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Belotti LMB, Di Martino M, Zenesini C, Vignatelli L, Baldin E, Baccari F, Ridley B, Nonino F. Impact of adherence to disease-modifying drugs in multiple sclerosis: A study on Italian real-world data. Mult Scler Relat Disord 2023; 80:105094. [PMID: 37913675 DOI: 10.1016/j.msard.2023.105094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/05/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system requiring complex diagnostic and therapeutic management. Treatment with Disease Modifying Drugs (DMDs) is aimed at reducing relapse rate and disease disability. Few real-world, population-based data are available on the impact of adherence on relapse rate. The objective of this study was to assess the impact of adherence to DMDs on relapses in a real-world Italian setting. METHODS Population-based cohort study. People with MS (PwMS) older than 18 years and residing in the Emilia-Romagna region, Northern Italy, were identified through administrative databases using a validated algorithm. A Cox regression model with a time-varying exposure was performed to assess the association between level of adherence to DMDs and relapses over a 5-year period. RESULTS A total of 2,528 PwMS receiving a first prescription of DMDs between 2015 and 2019 were included (average age of 42, two-thirds female). Highly adherent PwMS had a 25 % lower hazard of experiencing moderate or severe relapses than non-adherent PwMS (Hazard Ratio 0.75, 95 % CI 0.58 to 0.98), after adjusting for age and sex. Several sensitivity analyses supported the main result. CONCLUSION The results of our study support the hypothesis that a high level of DMD adherence in MS is associated with a lower risk of moderate or severe relapse. Therefore, choosing the DMD with which to start drug treatment and recommending adherence to treatment appear to be crucial aspects involving both physicians and patients.
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Affiliation(s)
- Laura Maria Beatrice Belotti
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy.
| | - Mirko Di Martino
- Department of Epidemiology of the Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112-00147 Roma, Italy
| | - Corrado Zenesini
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy
| | - Luca Vignatelli
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy
| | - Elisa Baldin
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy
| | - Flavia Baccari
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy
| | - Ben Ridley
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy
| | - Francesco Nonino
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy
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2
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Melamed E, Palmer JL, Fonken C. Advantages and limitations of experimental autoimmune encephalomyelitis in breaking down the role of the gut microbiome in multiple sclerosis. Front Mol Neurosci 2022; 15:1019877. [PMID: 36407764 PMCID: PMC9672668 DOI: 10.3389/fnmol.2022.1019877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/11/2022] [Indexed: 08/22/2023] Open
Abstract
Since the first model of experimental autoimmune encephalomyelitis (EAE) was introduced almost a century ago, there has been an ongoing scientific debate about the risks and benefits of using EAE as a model of multiple sclerosis (MS). While there are notable limitations of translating EAE studies directly to human patients, EAE continues to be the most widely used model of MS, and EAE studies have contributed to multiple key breakthroughs in our understanding of MS pathogenesis and discovery of MS therapeutics. In addition, insights from EAE have led to a better understanding of modifiable environmental factors that can influence MS initiation and progression. In this review, we discuss how MS patient and EAE studies compare in our learning about the role of gut microbiome, diet, alcohol, probiotics, antibiotics, and fecal microbiome transplant in neuroinflammation. Ultimately, the combination of rigorous EAE animal studies, novel bioinformatic approaches, use of human cell lines, and implementation of well-powered, age- and sex-matched randomized controlled MS patient trials will be essential for improving MS patient outcomes and developing novel MS therapeutics to prevent and revert MS disease progression.
