Ongoing increase in incidence and prevalence of multiple sclerosis in Newcastle, Australia: A 50-year study

Ribbons, Karen; Lea, Rodney Arthur; Tiedeman, Clare; Mackenzie, Laura; Lechner‐Scott, Jeannette

doi:10.1177/1352458516671819

Cited by 50 publications

(54 citation statements)

References 24 publications

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“…The average age at diagnosis was 40 years amongst the whole cohort (combined relapse onset MS/PPMS), comparable to that reported in the UK (Mackenzie et al, 2014), Australia (Ribbons et al, 2016) and Canada (Kingwell et al, 2015;Marrie et al, 2013). This is at the upper limit of the traditionally reported 20-40 year age range (Compston and Coles, 2008).…”

Section: Discussionsupporting

confidence: 75%

Incidence of multiple sclerosis in the Republic of Ireland: A prospective population-based study

O’Connell

Tubridy

Hutchinson

et al. 2017

Multiple Sclerosis and Related Disorders

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This is the first study to prospectively assess the incidence rate of MS in Ireland and shows that Ireland has a high incidence rate, comparable with the rest of the British Isles, with a persistent North-South gradient. The age of onset of relapsing remitting multiple sclerosis appears to be increasing over the last 20 years. It will be of interest to re-assess this population over time to see if increasing incidence rates, as well as improved survival, are driving the reported increases in MS prevalence.

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Section: Discussionsupporting

confidence: 75%

Incidence of multiple sclerosis in the Republic of Ireland: A prospective population-based study

O’Connell

Tubridy

Hutchinson

et al. 2017

Multiple Sclerosis and Related Disorders

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“…The variable magnitude of MS risk in 2 age ranges of population in Kuwait has also been previously documented [6, 7, 26]. A recent report of an ongoing increase in MS burden over 50 years period in Newcastle, Australia, also discerned similar age-specific bimodal patterns (at-onset) in MS incidence during 1986–2011 [27]. We are unaware of any study that reported such bimodality in age-specific MS risk based on APC analysis.…”

Section: Discussionmentioning

confidence: 57%

Age-Period-Cohort Modeling of Multiple Sclerosis Incidence Rates in Kuwait: 1980–2014

Akhtar¹,

Al-Abkal

Al-Hashel

et al. 2017

Neuroepidemiology

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Background: Multiple sclerosis (MS) is a complex immune-mediated disorder of the central nervous system with undefined etiology. Genetic predisposition and environmental factors play an imperative role in MS causation and its sustained increasing burden worldwide. This study examined the age, period, and cohort effects on MS incidence rates in Kuwait. Methods: In this retrospective cohort study, data on MS cases diagnosed between January 1, 1980 and December 31, 2014 and registered in National MS Registry and reference population were obtained. Age-period-cohort (APC) analysis was conducted using a loglinear Poisson regression model to supplement the descriptive and graphical presentation. Descriptive statistics were complemented with APC parameters’ estimates including net drift, local drift, age at onset curve, and longitudinal age trend. Age effect was presented as incidence rates (per 10⁵ person-years), whereas period and cohort effects were presented as adjusted relative rates. Results: A total of 1,131 cases were diagnosed in 1,385,923 person-years. Overall age-standardized MS incidence rate was 64.5 (95% CI 52.4–79.8). An estimated annual percentage change revealed 7.4% annual increase in MS incidence rate during the study period (Net drift = 7.4%; 95% CI 4.1–10.8%). APC “fitted” age-at-onset curve showed a bimodal pattern with peaked incidence rates at 20–24 years and 45–49 years of age. Compared with the referent period (1980–1984) and cohort (1970–1974), MS incidence rates progressively and significantly (p < 0.001) increased during subsequent time periods and in successive cohorts. Results of APC analysis are descriptive in nature and specific etiological hypotheses were not evaluated. However, the findings of this study substantiated the notion of multiplicity of genetic and/or environmental risk factors’ contributions. Conclusion: A substantial increase in MS incidence rates was recorded, which significantly varied in all 3 temporal dimensions during the study period. Future studies may contemplate biological basis for recorded temporal increase in MS risk.

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“…More recently, and when consistent means of identifying MS are applied, MS incidence has not increased in several locations, such as in the Canadian provinces of British Columbia (1996-2008) [10], Manitoba (1998Manitoba ( -2006 [11] and Nova Scotia (1990-2010) [12], as well as Western Norway [13] and the UK (1990-2010) [14]. There has been an apparent increase in other locations, such as Newcastle, Australia [9], although, again, this is a study within a small population (in 2011 the general population totalled 148 535) and with a small number of cases, particularly historically. We do not seek to fully review the incidence of MS worldwide, but to highlight that secular trends in MS are variable across countries, and that ascertainment and instability of estimates due to small numbers of people with MS still threaten the validity of estimates.…”

Section: Discussionmentioning

confidence: 99%

An ‘epidemic’ of multiple sclerosis and falling infection rates? Reflecting on comparisons made and the rising multiple sclerosis incidence in Bach's 2002 New England Journal of Medicine figure

Tremlett

Lucas

2017

Euro J of Neurology

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Background and purpose: We set out to revisit and comment on the evidence surrounding a popular figure published in the New England Journal of Medicine (2002), which suggests that the incidence of immune-mediated diseases, including multiple sclerosis (MS), is increased by reduced exposure to infections. Methods: Commentary. Results: We found that, to date (May 2017), this influential article has been cited >2000 times. However, on close investigation of the figure, we noticed some problems. Specifically, we observed several challenges inherent in using ecological data from disparate studies and countries to make conclusions surrounding the temporal patterns and relationships between diseases. For example, the figure depicts incidence data for MS based solely on a limited group of individuals with MS (n = 637; 455 women and 182 men) living within the region of Sassari on the island of Sardinia, known for its unique genealogy and risk of MS. However, the infectious-related data were based primarily on large population studies from the USA, with one derived from army recruits in France. Conclusions: We encourage the scientific community to apply rigorous, consistent methods in order to confirm or refute whether a strong, direct relationship does or does not exist between the incidence of MS and infectious diseases. Further, our article highlights a major knowledge gap that would benefit from a thorough review of the temporal trends related to MS incidence. Collation of this wide body of knowledge may provide a balanced understanding of this important topic and would best serve the progress of MS research.

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Ongoing increase in incidence and prevalence of multiple sclerosis in Newcastle, Australia: A 50-year study

Abstract: Prevalence of MS in Newcastle has risen linearly and is contributed to by a substantial increase in new cases over the preceding decade. Female predominance of MS cases continues to increase with a new diagnosis three times more likely in women.

Cited by 50 publications

References 24 publications

Incidence of multiple sclerosis in the Republic of Ireland: A prospective population-based study

Incidence of multiple sclerosis in the Republic of Ireland: A prospective population-based study

Age-Period-Cohort Modeling of Multiple Sclerosis Incidence Rates in Kuwait: 1980–2014

An ‘epidemic’ of multiple sclerosis and falling infection rates? Reflecting on comparisons made and the rising multiple sclerosis incidence in Bach's 2002 New England Journal of Medicine figure

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