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Bezzini D, Kundisova L, Gori F, Martini A, Giovannetti L, Stoppa G, Chellini E, Ulivelli M, Nante N, Messina G, Battaglia MA. Mortality trend for multiple sclerosis in Italy during the period 1980-2015. Mult Scler Relat Disord 2020; 44:102240. [PMID: 32512288 DOI: 10.1016/j.msard.2020.102240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The epidemiology of Multiple Sclerosis (MS) is relevant for health-services planning. Most of MS prevalence and incidence studies in Italy referred to specific geographical areas and periods, whereas mortality data are routinely collected at the national level. The aim was to assess MS mortality trend and geographical differences in Italy from 1980 to 2015. METHODS Mortality data were provided by the Italian Institute of Statistics. Due to a low number of annual deaths, mortality data were analysed for both the entire period under study and for sub-periods. Temporal trends were first evaluated using age-adjusted mortality rates (AMRs) comparing each sub-period with the initial one. Then, the annual percent change in mortality was estimated through the joinpoint regression model. Spatial differences between 5 main geographical areas were evaluated using standardized mortality ratios (SMRs). RESULTS During the study period, 4,959 deaths for males and 7,434 for females were observed. The higher overall AMR was observed for females (F:0.71 vs. M: 0.56 per 100,000 persons per year). Analysing mortality by gender and geographical area, SMRs 〈 100 were observed in South Italy for both sexes, and in Central Italy for males only, whereas SMRs 〉 100 for Islands for both sexes, and in North-East and North-West for females only. The analysis of the mortality trend through AMRs calculated for sub-periods revealed no difference between the first and the last period for males, whereas a significant increase in mortality was observed for females. The joinpoint regression analysis showed a significant decrease in mortality up to 1995 for males (APC -3.23%) and up to 1999 for females, (APC -1.01%), followed by a significant increase for both sexes, but more marked for females (APC +1.9% M, +2.34% F). CONCLUSION The increasing trend of mortality for MS, especially for females, may reflect the increase in the prevalence of MS and the improvement in the quality of diagnosis or coding of the cause of death.
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Affiliation(s)
- Daiana Bezzini
- Department of Life Sciences, University of Siena, Siena, Italy.
| | - Lucia Kundisova
- Post Graduate School of Public Health, University of Siena, Siena, Italy.
| | - Francesco Gori
- Post Graduate School of Public Health, University of Siena, Siena, Italy.
| | - Andrea Martini
- Institute for Study, Prevention and Cancer Network, Florence, Italy.
| | - Lucia Giovannetti
- Institute for Study, Prevention and Cancer Network, Florence, Italy.
| | - Giorgia Stoppa
- Department of Statistics, Informatics, Applications, University of Florence, Florence, Italy.
| | | | - Monica Ulivelli
- Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy.
| | - Nicola Nante
- Post Graduate School of Public Health, University of Siena, Siena, Italy; Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
| | - Gabriele Messina
- Post Graduate School of Public Health, University of Siena, Siena, Italy; Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
| | - Mario Alberto Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy; Italian Multiple Sclerosis Foundation, Genoa, Italy.
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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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Manouchehrinia A, Tanasescu R, Tench CR, Constantinescu CS. Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios. J Neurol Neurosurg Psychiatry 2016; 87:324-31. [PMID: 25935887 DOI: 10.1136/jnnp-2015-310361] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/06/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There are inconsistent data on mortality in people with multiple sclerosis (MS). We performed a meta-analysis of all-cause, cause-specific and gender-specific crude mortality rates (CMRs), and standardised mortality ratios (SMRs) in MS, and estimated the rate of change of CMR and SMR over the past 50 years. METHODS Medline, Embase and the Cochrane Library were searched. KEYWORDS 'Multiple Sclerosis' and ('standardised mortality' or 'standardized mortality'). INCLUSION CRITERIA availability of data on the number of deaths; mean or median patient follow-up or reports of SMRs; being a longitudinal study. 12 studies were included covering the period 1949-2012 (27 423 patients; 6628 deaths; 437 832 person-years follow-up). CMR was calculated. SMRs were extracted. CMRs and natural logarithm of SMRs were pooled by the method of the inverse of the variance. Meta-regression models were used to investigate the secular trends. RESULTS Pooled CMR was 9.78/1000 person-years (95% CI 6.81 to 14.02). Pooled all-cause SMR was 2.80 (95% CI 2.74 to 2.87). All-cause SMR was 2.56 (95% CI 2.47 to 2.66) in males and 3.06 (95% CI 2.97 to 3.17) in females. SMR due to cancer was 0.89 (95% CI 0.83 to 0.97). SMRs due to cardiovascular diseases, suicide, infection and respiratory diseases were 1.29 (95% CI 1.20 to 1.38), 2.13 (95% CI 1.80 to 2.51) and 2.91 (95% CI 2.60 to 3.26). There was no trend in CMRs, all-cause, and gender-specific SMRs. CONCLUSIONS The excess mortality in MS relative to the general population has not changed over the past 50 years. Female patients with MS have higher survival disadvantage compared to that of males. Death due to cardiovascular diseases, suicide and infection is higher in patients with MS compared to the general population.