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Affiliation(s)
- Esther Melamed
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, United States
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3
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Prosperini L, Lucchini M, Ruggieri S, Tortorella C, Haggiag S, Mirabella M, Pozzilli C, Gasperini C. Shift of multiple sclerosis onset towards older age. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329049. [PMID: 35477891 DOI: 10.1136/jnnp-2022-329049] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/01/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore whether age at onset increased over time despite a shortened interval from the initial clinical demyelinating event to the diagnosis of multiple sclerosis (MS), as promoted by updated diagnostic criteria. METHODS This was an independent, multicentre, retrospective study based on data from 4345 patients with relapsing-onset MS attending three tertiary MS Clinics in Italy. After stratifying the year of MS onset into four periods (<1991, 1991-2000, 2001-2010, 2011-2021), we analysed the temporal trends in age at onset and interval from onset to diagnosis; we then explored the female-to-male ratio and onset location across different classes of age at onset. RESULTS We observed an increased mean age at onset, and a shortened mean interval to diagnosis over time (p<0.0001). Accordingly, there were more MS onsets at the older age classes of 40-49, 50-59 and ≥60 years (p<0.0001). In cases with age at onset ≥40 years, we also found an increased female-to-male ratio (p=0.007), more frequent spinal cord (p=0.0004) and less frequent supratentorial onset (p=0.008). CONCLUSION Our study shows a forward shift towards an older age at onset of MS, thus suggesting considerable thought on the place-in-therapy of most currently used disease-modifying treatments, and on the standard of care to an older population.
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Affiliation(s)
- Luca Prosperini
- Dept. of Neurosciences, S. Camillo-Forlanini Hospital, Roma, Italy
| | - Matteo Lucchini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Dip.to di Neuroscienze, Centro di Ricerca per la Sclerosi Multipla (CERSM), Roma, Italy
| | - Serena Ruggieri
- Dept. of Human Neurosciences, Sapienza University, Roma, Italy
- Neuroimmunology Unit, S. Lucia Foundation, Roma, Italy
| | - Carla Tortorella
- Dept. of Neurosciences, S. Camillo-Forlanini Hospital, Roma, Italy
| | - Shalom Haggiag
- Dept. of Neurosciences, S. Camillo-Forlanini Hospital, Roma, Italy
| | - Massimiliano Mirabella
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Dip.to di Neuroscienze, Centro di Ricerca per la Sclerosi Multipla (CERSM), Roma, Italy
| | - Carlo Pozzilli
- Dept. of Human Neurosciences, Sapienza University, Roma, Italy
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4
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Ponzio M, Tacchino A, Amicizia D, Piazza MF, Paganino C, Trucchi C, Astengo M, Simonetti S, Gallo D, Sansone A, Brichetto G, Battaglia MA, Ansaldi F. Prevalence of multiple sclerosis in Liguria region, Italy: an estimate using the capture-recapture method. Neurol Sci 2021; 43:3239-3245. [PMID: 34817728 PMCID: PMC9018629 DOI: 10.1007/s10072-021-05718-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/30/2021] [Indexed: 11/21/2022]
Affiliation(s)
- M Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.
| | - A Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - D Amicizia
- A.Li.Sa, Liguria Health Authority, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M F Piazza
- A.Li.Sa, Liguria Health Authority, Genoa, Italy
| | - C Paganino
- A.Li.Sa, Liguria Health Authority, Genoa, Italy
| | - C Trucchi
- A.Li.Sa, Liguria Health Authority, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M Astengo
- A.Li.Sa, Liguria Health Authority, Genoa, Italy
| | | | - D Gallo
- A.Li.Sa, Liguria Health Authority, Genoa, Italy
| | - A Sansone
- AISM Rehabilitation Centre Liguria, Italian Multiple Sclerosis Society, Genoa, Italy
| | - G Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.,AISM Rehabilitation Centre Liguria, Italian Multiple Sclerosis Society, Genoa, Italy
| | - M A Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
| | - F Ansaldi
- A.Li.Sa, Liguria Health Authority, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
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5
