Multiple sclerosis in the Republic of San Marino, Italian peninsula: an incidence and prevalence study from a high-risk area

Caniglia-Tenaglia, Marta; Guttmann, Susanna; Monaldini, C.; Manzaroli, D.; Volpini, Mirco; Stumpo, Maurizio; Groppo, Elisabetta; Casetta, Ilaria; Govoni, Vittorio; Fonderico, Mattia; Pugliatti, Maura; Granieri, Enrico

doi:10.1007/s10072-018-3402-6

Cited by 7 publications

(6 citation statements)

References 33 publications

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“…The high proportion (68%) of the patients with no or minimal to moderate disability (EDSS score 0-3.5) gives support to this interpretation. In our last investigation in the Republic of San Marino, using the same diagnostic criteria and case-finding procedures, the percentage of patients showing minimal moderate or no disability (EDSS score,1-3.5) was 74.6% [35]. Similarly, data compatible with improved survival have been found in other MS populations, including those from Italy [22,25,29,30,37], Norway [9], and Canada [42].…”

Section: Discussionsupporting

confidence: 57%

“…The descriptive surveys that have been carried out in Italy since the 1980s are characterized by a similar methodology in case-finding procedures and diagnostic criteria. Our research group, by using the same methodology, recently found a prevalence rate of 204.3 per 100,000 in the territory of the Republic of San Marino, lying within the Italian peninsula [35]. The prevalence rate we found in Ferrara was much higher than the one of the same research group estimated during 4 decades of follow-up: 26.9 per 100,000 on 1978, 46.1 per 100,000 on 1981, 69.4 per 100,000 on 1993, 121.9 on 2004 [10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

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Multiple Sclerosis in Italy: A 40-Year Follow-Up of the Prevalence in Ferrara

et al. 2018

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Background: To assess a longitudinal follow-up of the prevalence of multiple sclerosis (MS) through 4 decades in the province of Ferrara, northern Italy, and reappraise the current rates on December 31, 2016. Methods: We conducted a community-based intensive prevalence study, by adopting a complete enumeration approach. MS cases were identified from administrative health data and medical records from the Units of Neurology and Motor Rehabilitation, Ferrara University Hospital, from other provincial neurological structures and from archives of the National Pension Institute and National Health Insurance scheme of the study area. Case ascertainment method and case definition are analogous to those adopted in previous surveys in the same area of study. Results: On December 31, 2016, 685 patients (478 women and 207 men) affected by definite or probable MS (Poser’s criteria) were living in the province of Ferrara (population 386,896), yielding a crude prevalence ratio of 194.91 (95% CI 180.4–209.6) per 100,000, 260.8 (95% CI 238.10–285.82) for women and 123.1 (95% CI 106.98–141.21) for men The prevalence ratio was 26.9 per 100,000 in 1978, increased to a value of 46.1 per 100,000 in 1981, 69.4 per 100,000 in 1993, 120.9 per 100,000 in 2004. Female to male ratio was 2.31 (1.2 on December 31, 1978). The mean duration of the disease at prevalence day was 17.5 ± 11.9 years (13.9 ± 10.8 years in 1978). The mean age at prevalence day was 52.04 ± 10.8 years (13.8 ± 10.8 years in 1978). Conclusion: Our study has confirmed the province of Ferrara is an area at high risk for MS, in line with epidemiological data from the regions of continental and insular Italy. The sharp increase in MS prevalence over time in this population can be imputed in part to a greater exposition to risk factors in genetically susceptible subjects but also to an increased survival and improved ascertainment. So, the results suggest that both methodologic and environmental factors are essential in determining the real distribution of MS. The need to get reliable estimates of MS prevalence must be highlighted as a public health and research priority, essential to support planning and prioritization of care services and to reduce the overall burden of chronic disease.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Multiple Sclerosis in Italy: A 40-Year Follow-Up of the Prevalence in Ferrara

et al. 2018

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“…Worth of interest are the results of the epidemiological studies done in the Republic of San Marino, a little independent State in the Northern Italy, 150 km South from Ferrara, whose population (32,876 inhabitants) is almost exclusively Caucasian (composed by natives in San Marino, 85%, and Italy, 10%). In this State, MS prevalence increased with the same trend: 51.6/100,000 in 1984 [ 19 ], 121/100,000 in 2005 and 203/100,000 on December 31, 2014 [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

