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Vitturi BK, Rahmani A, Dini G, Montecucco A, Debarbieri N, Bandiera P, Battaglia MA, Manacorda T, Persechino B, Buresti G, Ponzio M, Inglese M, Durando P. Spatial and temporal distribution of the prevalence of unemployment and early retirement in people with multiple sclerosis: A systematic review with meta-analysis. PLoS One 2022; 17:e0272156. [PMID: 35901070 PMCID: PMC9333213 DOI: 10.1371/journal.pone.0272156] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background We aimed to summarise the prevalence of unemployment and early retirement among people with MS and analyze data according to a spatio-temporal perspective. Methods We undertook a systematic search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect, and Web of Science. We included any peer-reviewed original article reporting the prevalence of unemployment and early retirement in the working-age population with MS. We excluded articles off-topic, with other study designs, whose study sample were unlikely to be representative of the MS population and in case of unavailability of the full text or essential information. A random-effects meta-analysis was used to measure overall prevalence estimates of unemployment and early retirement. We used meta-regression and subgroup analysis to evaluate potential moderators of prevalence estimates and the leave-one-out method for sensitivity analyses. Results Our research identified 153 studies across 29 countries encompassing 188436 subjects with MS. The pooled overall effect size for unemployment and early retirement was 35.6% (95% CI 32.8–38.4; I2 = 99.31) and 17.2% (95% CI 14.6–20.2; I2 = 99.13), respectively. The prevalence of unemployment varied according to the year of publication (p < 0.001) and there was a statistically significant decrease in the prevalence of unemployment over time (p = 0.042). Regarding early retirement, only seven (31.8%) estimates obtained from studies that were published before 2010 were below the overall effect size in comparison to 27 (60.0%) estimates extracted from data published between 2010 and 2021 (p = 0.039). There was a significant difference in prevalence according to countries (p < 0.001). Psychiatric illness was an important clinical feature responsible for patients leaving the workforce in regions with a high MS prevalence. Conclusions Unemployment and early retirement due to MS remain highly prevalent, despite a slight decline in the last decade. The prevalence of unemployment and early retirement varies globally.
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Affiliation(s)
| | - Alborz Rahmani
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Nicoletta Debarbieri
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Science, University of Siena, Siena, Italy
| | - Tommaso Manacorda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | | | | | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
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Vitturi BK, Rahmani A, Dini G, Montecucco A, Debarbieri N, Sbragia E, Bandiera P, Ponzio M, Battaglia MA, Manacorda T, Persechino B, Buresti G, Inglese M, Durando P. Occupational outcomes of people with multiple sclerosis: a scoping review. BMJ Open 2022; 12:e058948. [PMID: 35777874 PMCID: PMC9252209 DOI: 10.1136/bmjopen-2021-058948] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To update the knowledge on the occupational outcomes associated with multiple sclerosis (MS), systematically examine the extent, scope and nature of the pre-existing literature and identify research gaps in the existing literature. DESIGN Scoping review. DATA SOURCES A comprehensive database search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect and Web of Science was performed. There were no time limits. ELIGIBILITY CRITERIA We included any peer-reviewed original article reporting the occupational outcomes of people with MS between the ages of 18 and 65 years. We excluded those off-topic and with insufficient information. METHODS This review was conducted following the Joanna Briggs Institute recommendations and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping review checklist. Screening, reading of full-texts and data extraction was performed in a standardised way by expert reviewers from 14 July 2021 to 31 October 2021. We provided a narrative synthesis and an overview of findings. RESULTS The initial systematic search yielded 104 228 results. After removing duplicates and applying the exclusion criteria, 403 articles were included in the review. In total, the studies evaluated 492 062 subjects with MS. One hundred fifty-four (38.2%) articles were published in the last 5 years, mostly from Europe and North America (50.9% and 33.0%, respectively). Concerning the occupational outcomes, studies mostly addressed unemployment (311, 77.2%), early retirement (120, 29.8%), disability pension (117, 29.0%), sick leave (77, 19.1%), the indirect cost of MS (74, 18.4%) and work characteristics (57, 14.1%). The results were categorised into seven subtopics: 'Changes in work and occupational status due to MS', 'work-related socio-economic consequences of MS', 'risk factors for unfavourable occupational outcomes', 'reported barriers to employment', 'reported job accommodations and vocational rehabilitation strategies', 'job satisfaction, stigma, and disclosing the diagnosis in the workplace' and 'rating clinical scales'. CONCLUSIONS There are several issues that deserve further in-depth study by the scientific community in order to improve the occupational outcomes of people with MS.
