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April 17, 2018; 90 (16) Article

Temporal trends in multiple sclerosis prevalence and incidence in a large population

Dalia L. Rotstein, Hong Chen, Andrew S. Wilton, Jeffrey C. Kwong, Ruth Ann Marrie, Peter Gozdyra, Kristen M. Krysko, Alexander Kopp, Ray Copes, Karen Tu
First published March 16, 2018, DOI: https://doi.org/10.1212/WNL.0000000000005331
Dalia L. Rotstein
From the Division of Neurology, Department of Medicine (D.L.R., K.M.K.), Dalla Lana School of Public Health (H.C., R.C.), and Department of Family and Community Medicine (J.C.K., K.T.), University of Toronto; St. Michael's Hospital (D.L.R., P.G.), Toronto; Institute for Clinical Evaluative Sciences (D.L.R., H.C., A.S.W., J.C.K., A.K.), Toronto; Public Health Ontario (H.C., R.C.), Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; and Toronto Western Family Health Team (K.T.), University Health Network, Toronto, Canada.
MD, MPH
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Hong Chen
From the Division of Neurology, Department of Medicine (D.L.R., K.M.K.), Dalla Lana School of Public Health (H.C., R.C.), and Department of Family and Community Medicine (J.C.K., K.T.), University of Toronto; St. Michael's Hospital (D.L.R., P.G.), Toronto; Institute for Clinical Evaluative Sciences (D.L.R., H.C., A.S.W., J.C.K., A.K.), Toronto; Public Health Ontario (H.C., R.C.), Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; and Toronto Western Family Health Team (K.T.), University Health Network, Toronto, Canada.
PhD
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Andrew S. Wilton
From the Division of Neurology, Department of Medicine (D.L.R., K.M.K.), Dalla Lana School of Public Health (H.C., R.C.), and Department of Family and Community Medicine (J.C.K., K.T.), University of Toronto; St. Michael's Hospital (D.L.R., P.G.), Toronto; Institute for Clinical Evaluative Sciences (D.L.R., H.C., A.S.W., J.C.K., A.K.), Toronto; Public Health Ontario (H.C., R.C.), Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; and Toronto Western Family Health Team (K.T.), University Health Network, Toronto, Canada.
MSc
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Jeffrey C. Kwong
From the Division of Neurology, Department of Medicine (D.L.R., K.M.K.), Dalla Lana School of Public Health (H.C., R.C.), and Department of Family and Community Medicine (J.C.K., K.T.), University of Toronto; St. Michael's Hospital (D.L.R., P.G.), Toronto; Institute for Clinical Evaluative Sciences (D.L.R., H.C., A.S.W., J.C.K., A.K.), Toronto; Public Health Ontario (H.C., R.C.), Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; and Toronto Western Family Health Team (K.T.), University Health Network, Toronto, Canada.
MD
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Ruth Ann Marrie
From the Division of Neurology, Department of Medicine (D.L.R., K.M.K.), Dalla Lana School of Public Health (H.C., R.C.), and Department of Family and Community Medicine (J.C.K., K.T.), University of Toronto; St. Michael's Hospital (D.L.R., P.G.), Toronto; Institute for Clinical Evaluative Sciences (D.L.R., H.C., A.S.W., J.C.K., A.K.), Toronto; Public Health Ontario (H.C., R.C.), Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; and Toronto Western Family Health Team (K.T.), University Health Network, Toronto, Canada.
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Peter Gozdyra
From the Division of Neurology, Department of Medicine (D.L.R., K.M.K.), Dalla Lana School of Public Health (H.C., R.C.), and Department of Family and Community Medicine (J.C.K., K.T.), University of Toronto; St. Michael's Hospital (D.L.R., P.G.), Toronto; Institute for Clinical Evaluative Sciences (D.L.R., H.C., A.S.W., J.C.K., A.K.), Toronto; Public Health Ontario (H.C., R.C.), Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; and Toronto Western Family Health Team (K.T.), University Health Network, Toronto, Canada.
MA
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Kristen M. Krysko
From the Division of Neurology, Department of Medicine (D.L.R., K.M.K.), Dalla Lana School of Public Health (H.C., R.C.), and Department of Family and Community Medicine (J.C.K., K.T.), University of Toronto; St. Michael's Hospital (D.L.R., P.G.), Toronto; Institute for Clinical Evaluative Sciences (D.L.R., H.C., A.S.W., J.C.K., A.K.), Toronto; Public Health Ontario (H.C., R.C.), Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; and Toronto Western Family Health Team (K.T.), University Health Network, Toronto, Canada.
MD
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Alexander Kopp
From the Division of Neurology, Department of Medicine (D.L.R., K.M.K.), Dalla Lana School of Public Health (H.C., R.C.), and Department of Family and Community Medicine (J.C.K., K.T.), University of Toronto; St. Michael's Hospital (D.L.R., P.G.), Toronto; Institute for Clinical Evaluative Sciences (D.L.R., H.C., A.S.W., J.C.K., A.K.), Toronto; Public Health Ontario (H.C., R.C.), Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; and Toronto Western Family Health Team (K.T.), University Health Network, Toronto, Canada.
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Ray Copes
From the Division of Neurology, Department of Medicine (D.L.R., K.M.K.), Dalla Lana School of Public Health (H.C., R.C.), and Department of Family and Community Medicine (J.C.K., K.T.), University of Toronto; St. Michael's Hospital (D.L.R., P.G.), Toronto; Institute for Clinical Evaluative Sciences (D.L.R., H.C., A.S.W., J.C.K., A.K.), Toronto; Public Health Ontario (H.C., R.C.), Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; and Toronto Western Family Health Team (K.T.), University Health Network, Toronto, Canada.
MD, MSc
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Karen Tu
From the Division of Neurology, Department of Medicine (D.L.R., K.M.K.), Dalla Lana School of Public Health (H.C., R.C.), and Department of Family and Community Medicine (J.C.K., K.T.), University of Toronto; St. Michael's Hospital (D.L.R., P.G.), Toronto; Institute for Clinical Evaluative Sciences (D.L.R., H.C., A.S.W., J.C.K., A.K.), Toronto; Public Health Ontario (H.C., R.C.), Toronto; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; and Toronto Western Family Health Team (K.T.), University Health Network, Toronto, Canada.
MD, MSc
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Citation
Temporal trends in multiple sclerosis prevalence and incidence in a large population
Dalia L. Rotstein, Hong Chen, Andrew S. Wilton, Jeffrey C. Kwong, Ruth Ann Marrie, Peter Gozdyra, Kristen M. Krysko, Alexander Kopp, Ray Copes, Karen Tu
Neurology Apr 2018, 90 (16) e1435-e1441; DOI: 10.1212/WNL.0000000000005331

