Temporal trends in multiple sclerosis prevalence and incidence in a large population

ObjectiveWe sought to better understand the reasons for increasing prevalence of multiple sclerosis (MS) by studying prevalence in relation to incidence, mortality rates, sex ratio, and geographic distribution of cases.MethodsWe identified MS cases from 1996 to 2013 in Ontario, Canada, by applying a validated algorithm to health administrative data. We calculated age- and sex-standardized prevalence and incidence rates for the province and by census division. Incidence and prevalence sex ratios for women to men were computed.ResultsThe prevalence of MS increased by 69% from 1.57 (95% confidence interval [CI]: 1.54–1.59) per 1,000 in 1996 (n = 12,155) to 2.65 (95% CI: 2.62–2.68) in 2013 (n = 28,192). Incidence remained relatively stable except for a spike in 2010, followed by a subsequent decline in 2011–2013, particularly among young people and men. Mortality decreased by 33% from 26.7 (95% CI: 23.5–30.3) per 1,000 to 18.0 (95% CI: 16.4–19.8) per 1,000. The incidence sex ratio was stable from 1996 to 2009, then declined in 2010, with partial rebound by 2013. MS prevalence and incidence showed no consistent association with latitude.ConclusionIn this large, population-based MS cohort, we found stable incidence and increasing prevalence of MS; the latter largely reflected declining mortality. A spike in incidence in 2010 among younger patients and men at a time of widespread media coverage of MS suggests that these groups may be vulnerable to delayed diagnosis. We did not find a latitudinal gradient; however, most Ontarians live between the 42nd and 46th parallels, reducing our ability to detect an effect of latitude.

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Dietary inflammatory index and risk of multiple sclerosis: Findings from a large population-based incident case–control study

Clinical Nutrition ◽

10.1016/j.clnu.2020.02.033 ◽

2020 ◽

Vol 39 (11) ◽

pp. 3402-3407 ◽

Cited By ~ 1

Author(s):

Ibrahim Abdollahpour ◽

Dejan Jakimovski ◽

Nitin Shivappa ◽

James R. Hébert ◽

Farhad Vahid ◽

...

Keyword(s):

Multiple Sclerosis ◽

Case Control Study ◽

Large Population ◽

Population Based ◽

Case Control ◽

Dietary Inflammatory Index ◽

Incident Case ◽

Inflammatory Index ◽

Control Study

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Striking Racial/Ethnic Disparities in Liver Cancer Incidence Rates and Temporal Trends in California, 1988–2012

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djy051 ◽

2018 ◽

Vol 110 (11) ◽

pp. 1259-1269 ◽

Cited By ~ 15

Author(s):

Christopher Pham ◽

Tse-Ling Fong ◽

Juanjuan Zhang ◽

Lihua Liu

Keyword(s):

Asian American ◽

Temporal Trends ◽

Ethnic Disparities ◽

Population Based ◽

Incidence Rates ◽

Annual Percent Change ◽

Southeast Asians ◽

Ethnic Populations ◽

Race Ethnicity ◽

Racial Ethnic

AbstractBackgroundHepatocellular carcinoma (HCC) is characterized by disparate risk patterns by race/ethnicity. We examined HCC incidence patterns and temporal trends among detailed racial/ethnic populations, including disaggregated Asian-American subgroups.MethodsUsing data from the population-based California Cancer Registry, we identified 41 929 invasive HCC cases diagnosed during 1988–2012. Patients were grouped into mutually exclusive racial/ethnic groups of non-Hispanic (NH) white, NH black, Hispanic, and NH Asian/Pacific Islander (API), as well as Asian subgroups of Chinese, Filipino, Japanese, Korean, Vietnamese, Cambodian, Laotian, and South Asian. Age-adjusted and age-specific incidence rates by sex, race/ethnicity, and time period were calculated. The average annual percent change (AAPC) in incidence rates was estimated using joinpoint regression. All estimates were provided with the 95% confidence intervals (CIs).ResultsAggregated NH API had higher HCC risk than NH whites, NH blacks, and Hispanics. When disaggregated, Southeast Asians (Vietnamese, Cambodians, and Laotians) had overall HCC incidence rates eight to nine times higher than NH whites and more than twice that of other ethnic Asians. Statistically significant rising temporal trends of HCC were found in NH whites, NH blacks, and Hispanics, especially those older than age 50 years. Overall HCC risk declined in Chinese males (AAPC = –1.3%, 95% CI = –2.0 to –0.6), but rose in Filipino (AAPC = +1.2%, 95% CI = 0.3 to 2.1) and Japanese males (AAPC = +3.0%, 95% CI = 0.4 to 5.6) and Vietnamese (AAPC = +4.5%, 95% CI = 0.7 to 8.5) and Laotian (+3.4%, 95% CI = 0.1 to 6.8) females.ConclusionsOur findings provide valuable information for the identification of at-risk ethnic subgroups of Asian Americans while underscoring the importance of disaggregating ethnic populations in cancer research.