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Affiliation(s)
| | - Alborz Rahmani
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Nicoletta Debarbieri
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elvira Sbragia
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | - Michela Ponzio
- Research Area, Italian Multiple Sclerosis Association, Genoa, Italy
| | - Mario Alberto Battaglia
- Research Area, Italian Multiple Sclerosis Association, Genoa, Italy
- Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
- Department of Life Science, University of Siena, Siena, Italy
| | | | | | | | - Matilde Inglese
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Hashtarkhani S, Tabatabaei-Jafari H, Kiani B, Furst M, Salvador-Carulla L, Bagheri N. Use of geographical information systems in multiple sclerosis research: A systematic scoping review. Mult Scler Relat Disord 2021; 51:102909. [PMID: 33813094 DOI: 10.1016/j.msard.2021.102909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/06/2021] [Accepted: 03/14/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Geographical information system (GIS) and spatial analysis have an emerging role in the understanding and management of health-related outcomes. However, there is a knowledge gap about the extent to which GIS has supported multiple Sclerosis (MS) research. Therefore, this review aimed to explore the types of GIS applications and the complexity of their visualisation in MS research. METHODS A systematic scoping review was conducted based on York's five-stage framework. PubMed, Scopus and Web of Science were searched for relevant studies published between 2000 and 2020 using a comprehensive search strategy based on the main concepts related to GIS and MS. Grounded, inductive analysis was conducted to organize studies into meaningful application areas. Further, we developed a tool to assess the visualisation complexity of the selected papers. RESULTS Of 3,723 identified unique citations, 42 papers met our inclusion criteria for the final review. One or more of the following types of GIS applications were reported by these studies: (a) thematic mapping (37 papers); (b) spatial cluster detection (16 papers); (c) risk factors detection (16 papers); and (d) health access and planning (two papers). In the majority of studies (88%), the score of visualisation complexity was relatively low: three or less from the range of zero to six. CONCLUSIONS Although the number of studies using GIS techniques has dramatically increased in the last decade, the use of GIS in the areas of MS access and planning is still under-researched. Additionally, the capacity of GIS in visualising complex nature of MS care system is not yet fully investigated.
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Affiliation(s)
- Soheil Hashtarkhani
- Center for Mental Health Research College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia; Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Tabatabaei-Jafari
- Center for Mental Health Research College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Behzad Kiani
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - MaryAnne Furst
- Center for Mental Health Research College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Luis Salvador-Carulla
- Center for Mental Health Research College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nasser Bagheri
- Center for Mental Health Research College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia.
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Bergamaschi R, Monti MC, Trivelli L, Mallucci G, Gerosa L, Pisoni E, Montomoli C. PM 2.5 exposure as a risk factor for multiple sclerosis. An ecological study with a Bayesian mapping approach. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:2804-2809. [PMID: 32894443 PMCID: PMC7788018 DOI: 10.1007/s11356-020-10595-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
Some environmental factors are associated with an increased risk of multiple sclerosis (MS). Air pollution could be a main one. This study was conducted to investigate the association of particulate matter 2.5 (PM2.5) concentrations with MS prevalence in the province of Pavia, Italy. The overall MS prevalence in the province of Pavia is 169.4 per 100,000 inhabitants. Spatial ground-level PM2.5 gridded data were analysed, by municipality, for the period 2010-2016. Municipalities were grouped by tertiles according to PM2.5 concentration. Ecological regression and Bayesian statistics were used to analyse the association between PM2.5 concentrations, degree of urbanization, deprivation index and MS risk. MS risk was higher among persons living in areas with an average winter PM2.5 concentration above the European annual limit value (25 μg/m3). The Bayesian map revealed sizeable MS high-risk clusters. The study found a relationship between low MS risk and lower PM2.5 levels, strengthening the suggestion that air pollution may be one of the environmental risk factors for MS.