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Abstract

Objective We sought to better understand the reasons for increasing prevalence of multiple sclerosis (MS) by studying prevalence in relation to incidence, mortality rates, sex ratio, and geographic distribution of cases.

Methods We identified MS cases from 1996 to 2013 in Ontario, Canada, by applying a validated algorithm to health administrative data. We calculated age- and sex-standardized prevalence and incidence rates for the province and by census division. Incidence and prevalence sex ratios for women to men were computed.

Results The prevalence of MS increased by 69% from 1.57 (95% confidence interval [CI]: 1.54–1.59) per 1,000 in 1996 (n = 12,155) to 2.65 (95% CI: 2.62–2.68) in 2013 (n = 28,192). Incidence remained relatively stable except for a spike in 2010, followed by a subsequent decline in 2011–2013, particularly among young people and men. Mortality decreased by 33% from 26.7 (95% CI: 23.5–30.3) per 1,000 to 18.0 (95% CI: 16.4–19.8) per 1,000. The incidence sex ratio was stable from 1996 to 2009, then declined in 2010, with partial rebound by 2013. MS prevalence and incidence showed no consistent association with latitude.

Conclusion In this large, population-based MS cohort, we found stable incidence and increasing prevalence of MS; the latter largely reflected declining mortality. A spike in incidence in 2010 among younger patients and men at a time of widespread media coverage of MS suggests that these groups may be vulnerable to delayed diagnosis. We did not find a latitudinal gradient; however, most Ontarians live between the 42nd and 46th parallels, reducing our ability to detect an effect of latitude.

Glossary

CI=
confidence interval;
ICD=
International Classification of Diseases;
MS=
multiple sclerosis;
OHIP=
Ontario Health Insurance Plan

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article

  • Received August 28, 2017.
  • Accepted in final form January 16, 2018.
  • © 2018 American Academy of Neurology
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