The epidemiology of multiple sclerosis in the entre Douro e Vouga region of northern Portugal: a multisource population-based study

Abstract Background The prevalence of Multiple Sclerosis (MS) has been increasing worldwide and the north–south gradient of prevalence may be disappearing in the Northern hemisphere. The few previous prevalence studies performed in Portugal have reported a lower prevalence than the average for Western Europe. The aim of this study is to estimate the prevalence of MS in the Entre Douro e Vouga region, in Northern Portugal. Methods Multiple overlapping sources were used to ascertain all cases from the reference population: records from hospitals in the region and neighbouring regions; diagnostic databases of primary care physicians; and applications for disability benefits. The prevalence date was set at 1 January 2014. The reference population was 274,859 inhabitants. Patients’ neurologists were contacted to retrieve clinical information and confirm the diagnosis based. Results A total of 177 patients were identified after eliminating duplicates from different sources. The female to male ratio was 1.9 and the mean age at disease onset was 33.5 (standard deviation: 10.3). Clinically isolated syndrome accounted for 9.0% of patients, relapsing remitting for 58.8%, secondary progressive for 20.3% and primary progressive for 11.8%. The prevalence was estimated in 64.4 patients per 100,000 (95% confidence interval: 54.9;73.9). Conclusions In this study we report a higher point prevalence of MS than had been previously described in Portugal, but still far from the higher values recently reported in other Southern European countries.

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Prevalence of Multiple Sclerosis in Tuscany (Central Italy): A Study Based on Validated Administrative Data

Neuroepidemiology ◽

10.1159/000441567 ◽

2015 ◽

Vol 46 (1) ◽

pp. 37-42 ◽

Cited By ~ 15

Author(s):

Daiana Bezzini ◽

Laura Policardo ◽

Giuseppe Meucci ◽

Monica Ulivelli ◽

Sabina Bartalini ◽

...

Keyword(s):

Multiple Sclerosis ◽

Administrative Data ◽

Care Home ◽

Central Italy ◽

Population Based ◽

Term Care ◽

Prevalence Studies ◽

Hospital Discharge Records ◽

Test Algorithm

Background: Multiple Sclerosis (MS) epidemiology in Italy is mainly based on population-based prevalence studies. Administrative data are an additional source of information, when available, in prevalence studies of chronic diseases such as MS. The aim of our study is to update the prevalence rate of MS in Tuscany (central Italy) as at 2011 using a validated case-finding algorithm based on administrative data. Methods: The prevalence was calculated using an algorithm based on the following administrative data: hospital discharge records, drug-dispensing records, disease-specific exemptions from copayment to health care, home and residential long-term care and inhabitant registry. To test algorithm sensitivity, we used a true-positive reference cohort of MS patients from the Tuscan MS register. To test algorithm specificity, we used another cohort of individuals who were presumably not affected by MS. Results: As at December 31, 2011, we identified 6,890 cases (4,738 females and 2,152 males) with a prevalence of 187.9 per 100,000. The sensitivity of algorithm was 98% and the specificity was 99.99%. Conclusions: We found a prevalence higher than the rates present in literature. Our algorithm, based on administrative data, can accurately identify MS patients; moreover, the resulting cohort is suitable to monitor disease care pathways.

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Body size and the risk of multiple sclerosis in Norway and Italy: The EnvIMS study

Multiple Sclerosis Journal ◽

10.1177/1352458514546785 ◽

2014 ◽

Vol 21 (4) ◽

pp. 388-395 ◽

Cited By ~ 40

Author(s):

Kristin Wesnes ◽

Trond Riise ◽

Ilaria Casetta ◽

Jelena Drulovic ◽

Enrico Granieri ◽

...