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Multiple sclerosis presenting as a pure psychiatric disorder

Psychological Medicine ◽

10.1017/s0033291700026374 ◽

1993 ◽

Vol 23 (4) ◽

pp. 909-914 ◽

Cited By ~ 12

Author(s):

Keren Skegg

Keyword(s):

Multiple Sclerosis ◽

Psychiatric Disorder ◽

Diagnostic Criteria ◽

Large Population ◽

Population Based ◽

Population Based Study ◽

Mental Symptoms

SynopsisUsing strict diagnostic criteria, 91 patients with multiple sclerosis (MS) were identified in a defined population of 112000. Of these patients, 29 were found to have been referred to a psychiatrist at least once. Their psychiatric records were searched for cases of MS presenting as a pure psychiatric disorder. Only 18 of the 30 psychiatric referrals before the diagnosis of MS involved purely mental symptoms, and there was no reason to suppose most of them to be related to MS. This study highlighted the problem of how to define a true psychiatric presentation of MS. The uncovering of two likely candidates among a population-based sample of 91 supported the existence of such a phenomenon, but it was concluded that the only way to ascertain how often purely mental symptoms might be the first manifestation of MS would be to conduct a large population-based study with controls.

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Secular Trends of Stroke Epidemiology in Örebro, Sweden, 2017 Compared to the Trends in 1999: A Population-Based Study

Cerebrovascular Diseases ◽

10.1159/000504082 ◽

2019 ◽

Vol 48 (3-6) ◽

pp. 149-156 ◽

Cited By ~ 1

Author(s):

Peter Appelros

Keyword(s):

Length Of Stay ◽

Incidence Study ◽

Large Population ◽

Case Fatality ◽

Population Based ◽

Incidence Rates ◽

European Population ◽

Stroke Severity ◽

Stroke Incidence ◽

Preventive Medication

Background and Purpose: A stroke incidence study in Örebro, situated in Southern Sweden, that was carried out in 1999 showed high incidence rates. Since then, in many Western countries, declining incidence rates have been observed. The main purpose of this study is to examine whether there have been any changes in stroke incidence in the city of Örebro between 1999 and 2017. Secondary purposes are to show trends in stroke severity, length of stay and case fatality (CF). Methods: The criterion of an “ideal” stroke incidence study was used in both the 1999 and the present investigation. These criteria include uniform diagnostics, case ascertainment including strokes managed outside the hospital, and the use of several overlapping sources, prospective design, well-defined denominator, and a large population. Results: The overall stroke incidence rate of first ever stroke (adjusted to the 2013 European population) dropped from 346/100,000 (95% CI 314–380) to 168/100,000 (95% CI 148–190). Stroke severity declined from a median of 6 to 4 points on the National Institute of Health Stroke scale. CF within 28 days also declined from 19 to 16% (n.s.). Median length-of-stay in hospital was 16 days in 1999, and 10 days in 2017. Twenty-one per cent of all kinds of stroke were recurrent (not included in the above results). Conclusions: During the years between 1999 and 2017, there have been reductions in stroke incidence, severity and mortality. The explanation is most likely to be found in the prevalence of risk factors and how they are treated. The use of antihypertensives and statins has increased, corresponding to lower levels of blood pressure and cholesterol in the population. The use of anticoagulants in patients with atrial fibrillation has increased. Cigarette smoking has decreased. These are encouraging results that show that preventive medication and public health measures work in practice.

