Prevalence of multiple sclerosis in Denmark 1950—2005

2010 ◽  
Vol 16 (5) ◽  
pp. 520-525 ◽  
Author(s):  
Joan Bentzen ◽  
Esben Meulengracht Flachs ◽  
Egon Stenager ◽  
Henrik Brønnum-Hansen ◽  
Nils Koch-Henriksen
Keyword(s):  
Multiple Sclerosis ◽  
Confidence Interval ◽  
Environmental Changes ◽  
Population Based ◽  
National Registry ◽  
Age At First Birth ◽  
Genetic Changes ◽  
Increased Risk ◽  
Using Data ◽  
Multiple Sclerosis Patients

Multiple sclerosis is an inflammatory disease of the central nervous system of unknown aetiology. Its prevalence varies by ethnicity and place: persons of northern European descent are at increased risk while persons living at lower latitudes appear to be protected against the disease. The Danish Multiple Sclerosis Registry is a national registry established in 1956 after a population-based survey which receives information from numerous sources. It is considered to be more than 90% complete, with a validity of 94%. Using data from the Registry, we calculated prevalences per 100,000 inhabitants. The standardized prevalence of multiple sclerosis increased from 58.8 (95% confidence interval: 54.9—62.7) in 1950 to 154.5 per 100,000 (95% confidence interval: 148.8—160.2) in 2005, and the female to male ratio increased from 1.31 in 1950 to 2.02 in 2005. The increase in prevalence is due to both increased survival of multiple sclerosis patients and an increased incidence rate. The rise in prevalence in the past 50 years is probably due more to environmental factors than to genetic changes in the Danish population. Among women, environmental changes could include older age at first birth, use of oral contraceptives, or changes in sun behaviour and/or vitamin D status.

The risk of fracture in incident multiple sclerosis patients: The Danish National Health Registers

2012 ◽  
Vol 18 (11) ◽  
pp. 1609-1616 ◽  
Author(s):  
Marloes T Bazelier ◽  
Joan Bentzen ◽  
Peter Vestergaard ◽  
Egon Stenager ◽  
Hubert GM Leufkens ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Hip Fracture ◽  
National Health ◽  
Osteoporotic Fracture ◽  
Population Based ◽  
Risk Of Fracture ◽  
Increased Risk ◽  
Disability Status ◽  
Multiple Sclerosis Patients ◽  
Health Registers

Background: Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling. Objective: To evaluate the risk of fracture in incident MS patients drawn from a dedicated MS registry compared with population-based controls. Methods: We conducted a population-based cohort study (1996–2007) utilising the Danish National Health Registers that were linked to the Danish MS Registry and the Danish MS Treatment Registry. Incident MS patients (2963 cases) were 1:6 matched by year of birth, gender, calendar time and region to persons without MS (controls). Cox proportional hazards models and logistic regression were used to estimate the risk of fracture in MS. Time-dependent adjustments were made for age, history of diseases and drug use. Results: Compared with controls, patients with MS had no overall increased risk of fracture (adjusted hazard ratio (adj. HR): 1.0, 95% CI: 0.9–1.2). However, the risk of femur/hip fracture (adj. HR: 1.9, 95% CI: 1.1–3.4) was significantly increased compared to controls. As compared with unexposed patients, MS patients who had been exposed to a short course of methylprednisolone in the prior year had no significantly increased risk of osteoporotic fracture (adj. HR: 1.2, 95% CI: 0.5–2.9). Disabled MS patients with Expanded Disability Status Scale [EDSS] scores between 6 and 10, had a 2.6-fold increased risk of osteoporotic fracture (adjusted odds ratio (adj. OR): 2.6, 95% CI: 1.0–6.6) compared to patients with an EDSS score between 0 and 3. Conclusion: Patients with MS had a higher risk of femur/hip fracture than controls. Disability status is probably more important than glucocorticoid use in the aetiology of MS and osteoporotic fracture.