Keyword(s):

Multiple Sclerosis ◽

Risk Factor ◽

Body Size ◽

Case Control Study ◽

Disease Onset ◽

Large Body ◽

Population Based ◽

The Body ◽

Outdoor Activity ◽

Control Study

Background: Obesity may be a risk factor for developing multiple sclerosis (MS). Objective: We examined if body size influences the risk of MS in a population-based, case control study. Methods: A total of 953 cases and 1717 controls from Norway and 707 cases and 1333 controls from Italy reported their body size by choosing a silhouette 1 to 9 (largest) every fifth year from age 5 to 30 and at time of study. The body size-related MS risk was defined by odds ratios (ORs) in logistic regression analyses adjusting for age, smoking and outdoor activity. Results: In Norway a large body size (silhouettes 6–9) compared to silhouette 3 increased the risk of MS, especially at age 25 (OR 2.21; 95% CI 1.09–4.46 for men and OR 1.43; 95% CI 0.90–2.27 for women). When comparing silhouette 9 to 1, we found a significant dose-response from age 10 until age 30 peaking at age 25 (sex-adjusted OR 2.83; 95% CI 1.68–4.78). The association was present for at least 15 years prior to disease onset. No significant associations were found in Italy. Conclusions: Obesity from childhood until young adulthood is a likely risk factor for MS with a seemingly stronger effect in Norway than in Italy.

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Prevalence of multiple sclerosis in the South of Italy based on healthcare administrative data

European Journal of Public Health ◽

10.1093/eurpub/ckz186.211 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

R Palladino ◽

V Brescia Morra ◽

R Lanzillo ◽

R Giordana ◽

M G Fumo ◽

...

Keyword(s):

Multiple Sclerosis ◽

Reference Population ◽

Healthcare Resource Utilization ◽

European Population ◽

Healthcare Organization ◽

Administrative Databases ◽

Longitudinal Gradient ◽

Campania Region ◽

The North ◽

Environmental Background

Abstract Background Multiple sclerosis (MS) is an heterogenous disease whose prevalence varies in Europe. Hereby, we aimed to estimate prevalence of MS in the Campania Region of Italy. Methods To identify individuals with MS living in the Campania Region of Italy, we extracted data from the following healthcare administrative databases: hospital discharge records, regional drug registry, and specialist outpatient visits from Jan-2015 to 3Dec-2017. Individuals alive on the 1-Jan-2018 were included to capture prevalence on this date. Age-sex standardised prevalence rates were calculated using the direct standardisation method; the European population in 2018 was considered as reference population. To assess differences in the prevalence ratios across the five provinces of the region, standardised morbility ratios (SMR) were calculated. To calculate 95% confidence intervals (95%CI) for the standardised rates, the Byar’s approximation method based on the Poisson distribution was used. Results We identified 5,361 individuals with MS (females 64.5%, age 45.6±12.7 years). Standardised prevalence rate per 100,000 people was 90.0 cases (95%CI=87.60, 92.40) (112.07 for females [95%CI=108.36, 115.88] and 66.20 for males [95%CI=63.26, 69.25]). The SMR in the province of Naples, the most densely populated, was 0.90 (95%CI=0.86, 0.96), whereas the highest SMR was found in the province of Salerno (SMR=1.30; 95%CI=1.23, 1.38), and the lowest in the province of Caserta (SMR=0.89; 95%CI=0.82-0.96). Conclusions Prevalence of MS in the Campania Region is lower than previous estimates from smaller areas in the North of Italy, suggesting a longitudinal gradient. Differences within the Region could be explained by genetic/environmental background and healthcare organization (e.g., missing diagnoses). In the future, healthcare administrative databases could be used to monitor MS prevalence/incidence and to plan healthcare resource utilization. Key messages Prevalence of MS in the Campania Region is 90 cases per 100,000 people. It is lower than previous estimates from smaller areas in the North of Italy, suggesting a longitudinal gradient. Differences within the Region could be explained by genetic/environmental background and healthcare organization (e.g., missing diagnoses).

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Prevalence of community-associated methicillin-resistantStaphylococcus aureuscolonization outside the healthcare environment

Epidemiology and Infection ◽

10.1017/s0950268809002222 ◽

2009 ◽

Vol 137 (9) ◽

pp. 1237-1241 ◽

Cited By ~ 12

Author(s):

S. MALIK ◽

P. VRANKEN ◽

M. SILIO ◽

R. RATARD ◽

R. VAN DYKE

Keyword(s):