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Non-infectious comorbidity in patients with multiple sclerosis: A national cohort study in Sweden

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/2055217320947761 ◽

2020 ◽

Vol 6 (3) ◽

pp. 205521732094776

Author(s):

Anna Castelo-Branco ◽

Flaminia Chiesa ◽

Camilla E Bengtsson ◽

Sally Lee ◽

Neil N Minton ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cohort Study ◽

Improve Patient Care ◽

Bowel Dysfunction ◽

Population Based ◽

Incidence Rates ◽

Swedish Population ◽

Comorbidity Burden ◽

National Cohort ◽

Rate Ratios

Background Comorbidity is of significant concern in multiple sclerosis (MS). Few population-based studies have reported conditions occurring in MS after diagnosis, especially in contemporary cohorts. Objective To explore incident comorbidity, mortality and hospitalizations in MS, stratified by age and sex. Methods In a Swedish population-based cohort study 6602 incident MS patients (aged ≥18 years) and 61,828 matched MS-free individuals were identified between 1 January 2008 and 31 December 2016, using national registers. Incidence rates (IRs) and incidence rate ratios (IRRs) with 95% CI were calculated for each outcome. Results IRs of cardiovascular disease (CVD) were higher among MS patients than MS-free individuals, (major adverse CVD: IRR 1.42; 95% CI 1.12–1.82; hemorrhagic/ischemic stroke: 1.46; 1.05–2.02; transient ischemic attack: 1.65; 1.09–2.50; heart failure: 1.55; 1.15–2.10); venous thromboembolism: 1.42; 1.14–1.77). MS patients also had higher risks of several non-CVDs such as autoimmune conditions (IRR 3.83; 3.01–4.87), bowel dysfunction (2.16; 1.86–2.50), depression (2.38; 2.11–2.68), and fractures (1.32; 1.19–1.47), as well as being hospitalized and to suffer from CVD-related deaths ((1.91; 1.00–3.65), particularly in females (3.57; 1.58–8.06)). Conclusion MS-patients experience a notable comorbidity burden which emphasizes the need for integrated disease management in order to improve patient care and long-term outcomes of MS.

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Association between multiple sclerosis and epilepsy: large population-based record-linkage studies

BMC Neurology ◽

10.1186/1471-2377-13-189 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 19

Author(s):

Alexander N Allen ◽

Olena O Seminog ◽

Michael J Goldacre

Keyword(s):

Multiple Sclerosis ◽

Record Linkage ◽

Large Population ◽

Population Based ◽

Linkage Studies

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Cutaneous lymphoma incidence patterns in the United States: a population-based study of 3884 cases

Blood ◽

10.1182/blood-2008-10-184168 ◽

2009 ◽

Vol 113 (21) ◽

pp. 5064-5073 ◽

Cited By ~ 364

Author(s):

Porcia T. Bradford ◽

Susan S. Devesa ◽

William F. Anderson ◽

Jorge R. Toro

Keyword(s):

United States ◽

Large Population ◽

Survival Rates ◽

The United States ◽

Population Based ◽

Incidence Rates ◽

T Cell Lymphomas ◽

Cutaneous Lymphomas ◽

Distinct Disease ◽

Asian Pacific

Abstract There have been no prior large population-based studies focusing on cutaneous lymphomas (CL) in the United States. Using the Surveillance, Epidemiology and End Results (SEER) program data, we analyzed age-adjusted CL incidence rates (IRs) and survival rates by sex and race/ethnicity. There were 3884 CLs diagnosed during 2001-2005. Cutaneous T-cell lymphomas (CTCLs) accounted for 71% (age-adjusted incidence rate [IR] = 7.7/1 000 000 person-years), whereas cutaneous B-cell lymphomas(CBCLs) accounted for 29% (IR = 3.1/1 000 000 person-years). Males had a statistically significant higher IR of CL than females (14.0 vs 8.2/1 000 000 person-years, respectively; male-female IR ratio [M/F IRR] = 1.72; P < .001). CL IRs were highest among blacks and non-Hispanic whites (both 11.5/1 000 000 person-years), followed by Hispanic whites (7.9) and Asian/Pacific Islanders (7.1). The CTCL IR was highest among blacks (10.0/1 000 000 person-years), whereas the CBCL IR was highest among non-Hispanic whites (3.5). Over the past 25 years, the CL IR increased from 5.0/1 000 000 person-years during 1980-1982 to 14.3 during 2001-2003. During 2004-2005, the CL IR was 12.7. This recent apparent change could be incomplete case ascertainment or potential leveling off of IRs. CLs rates vary markedly by race and sex, supporting the notion that they represent distinct disease entities.

