Epidemiology in multiple sclerosis: a pilgrim’s progress

Kurtzke, John F.

doi:10.1093/brain/awt220

Cited by 36 publications

(18 citation statements)

References 37 publications

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“…A north to south decrease in prevalence by latitude gradient has been recognised in North America and western Europe,28, 29 and a reverse south to north increase in gradient has been reported in Australia 28 . Temporal trends in prevalence show that these gradients were weakening in the 20th century, 9 but the distribution of multiple sclerosis can still be generally described as having three zones of frequency or risk (figure 1), as originally proposed by Kurtzke 30 . In 2016, northern European countries and North America made up the high-risk prevalence zone, with estimates of 100 or more cases of multiple sclerosis per 100 000 population.…”

Section: Discussionmentioning

confidence: 86%

Global, regional, and national burden of multiple sclerosis 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Wallin¹,

Culpepper²,

Nichols³

et al. 2019

The Lancet Neurology

990

641

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Summary Background Multiple sclerosis is the most common inflammatory neurological disease in young adults. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic method of quantifying various effects of a given condition by demographic variables and geography. In this systematic analysis, we quantified the global burden of multiple sclerosis and its relationship with country development level. Methods We assessed the epidemiology of multiple sclerosis from 1990 to 2016. Epidemiological outcomes for multiple sclerosis were modelled with DisMod-MR version 2.1, a Bayesian meta-regression framework widely used in GBD epidemiological modelling. Assessment of multiple sclerosis as the cause of death was based on 13 110 site-years of vital registration data analysed in the GBD's cause of death ensemble modelling module, which is designed to choose the optimum combination of mathematical models and predictive covariates based on out-of-sample predictive validity testing. Data on prevalence and deaths are summarised in the indicator, disability-adjusted life-years (DALYs), which was calculated as the sum of years of life lost (YLLs) and years of life lived with a disability. We used the Socio-demographic Index, a composite indicator of income per person, years of education, and fertility, to assess relations with development level. Findings In 2016, there were 2 221 188 prevalent cases of multiple sclerosis (95% uncertainty interval [UI] 2 033 866–2 436 858) globally, which corresponded to a 10·4% (9·1 to 11·8) increase in the age-standardised prevalence since 1990. The highest age-standardised multiple sclerosis prevalence estimates per 100 000 population were in high-income North America (164·6, 95% UI, 153·2 to 177·1), western Europe (127·0, 115·4 to 139·6), and Australasia (91·1, 81·5 to 101·7), and the lowest were in eastern sub-Saharan Africa (3·3, 2·9–3·8), central sub-Saharan African (2·8, 2·4 to 3·1), and Oceania (2·0, 1·71 to 2·29). There were 18 932 deaths due to multiple sclerosis (95% UI 16 577 to 21 033) and 1 151 478 DALYs (968 605 to 1 345 776) due to multiple sclerosis in 2016. Globally, age-standardised death rates decreased significantly (change −11·5%, 95% UI −35·4 to −4·7), whereas the change in age-standardised DALYs was not significant (−4·2%, −16·4 to 0·8). YLLs due to premature death were greatest in the sixth decade of life (22·05, 95% UI 19·08 to 25·34). Changes in age-standardised DALYs assessed with the Socio-demographic Index between 1990 and 2016 were variable. Interpretation Multiple sclerosis is not common but is a potentially severe cause of neurological disability throughout adult life. Prevalence has increased substantially in many regions since 1990. These findings will be useful for resource allocation and planning in health services. Many regions worldwide have few or no epidemiological data on multiple sclerosis, and more studies a...

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Section: Discussionmentioning

confidence: 86%

Global, regional, and national burden of multiple sclerosis 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Wallin¹,

Culpepper²,

Nichols³

et al. 2019

The Lancet Neurology

990

641

View full text Add to dashboard Cite

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“…EBV, sunshine (UVB), smoking and vitamin D, combined with an individual's genetic background, play important roles in the causal pathway that results in MS development . Migration studies consistently support MS being secondary to an environmental exposure . Adult migrants from low risk countries, such as the West Indies, to Europe are at low risk of developing MS; however, children born to migrants in Europe are at high risk.…”

Section: Epidemiology and Aetiologymentioning

confidence: 99%

Multiple sclerosis – a review

Dobson

Giovannoni

2018

Euro J of Neurology

1,342

877

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Multiple sclerosis (MS) is the commonest non-traumatic disabling disease to affect young adults. The incidence of MS is increasing worldwide, together with the socioeconomic impact of the disease. The underlying cause of MS and mechanisms behind this increase remain opaque, although complex geneenvironment interactions almost certainly play a significant role. The epidemiology of MS indicates that low serum levels of vitamin D, smoking, childhood obesity and infection with the Epstein-Barr virus are likely to play a role in disease development. Changes in diagnostic methods and criteria mean that people with MS can be diagnosed increasingly early in their disease trajectory. Alongside this, treatments for MS have increased exponentially in number, efficacy and risk. There is now the possibility of a diagnosis of 'pre-symptomatic MS' being made; as a result potentially preventive strategies could be studied. In this comprehensive review, MS epidemiology, potential aetiological factors and pathology are discussed, before moving on to clinical aspects of MS diagnosis and management.

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“…I have a rather different explanation to offer, and that lies in my interpretation of the epidemiology of this disease from its earliest developments, into which the Middle East results seem to me to fit as well The basis for the statements to follow may be found in two recent summations, an Occasional Paper titled ‘Epidemiology in multiple sclerosis: a pilgrim's progress' [2] and its documentation and elaboration in a Monograph called ‘How Far Can Epidemiology Take Us in Finding the Cause of Multiple Sclerosis?' (Monograph 1, 2014, Department of Veterans Affairs MS Center of Excellence - East) [3].…”

Section: Tablementioning

confidence: 99%