically significant excess of disease
• This may be due to
• the small sample size (thus greater statistical
  variation)
• the comparisons / adjustments for age and
  latitude with
• the Olmsted County data

34
CONCLUSIONS (continued)

• Our results support other data suggesting a
  latitudinal
• variation in MS prevalence.
• We conclude that Granite County is located in a
  high-risk
• region for MS.
• We are unable to conclude whether or not a
  cluster
• of MS exists in Granite County.
• We have identified heavy metal exposure as the
  major
• environmental risk, but cannot make any
  conclusions
• about the relationship to MS prevalence in
  Granite County

35
RECOMMENDATIONS

• Completion of medical verification by board
  certified
• neurologist
• 2. Develop accurate MS prevalence estimates for
  the state
• of Montana using a standard case definition,
  case
• ascertainment methods, and adjustments for
  confounders
• 3. Track any missed/new MS cases and to
  re-analyze the
• Granite County cluster data when Montana
  prevalence
• estimates become available
• 4. Continue tracking case residency and
  groundwater
• exposure in relation to mining and tailing
  sites in Granite
• County

36
V. Personal Assessment
37
APPLICATION OF ESSENTIAL SERVICES OF PUBLIC HEALTH

• Monitor health status to identify and solve
  community health
• problems
• Work with small community on a purported disease
  cluster
• Established the groundwork from which to continue
  monitoring the rate
• of future cases in the study area

• Diagnose and investigate health hazards in the
  community
• Investigation of possible risk factors for MS
  both universal and unique to
• the study area
• Focus group, meetings with healthcare workers,
  and an interview with
• Missoula neurologist
• No relationship between MS and heavy metal
  exposure was confirmed,
• but investigating the possibility of this
  risk could be an avenue for future
• research.

38
APPLICATION OF ESSENTIAL SERVICES OF PUBLIC HEALTH

• Mobilize community partnerships and action to
  identify and
• solve health problems
• Investigation entailed working closely with local
  residents, healthcare
• workers, and public health officials.
• Open communication with the community aided in
  locating cases,
• determining local risk factors, and
  identifying commonalities amongst
• case load.

• Research for new insight and innovative solutions
  to
• health problems
• Recommendations based on previous MS prevalence
  studies including
• the importance of a standard case definition,
  similar methodology, and
• adjusting for variations in age, gender,
  latitude, and ancestry.
• Specifically to Granite County, I recommended
  the surveillance
• of local MS cases, and further investigation
  into case residential
• history in relation to mining/tailings site
  location.

39
Thank You