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Affiliation(s)
- Roberto Bergamaschi
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, via Mondino 2, 27100, Pavia, Italy
| | - Maria Cristina Monti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Leonardo Trivelli
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Giulia Mallucci
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, via Mondino 2, 27100, Pavia, Italy.
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
| | - Leonardo Gerosa
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, via Mondino 2, 27100, Pavia, Italy
| | - Enrico Pisoni
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Cristina Montomoli
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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Bergamaschi R, Monti MC, Trivelli L, Introcaso VP, Mallucci G, Borrelli P, Gerosa L, Montomoli C. Increased prevalence of multiple sclerosis and clusters of different disease risk in Northern Italy. Neurol Sci 2019; 41:1089-1095. [PMID: 31872352 DOI: 10.1007/s10072-019-04205-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/17/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The increasing multiple sclerosis (MS) prevalence is varying across the macroscopic regional areas. Only few studies have explored the microscopic geographic variation of MS prevalence, which could highlight MS spatial clusters. OBJECTIVE In this ecological study, we aimed to estimate 2016 MS prevalence in the province of Pavia (Northern Italy) and to describe MS risk geographical variation across small area units, compared to the year 2000. METHODS Bayesian models were fit to estimate area-specific MS relative risks. The mean of the posterior marginal distribution of relative risks differences for each area were used to describe the risk variation. RESULTS The 2016 overall prevalence was 169.4 per 100,000 inhabitants (95% CI 158.8-180.6). The Bayesian mapping of MS showed some clusters of higher and lower disease prevalence. Furthermore, several municipalities located in the north part of the province were more at risk with respect to the year 2000. CONCLUSIONS The current MS prevalence sets the province of Pavia among high-risk areas and, compared with the previous prevalence estimate (86 per 100,000 in year 2000), indicates an increased MS risk. The Bayesian mapping highlighted area with a significantly higher/lower MS risk where to investigate etiologic hypotheses based on environmental and genetic exposures.
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Affiliation(s)
- Roberto Bergamaschi
- Multiple Sclerosis Center, IRCCS Mondino Foundation, via Mondino 2, 27100, Pavia, Italy
| | - Maria Cristina Monti
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Leonardo Trivelli
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | | | - Giulia Mallucci
- Multiple Sclerosis Center, IRCCS Mondino Foundation, via Mondino 2, 27100, Pavia, Italy.
| | - Paola Borrelli
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Leonardo Gerosa
- Multiple Sclerosis Center, IRCCS Mondino Foundation, via Mondino 2, 27100, Pavia, Italy
| | - Cristina Montomoli
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
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McDonald JJ, Weller B, O'Neil M, Waters C, O'Riordan J. Latitudinal variation in MS incidence in Scotland. Mult Scler Relat Disord 2019; 32:116-122. [DOI: 10.1016/j.msard.2019.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/18/2019] [Accepted: 04/26/2019] [Indexed: 12/19/2022]
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7
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Disease mapping of tuberculosis prevalence in Eastern Cape Province, South Africa. J Public Health (Oxf) 2019. [DOI: 10.1007/s10389-018-0931-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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8
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Bezzini D, Pepe P, Profili F, Meucci G, Ulivelli M, Bartalini S, Battaglia MA, Francesconi P. Multiple sclerosis spatial cluster in Tuscany. Neurol Sci 2017; 38:2183-2187. [DOI: 10.1007/s10072-017-3120-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/07/2017] [Indexed: 11/24/2022]
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9
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Estimated prevalence of multiple sclerosis in Italy in 2015. Neurol Sci 2016; 38:473-479. [PMID: 28040843 DOI: 10.1007/s10072-016-2801-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
Italy is a high risk area for multiple sclerosis (MS) as confirmed by the numerous prevalence and incidence studies conducted in several regions/districts of the country. Nevertheless, there are no recent published epidemiological data, nor studies about the total prevalence of MS in Italy. Our aim was to update as of 2015 the prevalence rates of MS in different geographical areas using already published epidemiological studies, and to estimate the overall prevalence of the disease in Italy. We made a search in MEDLINE database of all published studies on epidemiology of MS in Italy. Then, we applied, to the already published prevalence data, the last published incidence and mortality rates to recalculate, as of 2015, the prevalence of MS. So, we calculated the mean prevalence rate from our extrapolations, and we applied it to the population in 2015 to estimate the number of MS patients in Italy. Our prevalence extrapolations ranged from 122 to 232 cases/100,000 in the mainland and Sicily, with an average of 176/100,000, and from 280 to 317 cases/100,000 in Sardinia with an average of 299/100,000. Applying these media to the Italian population in 2015, we obtained an estimate of more than 109,000 MS patients in Italy. Our estimates were higher than the latest published rates but consistent with the annual increase of prevalence due to incidence that exceeds mortality, with the increase of survival and, maybe, with the probable increase of incidence.
