Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition

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Abstract

Background:

High-quality epidemiologic data worldwide are needed to improve our understanding of disease risk, support health policy to meet the diverse needs of people with multiple sclerosis (MS) and support advocacy efforts.

Objectives:

The Atlas of MS is an open-source global compendium of data regarding the epidemiology of MS and the availability of resources for people with MS reported at country, regional and global levels.

Methods:

Country representatives reported epidemiologic data and their sources via survey between September 2019 and March 2020, covering prevalence and incidence in males, females and children, and age and MS type at diagnosis. Regional analyses and comparisons with 2013 data were conducted.

Results:

A total of 2.8 million people are estimated to live with MS worldwide (35.9 per 100,000 population). MS prevalence has increased in every world region since 2013 but gaps in prevalence estimates persist. The pooled incidence rate across 75 reporting countries is 2.1 per 100,000 persons/year, and the mean age of diagnosis is 32 years. Females are twice as likely to live with MS as males.

Conclusions:

The global prevalence of MS has risen since 2013, but good surveillance data is not universal. Action is needed by multiple stakeholders to close knowledge gaps.

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Most cited references 9

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Global, regional, and national burden of multiple sclerosis 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Mitchell T Wallin, William Culpepper, Emma Nichols … (2019)

Summary Background Multiple sclerosis is the most common inflammatory neurological disease in young adults. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic method of quantifying various effects of a given condition by demographic variables and geography. In this systematic analysis, we quantified the global burden of multiple sclerosis and its relationship with country development level. Methods We assessed the epidemiology of multiple sclerosis from 1990 to 2016. Epidemiological outcomes for multiple sclerosis were modelled with DisMod-MR version 2.1, a Bayesian meta-regression framework widely used in GBD epidemiological modelling. Assessment of multiple sclerosis as the cause of death was based on 13 110 site-years of vital registration data analysed in the GBD's cause of death ensemble modelling module, which is designed to choose the optimum combination of mathematical models and predictive covariates based on out-of-sample predictive validity testing. Data on prevalence and deaths are summarised in the indicator, disability-adjusted life-years (DALYs), which was calculated as the sum of years of life lost (YLLs) and years of life lived with a disability. We used the Socio-demographic Index, a composite indicator of income per person, years of education, and fertility, to assess relations with development level. Findings In 2016, there were 2 221 188 prevalent cases of multiple sclerosis (95% uncertainty interval [UI] 2 033 866–2 436 858) globally, which corresponded to a 10·4% (9·1 to 11·8) increase in the age-standardised prevalence since 1990. The highest age-standardised multiple sclerosis prevalence estimates per 100 000 population were in high-income North America (164·6, 95% UI, 153·2 to 177·1), western Europe (127·0, 115·4 to 139·6), and Australasia (91·1, 81·5 to 101·7), and the lowest were in eastern sub-Saharan Africa (3·3, 2·9–3·8), central sub-Saharan African (2·8, 2·4 to 3·1), and Oceania (2·0, 1·71 to 2·29). There were 18 932 deaths due to multiple sclerosis (95% UI 16 577 to 21 033) and 1 151 478 DALYs (968 605 to 1 345 776) due to multiple sclerosis in 2016. Globally, age-standardised death rates decreased significantly (change −11·5%, 95% UI −35·4 to −4·7), whereas the change in age-standardised DALYs was not significant (−4·2%, −16·4 to 0·8). YLLs due to premature death were greatest in the sixth decade of life (22·05, 95% UI 19·08 to 25·34). Changes in age-standardised DALYs assessed with the Socio-demographic Index between 1990 and 2016 were variable. Interpretation Multiple sclerosis is not common but is a potentially severe cause of neurological disability throughout adult life. Prevalence has increased substantially in many regions since 1990. These findings will be useful for resource allocation and planning in health services. Many regions worldwide have few or no epidemiological data on multiple sclerosis, and more studies are needed to make more accurate estimates. Funding Bill & Melinda Gates Foundation.

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Atlas of Multiple Sclerosis 2013: A growing global problem with widespread inequity.

Paul Browne, Dhia S. Chandraratna, Ceri Angood … (2014)

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Survival in MS: a randomized cohort study 21 years after the start of the pivotal IFNβ-1b trial.

D S Goodin, A T Reder, G Ebers … (2012)