An excessive risk of suicide may no longer be a reality for multiple sclerosis patients

2017 ◽  
Vol 23 (6) ◽  
pp. 864-871 ◽  
Author(s):  
Shoshannah Kalson-Ray ◽  
Gilles Edan ◽  
Emmanuelle Leray ◽  
Keyword(s):  
Multiple Sclerosis ◽  
General Population ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Clinical Onset ◽  
Increased Risk ◽  
Multiple Sclerosis Patients ◽  
Mean Time ◽  
Long Term Mortality

Background: Few recent studies have shown that there is no longer an increased risk of suicide in patients affected with multiple sclerosis (MS). Objectives: To describe suicide cases within a large French MS cohort and assess whether MS patients are at a higher risk of suicide compared with the general population. Methods: Data derives from a study on long-term mortality of 27,603 prevalent cases from 15 MS specialist centres. Of 1,569 deceased MS patients (5.7%) on 1 January 2010, 47 were suicides. Results: The mean time between MS clinical onset and death was 13.5 years (standard deviation (SD): 9.3 years; none within the first 3 years) and was significantly shorter than for MS patients who had died from other causes (mean = 21.4 (SD = 11.6), p < 0.0001). Age at death was also lower (46.3 vs 56.7). The standardized mortality rates were around 1 in several sensitivity analyses, reflecting no excess mortality in MS compared with general population. Conclusion: Our findings indicate that an excess suicide risk may no longer be true for MS patients and highlight the changing profile of cases, occurring later in the disease course. Further studies in population-based registries are needed to confirm and explain these potential changes (e.g. treatments’ impact?).

scholarly journals Concurrent Opioid and Benzodiazepine Prescriptions Among Older Women Diagnosed With Breast Cancer

2019 ◽  
Vol 112 (7) ◽  
pp. 765-768 ◽  
Author(s):  
Devon K Check ◽  
Aaron N Winn ◽  
Nicole Fergestrom ◽  
Katherine E Reeder-Hayes ◽  
Joan M Neuner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Confidence Interval ◽  
Low Income ◽  
Poisson Regression ◽  
Population Based ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Using Data

Abstract Guidelines recommend using caution in co-prescribing opioids with benzodiazepines, yet, in practice, the extent of concurrent prescribing is poorly understood. Notably, no population-based studies, to our knowledge, have investigated concurrent prescribing among patients with cancer. We conducted a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) database linked with Medicare claims (2012–2016) for women diagnosed with breast cancer. We used modified Poisson regression to examine predictors of any concurrent prescriptions in the year post-diagnosis and Poisson regression to examine predictors of the number of overlapping days. We found that 13.0% of the 19 267 women in our sample had concurrent prescriptions. Women who underwent more extensive treatment and those with previous use of opioids or benzodiazepines were at increased risk for concurrent prescriptions (adjusted risk ratio of previous benzodiazepine use vs no previous use = 15.05, 95% confidence interval = 13.19 to 17.19). Among women with concurrent prescriptions, overlap was most pronounced among low-income, rural, and Hispanic women (adjusted incidence rate ratio of Hispanic vs non-Hispanic white = 1.25, 95% confidence interval = 1.20 to 1.30). Our results highlight opportunities to reduce patients’ unnecessary exposure to this combination.

Sibling Alcohol Use Disorder Is Associated With Increased Risk for Suicide Attempt

2021 ◽  
pp. 216770262110250
Author(s):  
Mallory E. Stephenson ◽  
Sara Larsson Lönn ◽  
Jessica E. Salvatore ◽  
Jan Sundquist ◽  
Kenneth S. Kendler ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Suicide Attempt ◽  
Alcohol Use Disorder ◽  
Cox Regression ◽  
Population Based ◽  
Swedish Population ◽  
Sibling Pairs ◽  
Increased Risk ◽  
Using Data ◽  
Shared Genetic

The association between having a sibling diagnosed with alcohol use disorder (AUD) and risk for suicide attempt may be attributable to shared genetic liability between AUD and suicidal behavior, effects of environmental exposure to a sibling’s AUD, or both. To distinguish between these alternatives, we conducted a series of Cox regression models using data derived from Swedish population-based registers with national coverage. Among full sibling pairs (656,807 males and 607,096 females), we found that, even after we accounted for the proband’s AUD status, the proband’s risk for suicide attempt was significantly elevated when the proband’s sibling was affected by AUD. Furthermore, the proband’s risk for suicide attempt was consistently higher when the sibling’s AUD registration had occurred more recently. Our findings provide evidence for exposure to sibling AUD as an environmental risk factor for suicide attempt and suggest that clinical outreach may be warranted following a sibling’s diagnosis with AUD.