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Bargagli AM, Colais P, Agabiti N, Mayer F, Buttari F, Centonze D, Di Folco M, Filippini G, Francia A, Galgani S, Gasperini C, Giuliani M, Mirabella M, Nociti V, Pozzilli C, Davoli M. Prevalence of multiple sclerosis in the Lazio region, Italy: use of an algorithm based on health information systems. J Neurol 2016; 263:751-9. [PMID: 26886201 PMCID: PMC4826660 DOI: 10.1007/s00415-016-8049-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 11/22/2022]
Abstract
Compared with other areas of the country, very limited data are available on multiple sclerosis (MS) prevalence in Central Italy. We aimed to estimate MS prevalence in the Lazio region and its geographical distribution using regional health information systems (HIS). To identify MS cases we used data from drug prescription, hospital discharge and ticket exemption registries. Crude, age- and gender-specific prevalence estimates on December 31, 2011 were calculated. To compare MS prevalence between different areas within the region, we calculated age- and gender-adjusted prevalence and prevalence ratios using a multivariate Poisson regression model. Crude prevalence rate was 130.5/100,000 (95 % CI 127.5–133.5): 89.7/100,000 for males and 167.9/100,000 for females. The overall prevalence rate standardized to the European Standard Population was 119.6/100,000 (95 % CI 116.8–122.4). We observed significant differences in MS prevalence within the region, with estimates ranging from 96.3 (95 % CI 86.4–107.3) for Latina to 169.6 (95 % CI 147.6–194.9) for Rieti. Most districts close to the coast showed lower prevalence estimates compared to those situated in the eastern mountainous area of the region. In conclusion, this study produced a MS prevalence estimate at regional level using population-based health administrative databases. Our results showed the Lazio region is a high-risk area for MS, although with an uneven geographical distribution. While some limitations must be considered including possible prevalence underestimation, HIS represent a valuable source of information to measure the burden of SM, useful for epidemiological surveillance and healthcare planning.
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Affiliation(s)
- Anna Maria Bargagli
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy
| | - Paola Colais
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy.