Multiple sclerosis epidemiological trends in Italy highlight the environmental risk factors

Puthenparampil

Perini

Bergamaschi³

et al. 2021

J Neurol

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Italy is definitely a high-risk country for multiple sclerosis (MS). Over the last 50 years, several epidemiological studies, including longitudinal surveys, have disclosed that MS incidence and prevalence in Italy mainland and Islands (Sardinia and Sicily) have progressively increased, picturing a semi-parabolic curve. Based on the comprehensive scrutiny of 58 papers, we conclude that the latitude risk gradient does not fit to the Italian map of MS. The genetic heterogeneity of the Italian ethnicities, that likely forms the basis of MS predisposition, does not account for the dramatic increase of MS incidence and prevalence observed in Italy over the last half century that, rather, seems better explained by the effect of environmental factors.

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“…The proportion of increase in the SPMS prevalence was lower than that of MS prevalence in Newcastle, Australia [ 104 , 105 ]; Csongrad County, Hungary [ 32 , 33 ]; Catania, Italy [ 51 – 53 ]; Ferrara, Italy [ 44 , 46 ]; Swietokrzyskie Province, Poland [ 62 , 63 ]; and Isle of Man, UK [ 102 ]. The proportion of increase in the SPMS prevalence was higher than that of MS prevalence in the Republic of San Marino, Italy [ 41 , 45 ]; Ferrara, Italy [ 43 , 44 ]; and Leeds, UK [ 97 , 98 ].…”

Section: Resultsmentioning

confidence: 99%

“…A total of 18 MS moderate-quality studies reported the proportion of SPMS patients and thus were included in this meta-analysis [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]. The pooled prevalence of SPMS was 22.49 (99% CI: 14.97, 31.48)/100,000 (Fig.…”

Section: Italymentioning

confidence: 99%

Systematic literature review and meta-analysis of the prevalence of secondary progressive multiple sclerosis in the USA, Europe, Canada, Australia, and Brazil

Vasanthaprasad

Khurana²,

Vadapalle

et al. 2022

BMC Neurol

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Background Secondary progressive multiple sclerosis (SPMS) is a subtype of multiple sclerosis (MS), which is a chronic neurological disease, characterised by inflammation of the central nervous system. Most of MS patients eventually progress to SPMS. This study estimates the prevalence of SPMS in the United States of America, Europe, Canada, Australia, and Brazil. Methods A systematic literature search of the Medline and Embase databases was performed using the OVID™ SP platform to identify MS epidemiological studies published in English from database inception to September 22, 2020. Studies reporting the prevalence of MS and proportion of SPMS patients in the included population were selected. The pooled prevalence of SPMS was calculated based on the proportion of SPMS patients. The Loney quality assessment checklist was used for quality grading. A meta-analysis of the proportions was conducted in RStudio. Results A total of 4754 articles were retrieved, and prevalence was calculated from 97 relevant studies. Overall, 86 medium- and high-quality studies were included in the meta-analysis. Most studies were conducted in European countries (84 studies). The estimated pooled prevalence of SPMS was 22.42 (99% confidence interval: 18.30, 26.95)/100,000. The prevalence of SPMS was more in the North European countries, highest in Sweden and lowest in Brazil. A decline in SPMS prevalence was observed since the availability of oral disease-modifying therapies. We also observed a regional variation of higher SPMS prevalence in urban areas compared with rural areas. Conclusion High variability was observed in the estimated SPMS prevalence, and the quality of the studies conducted. The influence of latitude and other factors known to affect overall MS prevalence did not fully explain the wide range of inter-country and intra-country variability identified in the results.

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Multiple sclerosis in the Republic of San Marino, Italian peninsula: an incidence and prevalence study from a high-risk area

Cited by 7 publications

References 33 publications

Multiple Sclerosis in Italy: A 40-Year Follow-Up of the Prevalence in Ferrara

Multiple Sclerosis in Italy: A 40-Year Follow-Up of the Prevalence in Ferrara

Multiple sclerosis epidemiological trends in Italy highlight the environmental risk factors

Systematic literature review and meta-analysis of the prevalence of secondary progressive multiple sclerosis in the USA, Europe, Canada, Australia, and Brazil

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