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Fazia T, Marzanati D, Carotenuto AL, Beecham A, Hadjixenofontos A, McCauley JL, Saddi V, Piras M, Bernardinelli L, Gentilini D. Homozygosity Haplotype and Whole-Exome Sequencing Analysis to Identify Potentially Functional Rare Variants Involved in Multiple Sclerosis among Sardinian Families. Curr Issues Mol Biol 2021; 43:1778-1793. [PMID: 34889895 PMCID: PMC8929092 DOI: 10.3390/cimb43030125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/13/2021] [Accepted: 10/23/2021] [Indexed: 12/24/2022] Open
Abstract
Multiple Sclerosis (MS) is a complex multifactorial autoimmune disease, whose sex- and age-adjusted prevalence in Sardinia (Italy) is among the highest worldwide. To date, 233 loci were associated with MS and almost 20% of risk heritability is attributable to common genetic variants, but many low-frequency and rare variants remain to be discovered. Here, we aimed to contribute to the understanding of the genetic basis of MS by investigating potentially functional rare variants. To this end, we analyzed thirteen multiplex Sardinian families with Immunochip genotyping data. For five families, Whole Exome Sequencing (WES) data were also available. Firstly, we performed a non-parametric Homozygosity Haplotype analysis for identifying the Region from Common Ancestor (RCA). Then, on these potential disease-linked RCA, we searched for the presence of rare variants shared by the affected individuals by analyzing WES data. We found: (i) a variant (43181034 T > G) in the splicing region on exon 27 of CUL9; (ii) a variant (50245517 A > C) in the splicing region on exon 16 of ATP9A; (iii) a non-synonymous variant (43223539 A > C), on exon 9 of TTBK1; (iv) a non-synonymous variant (42976917 A > C) on exon 9 of PPP2R5D; and v) a variant (109859349-109859354) in 3'UTR of MYO16.
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Affiliation(s)
- Teresa Fazia
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (D.M.); (A.L.C.); (L.B.); (D.G.)
- Correspondence:
| | - Daria Marzanati
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (D.M.); (A.L.C.); (L.B.); (D.G.)
| | - Anna Laura Carotenuto
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (D.M.); (A.L.C.); (L.B.); (D.G.)
| | - Ashley Beecham
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.B.); (A.H.); (J.L.M.)
- Dr. John T. Macdonald Foundation Department of Human Genetics, Miller School of Medicine, Miami, FL 33136, USA
| | - Athena Hadjixenofontos
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.B.); (A.H.); (J.L.M.)
- Dr. John T. Macdonald Foundation Department of Human Genetics, Miller School of Medicine, Miami, FL 33136, USA
| | - Jacob L. McCauley
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.B.); (A.H.); (J.L.M.)
- Dr. John T. Macdonald Foundation Department of Human Genetics, Miller School of Medicine, Miami, FL 33136, USA
| | - Valeria Saddi
- Divisione di Neurologia, Presidio Ospedaliero S. Francesco, ASL Numero 3 Nuoro, 08100 Nuoro, Italy; (V.S.); (M.P.)
| | - Marialuisa Piras
- Divisione di Neurologia, Presidio Ospedaliero S. Francesco, ASL Numero 3 Nuoro, 08100 Nuoro, Italy; (V.S.); (M.P.)
| | - Luisa Bernardinelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (D.M.); (A.L.C.); (L.B.); (D.G.)
| | - Davide Gentilini
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (D.M.); (A.L.C.); (L.B.); (D.G.)
- Bioinformatics and Statistical Genomics Unit, Istituto Auxologico Italiano IRCCS, 20095 Cusano Milanino, Italy
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6
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Puthenparampil M, Perini P, Bergamaschi R, Capobianco M, Filippi M, Gallo P. Multiple sclerosis epidemiological trends in Italy highlight the environmental risk factors. J Neurol 2021; 269:1817-1824. [PMID: 34580756 PMCID: PMC8940874 DOI: 10.1007/s00415-021-10782-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
Italy is definitely a high-risk country for multiple sclerosis (MS). Over the last 50 years, several epidemiological studies, including longitudinal surveys, have disclosed that MS incidence and prevalence in Italy mainland and Islands (Sardinia and Sicily) have progressively increased, picturing a semi-parabolic curve. Based on the comprehensive scrutiny of 58 papers, we conclude that the latitude risk gradient does not fit to the Italian map of MS. The genetic heterogeneity of the Italian ethnicities, that likely forms the basis of MS predisposition, does not account for the dramatic increase of MS incidence and prevalence observed in Italy over the last half century that, rather, seems better explained by the effect of environmental factors.