| | - Flavia Mayer
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy
| | - Fabio Buttari
- MS Clinical and Research Center, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Via Atinense 18, 86077, Pozzilli, Isernia, Italy
| | - Diego Centonze
- MS Clinical and Research Center, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Via Atinense 18, 86077, Pozzilli, Isernia, Italy
| | - Marta Di Folco
- Department of Neurology and Psychiatry, Sapienza University, Viale Dell'Università 30, 00185, Rome, Italy
| | - Graziella Filippini
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Besta, Via Celoria 11, 20133, Milan, Italy
| | - Ada Francia
- Department of Neurology and Psychiatry, Sapienza University, Viale Dell'Università 30, 00185, Rome, Italy
| | - Simonetta Galgani
- Department of Neurosciences, S Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Claudio Gasperini
- Department of Neurosciences, S Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Manuela Giuliani
- Multiple Sclerosis Center, S Andrea Hospital, Sapienza University, Via di Grottarossa 1037, 00189, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Viviana Nociti
- Multiple Sclerosis Center, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Institute of Neurorehabilitation, Don C Gnocchi Foundation, Via Pier Alessandro Paravia 71, 20148, Milan, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, S Andrea Hospital, Sapienza University, Via di Grottarossa 1037, 00189, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy
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Torabi M, Green C, Yu N, Marrie RA. Application of Three Focused Cluster Detection Methods to Study Geographic Variation in the Incidence of Multiple Sclerosis in Manitoba, Canada. Neuroepidemiology 2014; 43:38-48. [DOI: 10.1159/000365761] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 07/07/2014] [Indexed: 11/19/2022] Open
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12
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Detection of clinical relapses in multiple sclerosis cohorts: construction and validation of a model based on administrative data. Neurol Sci 2014; 35:265-9. [DOI: 10.1007/s10072-013-1503-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/03/2013] [Indexed: 11/27/2022]
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13
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Marrie RA, Gryba C. The incidence and prevalence of neuromyelitis optica: a systematic review. Int J MS Care 2014; 15:113-8. [PMID: 24453773 DOI: 10.7224/1537-2073.2012-048] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Interest in neuromyelitis optica (NMO) has increased substantially over the last few years, but it is not known whether NMO has the same geographic and temporal variations in disease risk as multiple sclerosis (MS). We aimed to evaluate the worldwide incidence and prevalence of NMO through a systematic review of published peer-reviewed studies. We performed a search of the English-language literature using MEDLINE and EMBASE from January 1985 to March 2012. Search terms included "neuromyelitis optica," "Devic's," "opticospinal," "incidence," "prevalence," and "epidemiology." We assessed study quality using a standardized instrument. A total of five studies met the inclusion criteria. Three of the studies were from North America, and all studies were published between 2005 and 2012. All studies were of good quality, but only one study reported standardized rates, and subgroup-specific estimates were rarely reported. The incidence of NMO per 100,000 population ranged from 0.053 to 0.40, while the prevalence per 100,000 population ranged from 0.52 to 4.4. Heterogeneity was high among the incidence (I(2) = 68.0%) and prevalence studies (I(2) = 94.0%). This review highlights the limited knowledge regarding the epidemiology of NMO and the importance of obtaining estimates standardized to common populations to enhance comparability of studies from different jurisdictions. Future studies would also benefit from reporting age-, sex-, and race- or ethnicity-specific estimates.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine (RAM, CG) and the Department of Community Health Sciences (RAM), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Caroline Gryba
- Department of Internal Medicine (RAM, CG) and the Department of Community Health Sciences (RAM), University of Manitoba, Winnipeg, Manitoba, Canada
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14
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Puthenparampil M, Seppi D, Rinaldi F, Federle L, Calabrese M, Perini P, Gallo P. Increased incidence of multiple sclerosis in the Veneto region, Italy. Mult Scler 2013; 19:601-4. [PMID: 23599184 DOI: 10.1177/1352458512461970] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To what extent the progressive increase in the incidence of multiple sclerosis (MS) observed in the province of Padova over the period 1970-1999 was an expression of a real increased risk of developing MS remained unclear. OBJECTIVE The objective of this paper is to update the epidemiological figures of MS and probe whether the risk of having MS has increased in the province of Padova during the decade 2000-2009. METHODS All patients born in Italy and having a diagnosis of MS or possible MS identified through analysis of all available sources of information were included in the study. The incidence and prevalence rates between 2000 and 2009 were obtained and compared with our previously published data. RESULTS On 31 December 2009, the overall prevalence was 139.5/100,000, 192.0 ± 9.5 for females and 83.9 ± 6.3 for males. During the decade 2000-2009, the overall incidence rate of MS was 5.5 ± 0.5, 7.4 ± 0.8 for females and 3.5 ± 0.6 for males. The onset-diagnosis delay, the female/male ratio and the mean age at onset did not significantly change compared to the prior period of observation. CONCLUSION Our findings support the hypothesis of a real increased risk of developing MS in the province of Padova. Moreover, the actual prevalence of 1.4/1000 makes our region a high-risk geographical area for MS. The role played by exogenous factors in determining susceptibility to MS needs to be thoroughly investigated.