Risk Factors ◽

Clinical Information ◽

Population Based ◽

Indwelling Catheter ◽

Prevalence Studies ◽

Healthcare Environments ◽

History Of ◽

Surgical Device ◽

Mrsa Colonization ◽

Close Contacts

SUMMARYCommunity-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) infections are increasingly recognized in persons without established risk factors. Population-based prevalence studies of CA-MRSA colonization in persons without risk factors are relatively limited. Subjects aged 2–65 years were enrolled from a student recreation centre, public office building, and out-patient clinics. Persons or close contacts with a history of hospitalization, nursing-home residence, surgery, emergency-department visit, or healthcare employment during the previous year and persons with chronic debilitating illness, indwelling catheter, or surgical device were excluded. Swabs of anterior nares were obtained. Demographic and clinical information was collected. During January–June 2005, three (1·2%) of 259 subjects were colonized with MRSA. All three subjects were adults enrolled at the recreation centre. Healthy persons living in households without recent exposure to healthcare environments were at low risk for MRSA colonization. Studies from other geographic locations are needed to elucidate differences in prevalence of CA-MRSA.

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Late-onset multiple sclerosis presenting with cognitive dysfunction and severe cortical/infratentorial atrophy

Multiple Sclerosis Journal ◽

10.1177/1352458514542363 ◽

2014 ◽

Vol 21 (5) ◽

pp. 580-589 ◽

Cited By ~ 11

Author(s):

Massimiliano Calabrese ◽

Alberto Gajofatto ◽

Francesca Gobbin ◽

Giulia Turri ◽

Silvia Richelli ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Dysfunction ◽

Progressive Disease ◽

Late Onset ◽

Disease Onset ◽

Reference Population ◽

Healthy Controls ◽

Cognitively Normal ◽

Midbrain Tegmentum ◽

Symptoms And Signs

Objective: Although cognitive dysfunction is a relevant aspect of multiple sclerosis (MS) from the earliest disease phase, cognitive onset is unusual thus jeopardizing early and accurate diagnosis. Here we describe 12 patients presenting with cognitive dysfunction as primary manifestation of MS with either mild or no impairment in non-cognitive neurological domains. Methods: Twelve patients with cognitive onset who were subsequently diagnosed with MS (CI-MS) were included in this retrospective study. Twelve cognitively normal MS patients (CN-MS), 12 healthy controls and four patients having progressive supranuclear palsy (PSP) served as the reference population. Results: Ten CI-MS patients had progressive clinical course and all patients had late disease onset (median age = 49 years; range = 40–58 years). Among cognitive functions, frontal domains were the most involved. Compared to CN-MS and healthy controls, significant cortical and infratentorial atrophy characterized CI-MS patients. Selective atrophy of midbrain tegmentum with relative sparing of pons, known as “The Hummingbird sign,” was observed in eight CI-MS and in three PSP patients. Discussion: Our observation suggests that MS diagnosis should be taken into consideration in case of cognitive dysfunction, particularly when associated with slowly progressive disease course and severe cortical, cerebellar and brainstem atrophy even in the absence of other major neurological symptoms and signs.

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Age at onset as a determinant of presenting phenotype and initial relapse recovery in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458511417479 ◽

2011 ◽

Vol 18 (1) ◽

pp. 45-54 ◽

Cited By ~ 52

Author(s):

M Cossburn ◽

G Ingram ◽

C Hirst ◽

Y Ben-Shlomo ◽

TP Pickersgill ◽

...

Keyword(s):

Multiple Sclerosis ◽

Late Onset ◽

Age At Onset ◽

Disease Onset ◽

Complete Recovery ◽

Population Based ◽

Disease Course ◽

Index Event ◽

Relapsing Remitting ◽

Age Dependent

Background: Age at onset modifies prognosis in multiple sclerosis (MS) and may also exert an effect on the characteristics of disease ignition. Understanding how age influences presentation informs disease management and may allow differentiation of distinct clinical sub-groups. Objectives: To determine the nature of age-specific presentations of relapsing–remitting MS (RRMS) with respect to onset symptoms, gender ratios and index event outcomes. Methods: In a prospective, population-based sample of 1424 patients in South-East Wales we examined associations between age at onset, clinical features and outcome of the onset event, making specific comparisons between paediatric, adolescent and late-onset MS. Results: Age at onset varied significantly between sexes (Male 31.2, Female 29.3, p = 0.002), 0.7% had paediatric onset, 2.7% adolescent onset and 2.8% late-onset MS (>50 years). Optic neuritis was common in younger patients and declined after age 30. Lower limb motor, facial sensory, sexual and sphincteric symptoms rose with age independent of sex and disease course. F:M ratios were highest <16 years of age and declined with increasing age, with a male excess in those over 50. Probability of complete recovery from index event declined with age from 87.4% in the youngest group to 68% in the eldest ( p = 0.009). Conclusions: Age at disease onset in RRMS exerts a significant effect on gender ratios and presenting phenotype, and allows identification of specific clinical sub-groups. In addition, ability to recover from initial relapse declines with age, suggesting accumulation of disability in MS is an age-dependent response to relapse.