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The impact of risk factor trends on intracerebral hemorrhage incidence over the last two decades—The Tromsø Study

International Journal of Stroke ◽

10.1177/1747493018789996 ◽

2018 ◽

Vol 14 (1) ◽

pp. 61-68 ◽

Cited By ~ 2

Author(s):

Maria Carlsson ◽

Tom Wilsgaard ◽

Stein Harald Johnsen ◽

Liv-Hege Johnsen ◽

Maja-Lisa Løchen ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Intracerebral Hemorrhage ◽

Proportional Hazards ◽

Temporal Trends ◽

Population Based ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Intracerebral Hemorrhages ◽

The Impact

Background Studies on the relationship between temporal trends in risk factors and incidence rates of intracerebral hemorrhage are scarce. Aims To analyze temporal trends in risk factors and incidence rates of intracerebral hemorrhage using individual data from a population-based study. Methods We included 28,167 participants of the Tromsø Study enrolled between 1994 and 2008. First-ever intracerebral hemorrhages were registered through 31 December 2013. Hazard ratios (HRs) for intracerebral hemorrhage were analyzed by Cox proportional hazards models, risk factor levels over time by generalized estimating equations, and incidence rate ratios (IRR) by Poisson regression. Results We registered 219 intracerebral hemorrhages. Age, male sex, systolic blood pressure (BP), diastolic BP, and hypertension were associated with intracerebral hemorrhage. Hypertension was more strongly associated with non-lobar intracerebral hemorrhage (HR 5.08, 95% CI 2.86–9.01) than lobar intracerebral hemorrhage (HR 1.91, 95% CI 1.12–3.25). In women, incidence decreased significantly (IRR 0.46, 95% CI 0.23–0.90), driven by a decrease in non-lobar intracerebral hemorrhage. Incidence rates in men remained stable (IRR 1.27, 95% CI 0.69–2.31). BP levels were lower and decreased more steeply in women than in men. The majority with hypertension were untreated, and a high proportion of those treated did not reach treatment goals. Conclusions We observed a significant decrease in intracerebral hemorrhage incidence in women, but not in men. A steeper BP decrease in women may have contributed to the diverging trends. The high proportion of untreated and sub-optimally treated hypertension calls for improved strategies for prevention of intracerebral hemorrhage.

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Short- and long-term outcomes of infective endocarditis admission in adults: A population-based registry study in Finland

PLoS ONE ◽

10.1371/journal.pone.0254553 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254553

Author(s):

Elina Ahtela ◽

Jarmo Oksi ◽

Tero Vahlberg ◽

Jussi Sipilä ◽

Päivi Rautava ◽

...

Keyword(s):

Infective Endocarditis ◽

Large Population ◽

Temporal Trends ◽

Population Based ◽

Factors Affecting ◽

Comorbidity Burden ◽

Hospital Stays ◽

Population Based Registry ◽

Long Term Mortality

Infective endocarditis (IE) is associated with high mortality. However, data on factors associated with length of stay (LOS) in hospital due to IE are scarce. In addition, long-term mortality of more than 1 year is inadequately known. In this large population-based study we investigated age and sex differences, temporal trends, and factors affecting the LOS in patients with IE and in-hospital, 1-year, 5-year and 10-year mortality of IE. Data on patients (≥18 years of age) admitted to hospital due to IE in Finland during 2005–2014 were collected retrospectively from nationwide obligatory registries. We included 2166 patients in our study. Of the patients 67.8% were men. Women were older than men (mean age 63.3 vs. 59.5, p<0.001). The median LOS was 20.0 days in men and 18.0 in women, p = 0.015. In the youngest patients (18–39 years) the median LOS was significantly longer than in the oldest patients (≥80 years) (24.0 vs. 16.0 days, p = 0.014). In-hospital mortality was 10% with no difference between men and women. Mortality was 22.7% at 1 year whereas 5- and 10-year mortality was 37.5% and 48.5%, respectively. The 5-year and 10-year mortality was higher in women (HR 1.18, p = 0.034; HR 1.18, p = 0.021). Both in-hospital and long-term mortality increased significantly with aging and comorbidity burden. Both mortality and LOS remained stable over the study period. In conclusion, men had longer hospital stays due to IE compared to women. The 5- and 10-year mortality was higher in women. The mortality of IE or LOS did not change over time.

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