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Affiliation(s)
- M Puthenparampil
- The Multiple Sclerosis Centre of the Veneto Region, First Neurology Clinic, Department of Neurosciences, University Hospital of Padova, Italy
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Green C, Yu BN, Marrie RA. Exploring the implications of small-area variation in the incidence of multiple sclerosis. Am J Epidemiol 2013; 178:1059-66. [PMID: 23897644 DOI: 10.1093/aje/kwt092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
In this study, we describe the geospatial variation in the incidence of multiple sclerosis (MS) in Manitoba, Canada, and the sociodemographic characteristics associated with MS incidence. By using administrative health data, we identified all incident cases of MS in Manitoba from 1990 to 2006 (n = 2,290) and geocoded them to 230 neighborhoods in the City of Winnipeg and 268 municipalities in rural Manitoba. Age-standardized incidence rates for 1990-2006 (combined) were calculated for each region. By using the spatial scan statistic, we identified high-rate clusters in southwestern (incidence rate ratio (IRR) = 1.48) and central Winnipeg (IRR = 1.54) and low-rate clusters in north-central Winnipeg (IRR = 0.52) and northern Manitoba (IRR = 0.48). Multivariable Poisson regression showed a positive association between MS incidence rates and socioeconomic status. Despite our finding that MS incidence varied geographically and by socioeconomic status, the low Gini coefficient of 0.152 for MS incidence identified in this study suggests that the causes of MS are pervasive across all population groups. Searching for local-level causes of the disease may therefore not be as productive as investigating etiological factors operating at the population level. This may require an examination of macro-level differences in environmental exposures between high- and low-incidence regions of the world.
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Incidence and prevalence of multiple sclerosis in Europe: a systematic review. BMC Neurol 2013; 13:128. [PMID: 24070256 PMCID: PMC3856596 DOI: 10.1186/1471-2377-13-128] [Citation(s) in RCA: 317] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common cause of neurological disability in young adults worldwide and approximately half of those affected are in Europe. The assessment of differential incidence and prevalence across populations can reveal spatial, temporal and demographic patterns which are important for identifying genetic and environmental factors contributing to MS. However, study methodologies vary and the quality of the methods can influence the estimates. This study aimed to systematically review European studies of incidence and prevalence of MS and to provide a quantitative assessment of their methodological quality. METHODS A comprehensive literature search was performed to obtain all original population-based studies of MS incidence and prevalence in European populations conducted and published between January 1985 and January 2011. Only peer-reviewed full-text articles published in English or French were included. All abstracts were screened for eligibility and two trained reviewers abstracted the data and graded the quality of each study using a tool specifically designed for this study. RESULTS There were 123 studies that met the inclusion criteria. The study estimates were highly heterogeneous, even within regions or countries. Quality was generally higher in the more recent studies, which also tended to use current diagnostic criteria. Prevalence and incidence estimates tended to be higher in the more recent studies and were higher in the Nordic countries and in northern regions of the British Isles. With rare exceptions, prevalence and incidence estimates were higher in women with ratios as high as 3:1. Few studies examined ethnicity. Epidemiological data at the national level was uncommon and there were marked geographical disparities in available data, with large areas of Europe unrepresented and other regions well-represented in the literature. Only 37% of the studies provided standardized estimates. CONCLUSIONS Despite the breadth of the literature on the epidemiology of MS in Europe, inter-study comparisons are hampered by the lack of standardization. Further research should focus on regions not yet studied and the evaluation of ethnic differences in MS prevalence and incidence. National-level studies using current diagnostic criteria, validated case definitions and similar age- and sex-standardization would allow better geographical comparisons.