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Multiple Sclerosis Epidemiology in East Asia, South East Asia and South Asia: A Systematic Review

Neuroepidemiology ◽

10.1159/000444019 ◽

2016 ◽

Vol 46 (3) ◽

pp. 209-221 ◽

Cited By ~ 58

Author(s):

Sharareh Eskandarieh ◽

Pouria Heydarpour ◽

Alireza Minagar ◽

Shadi Pourmand ◽

Mohammad Ali Sahraian

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

East Asia ◽

South Asia ◽

Disease Onset ◽

Hospital Setting ◽

Population Based ◽

Epidemiologic Studies ◽

Cochrane Library ◽

South East Asia

Background: Multiple sclerosis (MS) is one of the most common chronic immune-mediated diseases of the human central nervous system and an important cause of non-traumatic neurologic disability among young population in several countries. Recent reports from East Asia, South East Asia and South Asia have proposed a low to moderate prevalence of MS in these countries. Methods: A literature review search was carried out in December 2014 in Medline, Embase, Scopus and Cochrane library to recover original population-based studies on MS epidemiology in East Asia, South East Asia and South Asia countries published between January 1, 1950 and December 30, 2014. We intended search strategies using the key words: multiple sclerosis, prevalence, incidence and epidemiology. Based on our inclusion criteria, 68 epidemiologic studies were included in this systematic review. Results: The most extensively used diagnostic criteria in the studies were McDonald's criteria. Most studies were performed in a multi-center hospital setting. The female to male ratio varied and ranged from 0.7 in India to 9.0 in China. The mean age at disease onset ranged from the lowest age of 25.3 in Iran to the highest age of 46.4 in China. MS prevalence ranged from 0.77 in 100,000 populations in Hong Kong (1999) to 85.80 in 100,000 in Iran (2013). Conclusions: Advances in MS registries around the globe allow nationwide population-based studies and will allow worldly comparisons between the prevalence and incidence in different regions that are provided to monitor estimation.

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Older Age at Multiple Sclerosis Onset Is an Independent Factor of Poor Prognosis: A Population-Based Cohort Study

Neuroepidemiology ◽

10.1159/000479516 ◽

2017 ◽

Vol 48 (3-4) ◽

pp. 179-187 ◽

Cited By ~ 19

Author(s):

Francis Guillemin ◽

Cédric Baumann ◽

Jonathan Epstein ◽

Philippe Kerschen ◽

Teresa Garot ◽

...

Keyword(s):

Multiple Sclerosis ◽

Poor Prognosis ◽

Cox Regression ◽

Late Onset ◽

Disease Onset ◽

Population Based ◽

Male Gender ◽

Disability Progression ◽

Relapsing Remitting ◽

Short Time

Background: Late-onset multiple sclerosis (LOMS) frequently features a primary progressive (PP) course, strongly predicting severe disability. In this population-based cohort, we estimated the prognostic role of age at multiple sclerosis (MS) onset, independent of PP course, on disability progression. Methods: The association of age at disease onset (adult, <50 years [AOMS], vs. late, ≥50 years [LOMS]) and time to Expanded Disability Status Scale (EDSS) score 4 and 6 was estimated by Cox regression modelling. Results: Among 3,597 patients, 245 had LOMS. Relapsing-remitting (RR) disease was less frequent with LOMS than AOMS (51.8 vs. 90.8%, p < 0.0001). PP course, LOMS and male gender predicted short time to EDSS 4 and 6. Worse outcome with LOMS (time to EDSS 4 and 6, HR 2.0 [95% CI 1.7-2.4] and 2.3 [1.9-2.9]) was independent of PP course or male gender. LOMS had greater impact on RR than PP disease (time to EDSS 4 and 6, HR 3.1 [2.3-4.0] and 4.0 [2.9-5.6]). Only LOMS predicted time from EDSS 4 to 6 (p < 0.0001). Conclusions: Late onset MS was strongly associated with poor prognosis, independent of initial disease course, in predicting the disability progression along time.