Systemic sclerosis portends increased risk of conduction and rhythm abnormalities at diagnosis and during disease course: A US population-based cohort

2021 ◽  
pp. 239719832110340
Author(s):  
Yasser A Radwan ◽  
Reto D Kurmann ◽  
Avneek S Sandhu ◽  
Edward A El-Am ◽  
Cynthia S Crowson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Systemic Sclerosis ◽  
Confidence Interval ◽  
Cumulative Incidence ◽  
Disease Onset ◽  
Population Based ◽  
Hazard Ratio ◽  
Conduction Disorders ◽  
Increased Risk

Objectives: To study the incidence, risk factors, and outcomes of conduction and rhythm disorders in a population-based cohort of patients with systemic sclerosis versus nonsystemic sclerosis comparators. Methods: An incident cohort of patients with systemic sclerosis (1980–2016) from Olmsted County, MN, was compared to age- and sex-matched nonsystemic sclerosis subjects (1:2). Electrocardiograms, Holter electrocardiograms, and a need for cardiac interventions were reviewed to determine the occurrence of any conduction or rhythm abnormalities. Results: Seventy-eight incident systemic sclerosis cases and 156 comparators were identified (mean age 56 years, 91% female). The prevalence of any conduction disorder before systemic sclerosis diagnosis compared to nonsystemic sclerosis subjects was 15% versus 7% ( p = 0.06), and any rhythm disorder was 18% versus 13% ( p = 0.33). During a median follow-up of 10.5 years in patients with systemic sclerosis and 13.0 years in nonsystemic sclerosis comparators, conduction disorders developed in 25 patients with systemic sclerosis with cumulative incidence of 20.5% (95% confidence interval: 12.4%–34.1%) versus 28 nonsystemic sclerosis patients with cumulative incidence of 10.4% (95% confidence interval: 6.2%–17.4%) (hazard ratio: 2.57; 95% confidence interval: 1.48–4.45), while rhythm disorders developed in 27 patients with systemic sclerosis with cumulative incidence of 27.3% (95% confidence interval: 17.9%–41.6%) versus 43 nonsystemic sclerosis patients with cumulative incidence of 18.0% (95% confidence interval: 12.3%–26.4%) (hazard ratio: 1.62; 95% confidence interval: 1.00–2.64). Age, pulmonary hypertension, and smoking were identified as risk factors. Conclusion: Patients with systemic sclerosis have an increased risk of conduction and rhythm disorders both at disease onset and over time, compared to nonsystemic sclerosis patients. These findings warrant increased vigilance and screening for electrocardiogram abnormalities in systemic sclerosis patients with pulmonary hypertension.

Past environmental sun exposure and risk of multiple sclerosis: a role for the Cdx-2 Vitamin D receptor variant in this interaction

2009 ◽  
Vol 15 (5) ◽  
pp. 563-570 ◽  
Author(s):  
JL Dickinson ◽  
DI Perera ◽  
AF van der Mei ◽  
A-L Ponsonby ◽  
AM Polanowski ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Vitamin D ◽  
Vitamin D Receptor ◽  
Significant Interaction ◽  
Important Determinant ◽  
Sun Exposure ◽  
Population Based ◽  
Vdr Gene ◽  
Increased Risk ◽  
Group 2