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Affiliation(s)
- Ali Manouchehrinia
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Radu Tanasescu
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK Department of Neurology, Neurosurgery and Psychiatry, University of Medicine and Pharmacy Carol Davila, Colentina Hospital, Bucharest, Romania
| | - Christopher R Tench
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Cris S Constantinescu
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Pugliatti M, Rosati G, Carton H, Riise T, Drulovic J, Vécsei L, Milanov I. The epidemiology of multiple sclerosis in Europe. Eur J Neurol 2006; 13:700-22. [PMID: 16834700 DOI: 10.1111/j.1468-1331.2006.01342.x] [Citation(s) in RCA: 370] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Multiple sclerosis (MS) is a chronic and potentially highly disabling disorder with considerable social impact and economic consequences. It is the major cause of non-traumatic disability in young adults. The social costs associated with MS are high because of its long duration, the early loss of productivity, the need for assistance in activities of daily living and the use of immunomodulatory treatments and multidisciplinary health care. Available MS epidemiological estimates are aimed at providing a measure of the disease burden in Europe. The total estimated prevalence rate of MS for the past three decades is 83 per 100,000 with higher rates in northern countries and a female:male ratio around 2.0. Prevalence rates are higher for women for all countries considered. The highest prevalence rates have been estimated for the age group 35-64 years for both sexes and for all countries. The estimated European mean annual MS incidence rate is 4.3 cases per 100,000. The mean distribution by disease course and by disability is also reported. Despite the wealth of epidemiological data on MS, comparing epidemiological indices among European countries is a hard task and often leads only to approximate estimates. This represents a major methodological concern when evaluating the MS burden in Europe and when implementing specific cost-of-illness studies.
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Affiliation(s)
- M Pugliatti
- Ist. Clinica Neurologica, Facoltà di Medicina e Chirurgia, Università di Sassari, Viale San Pietro 10, 07100 Sassari, Italy.
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Rüegg SJ, Bühlmann M, Renaud S, Steck AJ, Kappos L, Fuhr P. Cervical dystonia as first manifestation of multiple sclerosis. J Neurol 2004; 251:1408-10. [PMID: 15592741 DOI: 10.1007/s00415-004-0544-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2004] [Revised: 05/10/2004] [Accepted: 05/17/2004] [Indexed: 11/29/2022]
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Ekestern E, Lebhart G. Mortality from multiple sclerosis in Austria 1970-2001: dynamics, trends, and prospects. Eur J Neurol 2004; 11:511-20. [PMID: 15272894 DOI: 10.1111/j.1468-1331.2004.00818.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A divergence in earlier multiple sclerosis (MS) mortality rates observed within Europe, prompted us to determine the MS mortality rate in Austria and several European countries. Our aim was to examine the temporal and geographical variations within Austria and to determine future MS mortality rates based on a projection model. MS mortality data set, differentiated by age groups, sex, and region at death for the period 1970-2001 were obtained. Prognostic MS mortality trends for the period 2002-2020 were estimated using the simultaneous multiple cause-delay (SIMCAD) method. Our findings indicate a decline (47%) in the MS mortality rate from 1.41 (1970-79) to 0.96 (1980-89) and 0.70 (1990-2001) per 100 000 in Austria during the 32-year period observed. Conversely, the scenarios of our projection for the period 2002-2020, reveal an increasing MS mortality rate. The median age at death because of MS increased with 0.7 years for men and 2.9 years for women during the observed period (1970-2001). Austria, like many other European countries, has experienced a decreasing MS mortality rate over the last three decades. An increased MS mortality rate is however expected over the next decades in Austria. This increase will be most prominent in the elderly population cohorts because of demographic shifts.
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Affiliation(s)
- E Ekestern
- Department of Neuroimmunology, Brain Research Institute, University of Vienna, Vienna, Austria.
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Meehan TF, DeLuca HF. The vitamin D receptor is necessary for 1alpha,25-dihydroxyvitamin D(3) to suppress experimental autoimmune encephalomyelitis in mice. Arch Biochem Biophys 2002; 408:200-4. [PMID: 12464272 DOI: 10.1016/s0003-9861(02)00580-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The active metabolite of vitamin D, 1alpha,25-dihydroxyvitamin D(3), suppresses autoimmune disease in several animal models including experimental autoimmune encephalomyelitis (EAE), a model of multiple sclerosis. The molecular mechanism of this immunosuppression is at present unknown. While 1alpha,25-dihydroxyvitamin D(3) is believed to function through a single vitamin D receptor, there are reports of other vitamin D receptors as well as a "nongenomic" mode of action. We have prepared the EAE model possessing the vitamin D receptor null mutation and determined if 1alpha,25-dihydroxyvitamin D(3) can suppress this disease in the absence of a functional vitamin D receptor. Vitamin D receptor null mice develop EAE although the incidence rate is one-half that of wild-type controls. The administration of 1alpha,25-dihydroxyvitamin D(3) had no significant effect on the incidence of EAE in the vitamin D receptor null mice, while it completely blocked EAE in the wild-type mice. We conclude that 1alpha,25-dihydroxyvitamin D(3) functions to suppress EAE through the well-known VDR and not through an undiscovered receptor or through a "nongenomic" mechanism.
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Affiliation(s)
- Terrence F Meehan
- Department of Biochemistry, College of Agricultural and Life Sciences, University of Wisconsin--Madison, 53706, USA
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