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Tried and tested: the psychometric properties of the multiple sclerosis impact scale (MSIS-29) in a population-based study

Multiple Sclerosis Journal ◽

10.1177/1352458508096872 ◽

2009 ◽

Vol 15 (1) ◽

pp. 75-80 ◽

Cited By ~ 36

Author(s):

OM Gray ◽

GV McDonnell ◽

SA Hawkins

Keyword(s):

Multiple Sclerosis ◽

Psychometric Properties ◽

Convergent Validity ◽

Population Based ◽

Population Based Study ◽

North East ◽

The North ◽

Impact Scale ◽

Disability Status ◽

Physical Impact

Objective To investigate the psychometric properties of the Multiple Sclerosis Impact Scale (MSIS-29) and to assess the relationship between the Kurtzke Expanded Disability Status Scale and the physical and psychological parts of this score. Methods A population-based study identified cases with definite multiple sclerosis (MS) in the north-east region of Ireland. They were examined and completed the MSIS-29. Cases were classified as mild (Expanded Disability Status Score (EDSS) 0–3.0), moderate (EDSS 3.5–5.5), or severe (6.0–9.5) MS. Results The 248 participants (82 male, 166 female) had a mean age of 49.1 years (SD 12.4). EDSS ranged from 0 to 9.5 (median 6.0). Data quality was excellent (0.02% missing data), physical and psychological scores spanned the entire range with low floor and ceiling effects. Internal consistency was high (Cronbach’s alpha 0.97 – physical score, 0.93 – psychological score). The convergent validity of the physical impact score of the MSIS-29 with the Kurtzke EDSS was confirmed with a high Spearman’s rank coefficient correlation of 0.63 ( P = 0.01). Physical impact scores for mild, moderate, and severe disability as were statistically different at 25.9%, 48.0%, and 63.9%, respectively. Mean psychological score was non-significantly higher in the moderately disabled group at 47.4% compared with the severely disabled at 44.3% ( P = 0.58). Conclusions The MSIS-29 is an acceptable, reliable, and valid method of recording quality of life. A significant relationship between higher physical impact scores of the MSIS-29 and higher Kurtzke EDSS values suggests that is may be of use in clinical trials to monitor progression.

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An assessment of the spectrum of disability and handicap in multiple sclerosis: a population-based study

Multiple Sclerosis Journal ◽

10.1177/135245850100700207 ◽

2001 ◽

Vol 7 (2) ◽

pp. 111-117 ◽

Cited By ~ 33

Author(s):

G V McDonnell ◽

S A Hawkins

Keyword(s):

Multiple Sclerosis ◽

Social Issues ◽

Population Based ◽

Community Services ◽

Service Planning ◽

Standards Of Care ◽

Full Time ◽

North East ◽

The North ◽

Environmental Status

Objectives: To establish the spectrum of disability and handicap in a population based sample of multiple sclerosis (MS) patients. Background: Much knowledge exists about the epidemiology of MS but, despite its importance for health and social service planning, there remains relatively little data on the extent and nature of disability and handicap in this population. Methods: In a prevalence study in the north-east of N. Ireland, 288 patients (Poser criteria) were identified. Disability and handicap were assessed using the Incapacity Status Scale and Environmental Status Scale of the Minimal Record of Disability for MS. Results: Both scales were completed for 248 (86%) of patients. Just 71 (29%) are fully independent in all basic ADL's of bathing, dressing, grooming and feeding. Fifty-seven (23%) are unable to climb a flight of stairs and 102 (42%) acknowledge problems with sexual function. Sixty-one (25%) were working essentially full-time and 53 (21%) had no external financial support. Forty-five (18%) had changed residence due to MS, 12 (5%) were institutionalised and 86 (35%) required assistance for at least 1 h/day with ADL's. Eighty-one (33%) were unable to drive a car or use public transport. Forty-two (17%) access community services for at least 1 h/day on average. Conclusions: This data gives a clear indication of the considerable range of basic health and social issues in a typical MS community. Further work is required to establish patient perceptions of the adequacy of care provision and whether standards of care for MS patients are being met.

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