To examine the effects of interferon beta (IFNβ)-1b on all-cause mortality over 21 years in the cohort of 372 patients who participated in the pivotal randomized clinical trial (RCT), retaining (in the analysis) the original randomized treatment-assignments. For this randomized long-term cohort study, the primary outcome, defined before data collection, was the comparison of all-cause mortality between the IFNβ-1b 250 μg and placebo groups from the time of randomization through the entire 21-year follow-up interval (intention-to-treat, log-rank test for Kaplan-Meier survival curves). All other survival outcomes were secondary. After a median of 21.1 years from RCT enrollment, 98.4%(366 of 372) of patients were identified, and, of these, 81 deaths were recorded (22.1% [81 of 366]). Patients originally randomly assigned to IFNβ-1b 250 μg showed a significant reduction in all-cause mortality over the 21-year period compared with placebo (p = 0.0173), with a hazard ratio of 0.532 (95% confidence interval 0.314-0.902). The hazard rate of death at long-term follow-up by Kaplan-Meier estimates was reduced by 46.8% among IFNβ-1b 250 μg-treated patients (46.0% among IFNβ-1b 50 μg-treated patients) compared with placebo. Baseline variables did not influence the observed treatment effect. There was a significant survival advantage in this cohort of patients receiving early IFNβ-1b treatment at either dose compared with placebo. Near-complete ascertainment, together with confirmatory findings from both active treatment groups, strengthens the evidence for an IFNβ-1b benefit on all-cause mortality. This study provides Class III evidence that early treatment with IFNβ-1b is associated with prolonged survival in initially treatment-naive patients with relapsing-remitting multiple sclerosis.

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Author and article information

Contributors

Clare Walton:

ORCID: https://orcid.org/0000-0002-8128-6439

Rachel King

Lindsay Rechtman

Wendy Kaye

Emmanuelle Leray

Ruth Ann Marrie:

ORCID: https://orcid.org/0000-0002-1855-5595

Neil Robertson

Nicholas La Rocca

Bernard Uitdehaag

Ingrid van der Mei

Mitchell Wallin

Anne Helme

Ceri Angood Napier

Nick Rijke

Peer Baneke

Journal

Journal ID (nlm-ta): Mult Scler

Journal ID (iso-abbrev): Mult Scler

Journal ID (publisher-id): MSJ

Journal ID (hwp): spmsj

Title: Multiple Sclerosis (Houndmills, Basingstoke, England)

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 1352-4585

ISSN (Electronic): 1477-0970

Publication date (Electronic): 11 November 2020

Publication date (Print): December 2020

Volume: 26

Issue: 14

Pages: 1816-1821

Affiliations

[1-1352458520970841]Multiple Sclerosis International Federation, London, UK

[2-1352458520970841]Multiple Sclerosis International Federation, London, UK

[3-1352458520970841]McKing Consulting Corporation, Atlanta, GA, USA

[4-1352458520970841]McKing Consulting Corporation, Atlanta, GA, USA

[5-1352458520970841]EA 7449 REPERES, Epidemiology, Ecole des Hautes Etudes en Sante Publique, Rennes, France

[6-1352458520970841]Internal Medicine, University of Manitoba, Winnipeg, MB, Canada

[7-1352458520970841]Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK

[8-1352458520970841]National MS Society, West Bath, ME, USA

[9-1352458520970841]Neurology, Amsterdam UMC–Locatie VUMC, Amsterdam, Netherlands

[10-1352458520970841]Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia

[11-1352458520970841]Department of Neurology, George Washington University, Washington, DC, USA

[12-1352458520970841]Multiple Sclerosis International Federation, London, UK

[13-1352458520970841]Multiple Sclerosis International Federation, London, UK

[14-1352458520970841]Multiple Sclerosis International Federation, London, UK

[15-1352458520970841]Multiple Sclerosis International Federation, London, UK

Author notes

[*]C Walton MS International Federation, 200 Union Street, London SE1 0LX, UK. research@ 123456msif.org

Author information

Clare Walton https://orcid.org/0000-0002-8128-6439

Ruth Ann Marrie https://orcid.org/0000-0002-1855-5595

Article

Publisher ID: 10.1177_1352458520970841

DOI: 10.1177/1352458520970841

PMC ID: 7720355

PubMed ID: 33174475

SO-VID: e3da8bb6-8313-4c31-950c-8201b993a3c3

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 1 September 2020

Date revision received : 8 October 2020

Date accepted : 13 October 2020

Funding

Funded by: Biogen, FundRef https://doi.org/10.13039/100005614;

Funded by: Novartis, FundRef https://doi.org/10.13039/100004336;

Funded by: Vanneau Trust, ;

Funded by: Associazione Italiana Sclerosi Multipla, FundRef https://doi.org/10.13039/100007378;

Funded by: Multiple Sclerosis Society, FundRef https://doi.org/10.13039/501100000381;

Funded by: Merck, FundRef https://doi.org/10.13039/100004334;

Funded by: Bristol-Myers Squibb, FundRef https://doi.org/10.13039/100002491;

Funded by: Sanofi, FundRef https://doi.org/10.13039/100004339;

Funded by: National Multiple Sclerosis Society, FundRef https://doi.org/10.13039/100000890;

Funded by: Roche, FundRef https://doi.org/10.13039/100004337;

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ScienceOpen disciplines: Immunology

Keywords: multiple sclerosis,epidemiology

Data availability:

ScienceOpen disciplines: Immunology

Keywords: multiple sclerosis, epidemiology

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Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition

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Abstract

Background:

Objectives:

Methods:

Results:

Conclusions:

Related collections

Karger: Neurology and Neuroscience

Most cited references 9

Global, regional, and national burden of multiple sclerosis 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Atlas of Multiple Sclerosis 2013: A growing global problem with widespread inequity.

Survival in MS: a randomized cohort study 21 years after the start of the pivotal IFNβ-1b trial.

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