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Su J, Liang Y, He X. The overall and smoking-attributable burden of multiple sclerosis among older adults aged 65-89 years from 1990 to 2019 and predictions to 2040. Front Med (Lausanne) 2024; 11:1430741. [PMID: 39238595 PMCID: PMC11374621 DOI: 10.3389/fmed.2024.1430741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/13/2024] [Indexed: 09/07/2024] Open
Abstract
Background The global prevalence of aging individuals with multiple sclerosis (MS) is increasing. This study aimed to assess the burden and trends of overall and smoking-attributable MS in older adults aged 65-89 years at the global, regional, and national levels. Methods The number and rates of years of life lived with disability (YLD) and years of life lost (YLL) due to MS for older adults in 204 countries and territories from 1990 to 2019 were retrieved from the Global Burden of Disease (GBD) Study 2019. Estimated annual percentage change (EAPC) in the age-standardized YLD and YLL rates were calculated to quantify the temporal trends. The Bayesian age-period-cohort model was used to predict the trends from 2020 to 2040. Results In 2019, there were an estimated 80,040 (95% uncertainty interval 57,534 to 103,608) YLD and 139,132 (107,632 to 161,172) YLL caused by MS among older adults globally. The age-standardized YLD and YLL rates decreased by an average of -0.21% (95% CI -0.26 to -0.16) and - 0.2% (95% CI -0.26 to -0.14) per year for overall MS from 1990 to 2019, respectively. The number of YLL globally in 2019 was 7,891 (5,003 to 10,991) and 15,667 (10,833 to 20,076) due to smoking-attributable MS. The age-standardized YLD and YLL rates decreased by an annual average of -1.14% (95% CI -1.25 to -1.04) and - 1.15% (95% CI -1.27 to -1.03) for MS attributable to smoking. Although the global age-standardized rates of YLD and YLL for MS among older adults declined from 1990 to 2019, many regions showed increases. The largest increase in age-standardized YLD rate of MS was observed in East Asia (average annual change 1.62% [95% CI: 1.56 to 1.68]), while the largest increase in the age-standardized YLL rate occurred in High-income North America (1.74% [1.53 to 1.96]). Nationally, the age-standardized YLD and YLL rates for overall and smoking-attributable MS increased exponentially with increases in SDI level (all model p < 0.001). Furthermore, projections have also indicated an expected decrease in the age-standardized rates of YLD and YLL of MS in the elderly population from 2020 to 2040. Conclusion Tracking trends in MS burden among older adults provides insights into the potential shifts in disease patterns over time. The findings lay the groundwork for informed decision-making in public health and healthcare delivery, aiming to ensure that older adults with MS receive appropriate care and support.
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Affiliation(s)
- Jiao Su
- Department of Biochemistry, Changzhi Medical College, Changzhi, China
| | - Yuanhao Liang
- Clinical Experimental Center, Jiangmen Key Laboratory of Clinical Biobanks and Translational Research, Jiangmen Central Hospital, Jiangmen, China
| | - Xiaofeng He
- Institute of Evidence-Based Medicine, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
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Melmed KR, Lewis A, Kuohn L, Marmo J, Rossan-Raghunath N, Torres J, Muralidharan R, Lord AS, Ishida K, Frontera JA. Association of Neighborhood Socioeconomic Status With Withdrawal of Life-Sustaining Therapies After Intracerebral Hemorrhage. Neurology 2024; 102:e208039. [PMID: 38237088 PMCID: PMC11097759 DOI: 10.1212/wnl.0000000000208039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/07/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Mortality after intracerebral hemorrhage (ICH) is common. Neighborhood socioeconomic status (nSES) is an important social determinant of health (SDoH) that can affect clinical outcome. We hypothesize that SDoH, including nSES, contribute to differences in withdrawal of life-sustaining therapies (WLSTs) and mortality in patients with ICH. METHODS We performed a retrospective study of patients with ICH at 3 tertiary care hospitals between January 2017 and December 2022 identified through the Get with the Guidelines Database. We collected data on age, clinical severity, race/ethnicity, median household income, insurance, marital status, religion, mortality before discharge, and WLST from the electronic medical record. We assessed for associations between SDoH and WLST, mortality, and poor discharge mRS using Mann-Whitney U tests and χ2 tests. We performed multivariable analysis using backward stepwise logistic regression. RESULTS We identified 868 patients (median age 67 [interquartile range (IQR) 55-78] years; 43% female) with ICH. Of them, 16% were Black non-Hispanic, 17% were Asian, and 15% were of Hispanic ethnicity; 50% were on Medicare and 22% on Medicaid, and the median (IQR) household income was $81,857 ($58,669-$122,078). Mortality occurred in 17% of patients, and of them, 84% of patients had WLST. Patients from zip codes with higher median household incomes had higher incidence of WLST and mortality (p < 0.01). Black non-Hispanic race was associated with lower WLST and discharge mortality (p ≤ 0.01 for both). In multivariable analysis adjusting for age and clinical severity scores, patients who lived in zip codes with high-income levels were more likely to have WLST (adjusted odds ratio [aOR] 1.88; 95% CI 1.29-2.74) and mortality before discharge (aOR 1.5; 95% CI 1.06-2.13). DISCUSSION SDoH, including nSES, are associated with WLST after ICH. This has important implications for the care and management of patients with ICH.