Multiple studies have provided evidence for an association between reduced sun exposure and increased risk of multiple sclerosis (MS), an association likely to be mediated, at least in part, by the vitamin D hormonal pathway. Herein, we examine whether the vitamin D receptor ( VDR), an integral component of this pathway, influences MS risk in a population-based sample where winter sun exposure in early childhood has been found to be an important determinant of MS risk. Three polymorphisms within the VDR gene were genotyped in 136 MS cases and 235 controls, and associations with MS and past sun exposure were examined by logistic regression. No significant univariate associations between the polymorphisms, rs11574010 ( Cdx-2A > G), rs10735810 ( Fok1T >  C), or rs731236 ( Taq1C > T) and MS risk were observed. However, a significant interaction was observed between winter sun exposure during childhood, genotype at rs11574010, and MS risk ( P = 0.012), with the ‘G’ allele conferring an increased risk of MS in the low sun exposure group (≤2 h/day). No significant interactions were observed for either rs10735810 or rs731236, after stratification by sun exposure. These data provide support for the involvement of the VDR gene in determining MS risk, an interaction likely to be dependent on past sun exposure.

scholarly journals The Rationale for Monitoring Cognitive Function in Multiple Sclerosis: Practical Issues for Clinicians

2018 ◽  
Vol 12 (1) ◽  
pp. 31-40 ◽  
Author(s):  
Christos Bakirtzis ◽  
Panagiotis Ioannidis ◽  
Lambros Messinis ◽  
Grigorios Nasios ◽  
Elina Konstantinopoulou ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Practice ◽  
Cognitive Function ◽  
Cognitive Rehabilitation ◽  
Assessment Tools ◽  
Systematic Evaluation ◽  
Presenting Symptoms ◽  
Increased Risk ◽  
Medication Side ◽  
Multiple Sclerosis Patients

About half of patients with multiple sclerosis exhibit cognitive impairment which negatively affects their quality of life. The assessment of cognitive function in routine clinical practice is still undervalued, although various tools have been proposed for this reason. In this article, we describe the potential benefits of implementing cognitive assessment tools in routine follow -ups of MS patients. Early detection of changes in cognitive performance may provide evidence of disease activity, could unmask depression or medication side-effects and provide suitable candidates for cognitive rehabilitation. Since apathy and cognitive deficiencies are common presenting symptoms in Progressive Multifocal Leukoencephalopathy, we discuss the utility of frequent monitoring of mental status in multiple sclerosis patients at increased risk. In addition, we propose a relevant algorithm aiming to incorporate a systematic evaluation of cognitive function in every day clinical practice in multiple sclerosis.

Anxiety and depression in parents 4–9 years after the loss of a child owing to a malignancy: a population-based follow-up

2004 ◽  
Vol 34 (8) ◽  
pp. 1431-1441 ◽  
Author(s):  
ULRIKA KREICBERGS ◽  
UNNUR VALDIMARSDÓTTIR ◽  
ERIK ONELÖV ◽  
JAN-INGE HENTER ◽  
GUNNAR STEINECK
Keyword(s):  
Psychological Distress ◽  
Relative Risk ◽  
Confidence Interval ◽  
Stressful Life Event ◽  
Population Based ◽  
Anxiety And Depression ◽  
Control Group ◽  
Bereaved Parents ◽  
Increased Risk ◽  
Loss Of A Child

Background. Some consider the loss of a child as the most stressful life event. When the death is caused by a malignancy, the parents are commonly exposed not only to their own loss, but also to the protracted physical and emotional suffering of the child. We investigated parental risk of anxiety and depression 4–9 years after the loss of a child owing to a malignancy.Method. In 2001, we attempted to contact all parents in Sweden who had lost a child due to a malignancy during 1992–1997. We used an anonymous postal questionnaire and utilized a control group of non-bereaved parents with a living child.Results. Participation among bereaved parents was 449/561 (80%); among non-bereaved 457/659 (69%). We found an increased risk of anxiety (relative risk 1·5, 95% confidence interval 1·1–1·9) and depression (relative risk 1·4, 95% confidence interval 1·1–1·7) among bereaved parents compared with non-bereaved. The risk of anxiety and depression was higher in the period 4–6 years after bereavement than in the 7–9 years period, during which the average excess risks approached zero. Psychological distress was overall higher among bereaved mothers and loss of a child aged 9 years or older implied an increased risk, particularly for fathers.Conclusions. Psychological morbidity in bereaved parents decreases to levels similar to those among non-bereaved parents 7–9 years after the loss. Bereaved mothers and parents who lose a child 9 years or older have on average an excess risk for long-term psychological distress.

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