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Gajofatto A, Stefani A, Turatti M, Bianchi MR, Lira MG, Moretto G, Salviati A, Benedetti MD. Prevalence of multiple sclerosis in Verona, Italy: an epidemiological and genetic study. Eur J Neurol 2012; 20:697-703. [DOI: 10.1111/ene.12045] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 10/17/2012] [Indexed: 11/29/2022]
Affiliation(s)
- A. Gajofatto
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences; University of Verona; Verona Italy
| | - A. Stefani
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences; University of Verona; Verona Italy
| | - M. Turatti
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences; University of Verona; Verona Italy
| | - M. R. Bianchi
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences; University of Verona; Verona Italy
| | - M. G. Lira
- Department of Life and Reproduction Sciences; University of Verona; Verona Italy
| | - G. Moretto
- UOC Neurologia dO; Azienda Ospedaliera Universitaria Integrata Verona; Verona Italy
| | - A. Salviati
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences; University of Verona; Verona Italy
| | - M. D. Benedetti
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences; University of Verona; Verona Italy
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Montomoli C, Citterio A, Piccolo G, Cioccale R, Ferretti VV, Fratti C, Bergamaschi R, Cosi VE. Epidemiology and geographical variation of myasthenia gravis in the province of Pavia, Italy. Neuroepidemiology 2012; 38:100-5. [PMID: 22377708 DOI: 10.1159/000336002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 12/12/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Previous studies have reported a prevalence estimate of myasthenia gravis (MG) from 7.7 to 11.1 per 100,000 inhabitants in Europe. Moreover, the study of the geographical distribution of MG should be useful to generate specific hypotheses. The aims are to estimate MG prevalence and to investigate its geographical variation in a delimited area in Northern Italy. METHODS The primary source of data was the MG database of the Neurological Institute of Pavia and all other sources of case collection in and outside the province. We adopted a Bayesian approach to analyze MG geographical variation within the finest geographical grid. RESULTS We identified 119 live MG prevalent cases resident in the province of Pavia on December 31, 2008. The overall crude prevalence was 24 per 100,000 inhabitants. The Bayesian analysis identified a small cluster of higher MG prevalence in the northern area of the province. CONCLUSIONS The estimated MG prevalence sets the province of Pavia among the high-risk areas. The identification of high/low MG risk areas deserves further investigation of genetic and environmental factors possibly related to a major risk of the disease in that area.
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Poulos RG, Chong SSS, Olivier J, Jalaludin B. Geospatial analyses to prioritize public health interventions: a case study of pedestrian and pedal cycle injuries in New South Wales, Australia. Int J Public Health 2012; 57:467-75. [DOI: 10.1007/s00038-012-0331-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 10/28/2011] [Accepted: 01/05/2012] [Indexed: 10/14/2022] Open
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Abstract
BACKGROUND Multiple sclerosis (MS) is a disease with purported environmental causes. Consistent correlations have been found in various settings for latitude, smoking exposure, sunlight, and vitamin D deficiency. We analysed the contribution of various environmental factors to the risk of developing MS from a population perspective. METHODS We collated global data of MS prevalence from 54 studies over the previous ten years and calculated the degree of risk contributed by latitude, longitude, ultraviolet radiation (from NASA satellite data and formulae for available sunlight hours), population smoking rates (from WHO data), gender, study date, study demographics, and several socioeconomic factors. We report a very significant negative correlation between MS prevalence and available ultraviolet (UV) radiation. RESULTS The lack of available UV radiation outweighs other factors by at least 20 fold (p < 10⁻⁸) from single variate regression analysis. Multiple regression analysis revealed that latitude and longitude are also significant factors; smoking may also provide a very minimal role. The eight prevalence studies from Scandinavia produced prevalences that were lower than expected, given their global geospatial positioning. CONCLUSIONS The available ultraviolet radiation is a significant environmental factor, more so than all the other factors examined.
