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Correspondence: When an article is eligible for submission of Correspondence, a link to the response form is available within the full-text article. You must be a current subscriber who has activated the online portion of your subscription in order to send a Correspondence. Any reader can read published Correspondence.
Correspondence to:
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Correspondence:Correspondence published:
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![[Read Correspondence]](/icons/misc/sectionDOWN.gif)
Ethnic variation in the incidence of ALS: A systematic review
- Joe Jacob Alappat (24 April 2007)
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Reply from the Authors
- Orla Hardiman, Simon Cronin, Bryan J Traynor (24 April 2007)
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Joe Jacob Alappat, Neurology Ibn Sina Hospital, Safat, Kuwait
Send Correspondence to journal:
joealappat{at}yahoo.com Joe Jacob Alappat
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I read the article by Cronin et al with great interest. [1] During the course of this study, the authors attempt to determine ethnicity from the names of the subject population. This method of determining ethnicity can cause skewed results and should be avoided. Cummins et al indicated that determining ethnicity with this method had a false positivity of 36.8 percent, which was more than one third the study population. There is also an increasing trend of giving Western names within the Indian population. These concerns, along with the fact that ALS is an uncommon disease, may lead to a greater false positivity. References 1. Cronin S, Hardiman O, Traynor BJ. Ethnic variation in the incidence of ALS: A systematic review. Neurology 2007; 68: 1002-1007. 2.Cummins C, Winter H, Cheng KK, Maric R, Silcocks P, Varghese C. An assessment of the Nam Pehchan computer program for the identification of names of South Asian ethnic origin. J Public Health Med 1999;21:401-406. Disclosure: The author reports no conflicts of interest. |
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Orla Hardiman, Beaumont Hospital & RCSI Dept. Neurology, Beaumont Hospital, Dublin 9, Ireland, Simon Cronin, Bryan J Traynor
Send Correspondence to journal:
ohard{at}iol.ie Orla Hardiman, et al.
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We thank Dr. Alappat for his interest in our systematic review. [1] He refers to a single migration study performed in London during the 10-year period 1979-1988 that determined a patient’s ethnicity based on surnames. [3] We agree that this method of ethnic stratification is flawed. [4] Dr. Alappat’s comment also raises an important question concerning the best method to determine the ethnicity of an individual living within a geographical region. While there is evidence to support the accuracy of self-reported ethnicity [5], recent advances in population genetics have lead to the development of ethnic-specific genetic markers that can accurately delineate a person’s ancestry. [6] The definitive method to determine the importance of ethnicity in ALS is the performance of a large prospective study in a population of mixed ethnicity. Increased worldwide migration patterns have resulted in many racially admixed populations. Although calculating ethnicity-based risk in such populations is complex, the availability of panels of genetically characterized specific markers for some ancestral populations will help to resolve the challenges and concerns raised by Dr. Alappat.
References 3. Elian M, Dean G. Motor neuron disease and multiple sclerosis among immigrants to England from the Indian subcontinent, the Caribbean, and east and west Africa. J Neurol Neurosurg Psychiatry 1993;56:454–457. 4. Macfarlane GJ, Lunt M, Palmer B, Afzal C, Silman AJ, Esmail A. Determining aspects of ethnicity amongst persons of South Asian origin: the use of a surname-classification programme (Nam Pehchan). Public Health 2007;121:231-236. 5. Liu XQ, Paterson AD, John EM, Knight JA. The role of self-defined race/ethnicity in population structure control. Ann Hum Genet 2006;70:496-505. 6. Rosenberg NA, Pritchard JK, Weber JL, et al. Genetic structure of human populations. Science 2002;298:2381-2385. Disclosure: The authors report no conflicts of interest. |
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