A new way to estimate neurologic disease prevalence in the United States

Nelson, Lorene M.; Wallin, Mitchell T.; Marrie, Ruth Ann; Culpepper, William J.; Langer‐Gould, Annette; Campbell, John T.; Buka, Stephen L.; Tremlett, Helen; Cutter, Gary; Kaye, Wendy; Wagner, Laurie; LaRocca, Nicholas G.

doi:10.1212/wnl.0000000000007044

Cited by 40 publications

(36 citation statements)

References 32 publications

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“…Each method has strengths and limitations; however, the increasing availability of large AHC datasets has made this approach efficient and cost-effective. 1…”

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confidence: 99%

The prevalence of MS in the United States

et al. 2019

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ObjectiveTo generate a national multiple sclerosis (MS) prevalence estimate for the United States by applying a validated algorithm to multiple administrative health claims (AHC) datasets.MethodsA validated algorithm was applied to private, military, and public AHC datasets to identify adult cases of MS between 2008 and 2010. In each dataset, we determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. We applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the United States cumulated over 3 years. We also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated our estimate to 2017.ResultsThe estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000 (95% confidence interval [CI] 308.1–310.1), representing 727,344 cases. During the same time period, the MS prevalence was 450.1 per 100,000 (95% CI 448.1–451.6) for women and 159.7 (95% CI 158.7–160.6) for men (female:male ratio 2.8). The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group. A US north-south decreasing prevalence gradient was identified. The estimated MS prevalence is also presented for 2017.ConclusionThe estimated US national MS prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists. Our rigorous algorithm-based approach to estimating prevalence is efficient and has the potential to be used for other chronic neurologic conditions.

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“…Each method has strengths and limitations; however, the increasing availability of large AHC datasets has made this approach efficient and cost-effective. 1…”

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confidence: 99%

The prevalence of MS in the United States

et al. 2019

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“…Multiple Sclerosis presents most often in young adulthood and is chronic as most patients live with the disease for decades. Recent studies on prevalence uncovered that nearly a million people live with MS within the United States (Culpepper et al, 2019;Nelson et al, 2019;Wallin et al, 2019). Approximately 85% of patients present with the relapsing-remitting form of MS (RRMS) that involves episodes of neurological deficits followed by phases of recovery (Steinman, 2009).…”

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confidence: 99%

Pre-clinical and Clinical Implications of “Inside-Out” vs. “Outside-In” Paradigms in Multiple Sclerosis Etiopathogenesis

Titus

Chen

Podojil

et al. 2020

Front. Cell. Neurosci.

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Multiple Sclerosis (MS) is an immune-mediated neurological disorder, characterized by central nervous system (CNS) inflammation, oligodendrocyte loss, demyelination, and axonal degeneration. Although autoimmunity, inflammatory demyelination and neurodegeneration underlie MS, the initiating event has yet to be clarified. Effective disease modifying therapies need to both regulate the immune system and promote restoration of neuronal function, including remyelination. The challenge in developing an effective long-lived therapy for MS requires that three disease-associated targets be addressed: (1) self-tolerance must be re-established to specifically inhibit the underlying myelin-directed autoimmune pathogenic mechanisms; (2) neurons must be protected from inflammatory injury and degeneration; (3) myelin repair must be engendered by stimulating oligodendrocyte progenitors to remyelinate CNS neuronal axons. The combined use of chronic and relapsing remitting experimental autoimmune encephalomyelitis (C-EAE, R-EAE) ("outside-in") as well as progressive diphtheria toxin A chain (DTA) and cuprizone autoimmune encephalitis (CAE) ("inside-out") mouse models allow for the investigation and specific targeting of all three of these MSassociated disease parameters. The "outside-in" EAE models initiated by myelin-specific autoreactive CD4 + T cells allow for the evaluation of both myelin-specific tolerance in the absence or presence of neuroprotective and/or remyelinating agents. The "inside-out" mouse models of secondary inflammatory demyelination are triggered by toxin-induced oligodendrocyte loss or subtle myelin damage, which allows evaluation of novel therapeutics that could promote remyelination and neuroprotection in the CNS. Overall, utilizing these complementary pre-clinical MS models will open new avenues for developing therapeutic interventions, tackling MS from the "outside-in" and/or "inside-out".

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“…Thus, longitudinal investigations, in well-defined populations, applying epidemiologic methods may reveal clues to novel risk factors while simultaneously providing measures needed for estimation of disease burden, resource allocation, and health service planning. 3 We aimed to produce a robust estimate of MS prevalence and to examine the time trends of incidence during 7 decades in Møre and Romsdal County, Western Norway.…”

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High incidence and prevalence of MS in Møre and Romsdal County, Norway, 1950–2018

Willumsen

Aarseth

Myhr

et al. 2020

Neurol Neuroimmunol Neuroinflamm

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ObjectiveTo determine prevalence and longitudinal trends in incidence of MS in Møre and Romsdal County, Western Norway, from 1950 to 2018.MethodsRetrospective longitudinal population-based observational study. All patients diagnosed, or living, with MS in Møre and Romsdal were identified as incident or prevalent cases from local, regional, and national sources. We compiled the data in the Norwegian Multiple Sclerosis Registry and Biobank and used the aggregated data set to calculate incidence and prevalence rates using population measures obtained from Statistics Norway.ResultsOn January 1, 2018, the estimated prevalence was 335.8 (95% CI, 314.1–358.5) per 100,000 inhabitants, with a female:male ratio of 2.3. From 1950 through 2017, we observed a considerable (p < 0.001) increase in average annual incidence rates from 2.1 (95% CI, 1.3–3.3) to 14.4 (95% CI, 11.9–17.3) per 100,000. From 2005 through 2017, the incidence among women increased from 17.1 (95% CI, 14.0–20.7) to 23.2 (95% CI, 18.7–28.5) per 100,000, whereas the incidence among men declined from 10.3 (95% CI, 7.9–13.2) to 5.9 (95% CI, 3.4–8.8) per 100,000.ConclusionMøre and Romsdal County in Western Norway has the highest prevalence of MS reported in Norway. The incidence has steadily increased since 1950, and during the latest 15 years, we observed opposing trends in sex-specific incidence rates.

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A new way to estimate neurologic disease prevalence in the United States

Cited by 40 publications

References 32 publications

The prevalence of MS in the United States

The prevalence of MS in the United States

Pre-clinical and Clinical Implications of “Inside-Out” vs. “Outside-In” Paradigms in Multiple Sclerosis Etiopathogenesis

High incidence and prevalence of MS in Møre and Romsdal County, Norway, 1950–2018

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