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Affiliation(s)
- Kara R Melmed
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Ariane Lewis
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Lindsey Kuohn
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Joanna Marmo
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Nirmala Rossan-Raghunath
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Jose Torres
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Rajanandini Muralidharan
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Aaron S Lord
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Koto Ishida
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Jennifer A Frontera
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
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Giovannoni G, Ford HL, Schmierer K, Middleton R, Stennett AM, Pomeroy I, Fisniku L, Scalfari A, Bannon C, Stross R, Hughes S, Williams A, Josephs S, Peel C, Straukiene A. MS care: integrating advanced therapies and holistic management. Front Neurol 2024; 14:1286122. [PMID: 38351950 PMCID: PMC10862341 DOI: 10.3389/fneur.2023.1286122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/23/2023] [Indexed: 02/16/2024] Open
Abstract
Lifestyle and environmental factors are key determinants in disease causality and progression in neurological conditions, including multiple sclerosis (MS). Lack of exercise, poor diet, tobacco smoking, excessive alcohol intake, social determinants of health, concomitant medications, poor sleep and comorbidities can exacerbate MS pathological processes by impacting brain health and depleting neurological reserves, resulting in more rapid disease worsening. In addition to using disease-modifying therapies to alter the disease course, therapeutic strategies in MS should aim to preserve as much neurological reserve as possible by promoting the adoption of a "brain-healthy" and "metabolically-healthy" lifestyle. Here, we recommend self-regulated lifestyle modifications that have the potential to improve brain health, directly impact on disease progression and improve outcomes in people with MS. We emphasise the importance of self-management and adopting a multidisciplinary, collaborative and person-centred approach to care that encompasses the healthcare team, family members and community support groups.
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Affiliation(s)
- Gavin Giovannoni
- Centre for Neuroscience, Surgery and Trauma, Faculty of Medicine and Dentistry, The Blizard Institute, Queen Mary University of London, London, United Kingdom
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Helen L. Ford
- Leeds Teaching Hospitals, University of Leeds, Leeds, United Kingdom
| | - Klaus Schmierer
- Centre for Neuroscience, Surgery and Trauma, Faculty of Medicine and Dentistry, The Blizard Institute, Queen Mary University of London, London, United Kingdom
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Rod Middleton
- Disease Registers & Data Research in Health Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Andrea M. Stennett
- Centre for Neuroscience, Surgery and Trauma, Faculty of Medicine and Dentistry, The Blizard Institute, Queen Mary University of London, London, United Kingdom
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Ian Pomeroy
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Department of Neurology, University of Liverpool, Liverpool, United Kingdom
| | - Leonora Fisniku
- Department of Neurosciences (Addenbrooke’s), Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Antonio Scalfari
- Centre of Neuroscience, Department of Medicine, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | | | - Ruth Stross
- Neurology Academy, Sheffield, United Kingdom
- Kingston Hospitals NHS Foundation Trust, Surrey, United Kingdom
| | - Sarah Hughes
- Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom
| | - Adam Williams
- Devon Partnership NHS Trust, Paignton, United Kingdom
| | | | | | - Agne Straukiene
- Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom
- University of Plymouth, Plymouth, United Kingdom
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Cruz Rivera S, Aiyegbusi OL, Piani Meier D, Dunne A, Harlow DE, Henke C, Kamudoni P, Calvert MJ. The effect of disease modifying therapies on fatigue in multiple sclerosis. Mult Scler Relat Disord 2023; 79:105065. [PMID: 37839365 DOI: 10.1016/j.msard.2023.105065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Fatigue is one of the most common and debilitating symptoms in people with multiple sclerosis (PwMS). Disease-modifying therapies (DMTs) are currently the gold standard in the treatment of MS and their effectiveness has been assessed through randomized clinical trials (RCTs). However, there is limited evidence on the impact of DMTs on fatigue in (PwMS). We conducted a systematic review to 1) understand whether fatigue is included as an outcome in MS trials of DMTs; 2) determine the effects on fatigue of treating MS with DMTs and 3) assess the quality of MS trials including fatigue as an outcome. METHODS Two independent researchers systematically searched MEDLINE, EMBASE and ClinicalTrials.gov from 1993 to January 2023 for RCTs that measured fatigue as an outcome. Adherence to reporting standards was assessed with the Consolidated Standards of Reporting Trials (CONSORT)-Patient-Reported Outcomes (PRO), while the risk of bias (RoB) was assessed with the RoB 2 tool by the Cochrane Handbook for Systematic Reviews of Interventions. The systematic review protocol was registered in PROSPERO (CRD42022383321). RESULTS The search strategy identified 130 RCTs of DMTs of which 7 (5%) assessed fatigue as an outcome. Of the 7 trials, only two presented statistically significant results. In addition, the reporting of fatigue among RCTs was suboptimal with a mean adherence to the CONSORT-PRO Statement of 36% across all trials. Of the 7 trials included, four were assessed as 'high' RoB.. CONCLUSIONS Fatigue has a major impact on PwMS yet there is limited trial-based evidence on the impact of DMTs on fatigue. Assessment of fatigue as an outcome is underrepresented in trials of DMTs and the reporting of PRO trial data is suboptimal. Thus, it is imperative that MS researchers conduct RCTs that include fatigue as an outcome, to support clinicians and people with MS (PwMS) to consider the impact of the different DMTs on fatigue.
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Affiliation(s)
- Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, UK
| | | | | | | | | | | | - Melanie J Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, UK; UK SPINE, University of Birmingham, Birmingham, UK; Health Data Research, Birmingham, UK
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