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Abstract
Multiple sclerosis (MS) is a progressive demyelinating and degenerative disease of the CNS with symptoms dependent on the type of the disease and the site of lesions. During the progression of the disease, symptoms become more permanent and progressive disability ensues. MS is a disease characterized by wide variations between patients, thus making categorization difficult. The aim of the current study was to review the existing epidemiological data of MS in Europe published during the last decade (2000-2009), using PubMed. Findings revealed an increasing incidence of MS during the last decade. Recent data indicate that latitude does not play a key role in determining the onset of the disease. MS has a significant impact on the quality of life for most patients over many years. The disease is twice as common in women than in men, and is at its peak in the most economically productive years of life. Pregnancy, postpartum status and vaccines may influence the onset and the course of the disease. Only one of the reviewed papers provides a view of progression from onset to death.
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Affiliation(s)
- Ephrosyni Koutsouraki
- First Department of Neurology, AHEPA Hospital, School of Medicine, Aristotelian University, Thessaloniki 54621, Greece.
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Koch-Henriksen N, Sørensen PS. The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol 2010; 9:520-32. [PMID: 20398859 DOI: 10.1016/s1474-4422(10)70064-8] [Citation(s) in RCA: 751] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The uneven distribution of multiple sclerosis (MS) across populations can be attributed to differences in genes and the environment and their interaction. Prevalence and incidence surveys could be affected by inaccuracy of diagnosis and ascertainment, and prevalence also depends on survival. These sources of error might play a part in the geographical and temporal variations. Our literature search and meta-regression analyses indicated an almost universal increase in prevalence and incidence of MS over time; they challenge the well accepted theory of a latitudinal gradient of incidence of MS in Europe and North America, while this gradient is still apparent for Australia and New Zealand; and suggest a general, although not ubiquitous, increase in incidence of MS in females. The latter observation should prompt epidemiological studies to focus on changes in lifestyle in females. New insights into gene-environment and gene-gene interactions complicate interpretations of demographic epidemiology and have made obsolete the idea of simple causative associations between genes or the environment and MS.
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Affiliation(s)
- Nils Koch-Henriksen
- Department of Neurology, Aarhus University Hospital in Aalborg, Aalborg, Denmark.
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Randremanana RV, Richard V, Rakotomanana F, Sabatier P, Bicout DJ. Bayesian mapping of pulmonary tuberculosis in Antananarivo, Madagascar. BMC Infect Dis 2010; 10:21. [PMID: 20137083 PMCID: PMC2829568 DOI: 10.1186/1471-2334-10-21] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 02/05/2010] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB), an infectious disease caused by the Mycobacterium tuberculosis is endemic in Madagascar. The capital, Antananarivo is the most seriously affected area. TB had a non-random spatial distribution in this setting, with clustering in the poorer areas. The aim of this study was to explore this pattern further by a Bayesian approach, and to measure the associations between the spatial variation of TB risk and national control program indicators for all neighbourhoods. Methods Combination of a Bayesian approach and a generalized linear mixed model (GLMM) was developed to produce smooth risk maps of TB and to model relationships between TB new cases and national TB control program indicators. The TB new cases were collected from records of the 16 Tuberculosis Diagnostic and Treatment Centres (DTC) of the city from 2004 to 2006. And five TB indicators were considered in the analysis: number of cases undergoing retreatment, number of patients with treatment failure and those suffering relapse after the completion of treatment, number of households with more than one case, number of patients lost to follow-up, and proximity to a DTC. Results In Antananarivo, 43.23% of the neighbourhoods had a standardized incidence ratio (SIR) above 1, of which 19.28% with a TB risk significantly higher than the average. Identified high TB risk areas were clustered and the distribution of TB was found to be associated mainly with the number of patients lost to follow-up (SIR: 1.10, CI 95%: 1.02-1.19) and the number of households with more than one case (SIR: 1.13, CI 95%: 1.03-1.24). Conclusion The spatial pattern of TB in Antananarivo and the contribution of national control program indicators to this pattern highlight the importance of the data recorded in the TB registry and the use of spatial approaches for assessing the epidemiological situation for TB. Including these variables into the model increases the reproducibility, as these data are already available for individual DTCs. These findings may also be useful for guiding decisions related to disease control strategies.
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Affiliation(s)
- Rindra V Randremanana
- Unité Epidémiologie, Institut Pasteur de Madagascar, BP 1274, Antananarivo (101), Madagascar.
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