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Affiliation(s)
- M Puthenparampil
- Department of Neurosciences, University of Padua, via Giustiniani 5, 35128, Padua, Italy. .,Multiple Sclerosis Centre, University Hospital of Padua, via Giustiniani 5, 35128, Padua, Italy.
| | - P Perini
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | - R Bergamaschi
- Multiple Sclerosis Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - M Capobianco
- Centro di Riferimento Regionale Sclerosi Multipla (CReSM), SCDO Neurologia, AOU S. Luigi Gonzaga, Orbassano, Turin, Italy
| | - M Filippi
- Unit of Neurology, Unit of Neurorehabilitation and Neurophysiology Service, IRCCS San Raffaele Institute, Milan, Italy
| | - P Gallo
- Department of Neurosciences, University of Padua, via Giustiniani 5, 35128, Padua, Italy.,Multiple Sclerosis Centre, University Hospital of Padua, via Giustiniani 5, 35128, Padua, Italy
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7
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Petit P, Bosson-Rieutort D, Maugard C, Gondard E, Ozenfant D, Joubert N, François O, Bonneterre V. The TRACTOR Project: TRACking and MoniToring Occupational Risks in Agriculture Using French Insurance Health Data (MSA). Ann Work Expo Health 2021; 66:402-411. [PMID: 34562080 DOI: 10.1093/annweh/wxab083] [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: 07/05/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES A vast data mining project called 'TRACking and moniToring Occupational Risks in agriculture' (TRACTOR) was initiated in 2017 to investigate work-related health events among the entire French agricultural workforce. The goal of this work is to present the TRACTOR project, the challenges faced during its implementation, to discuss its strengths and limitations and to address its potential impact for health surveillance. METHODS Three routinely collected administrative health databases from the National Health Insurance Fund for Agricultural Workers and Farmers (MSA) were made available for the TRACTOR project. Data management was required to properly clean and prepare the data before linking together all available databases. RESULTS After removing few missing and aberrant data (4.6% values), all available databases were fully linked together. The TRACTOR project is an exhaustive database of agricultural workforce (active and retired) from 2002 to 2016, with around 10.5 million individuals including seasonal workers and farm managers. From 2012 to 2016, a total of 6 906 290 individuals were recorded. Half of these individuals were active and 46% had at least one health event (e.g. declared chronic disease, reimbursed drug prescription) during this 5-year period. CONCLUSIONS The assembled MSA databases available in the TRACTOR project are regularly updated and represent a promising and unprecedent dataset for data mining analysis dedicated to the early identification of current and emerging work-related illnesses and hypothesis generation. As a result, this project could help building a prospective integrated health surveillance system for the benefit of agricultural workers.
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Affiliation(s)
- Pascal Petit
- Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, France
| | - Delphine Bosson-Rieutort
- School of Public Health, Department of Management, Evaluation and Health Policy, University of Montreal, Montreal, Canada.,Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - Charlotte Maugard
- Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, France
| | - Elise Gondard
- Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, France
| | | | | | - Olivier François
- Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, France
| | - Vincent Bonneterre
- Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, France
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8
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Farcomeni A, Dotto F. A correction to make Chao estimator conservative when the number of sampling occasions is finite. Stat Probab Lett 2021. [DOI: 10.1016/j.spl.2021.109154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Mirahmadizadeh A, Banihashemi SA, Hashemi M, Amiri S, Basir S, Heiran A, Keshavarzian O. Estimating the prevalence and incidence of treated type 2 diabetes using prescription data as a proxy: A stepwise approach on Iranian data. Heliyon 2021; 7:e07260. [PMID: 34179534 PMCID: PMC8213903 DOI: 10.1016/j.heliyon.2021.e07260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 05/16/2020] [Accepted: 06/03/2021] [Indexed: 11/21/2022] Open
Abstract
AIMS Type 2 diabetes is a serious health challenge, and large-scale studies on its prevalence in Iran are lacking. In pharmacoepidemiology, case-finding can be done by reviewing the prescription databases for specific drug(s) prescribed for a disease. We aimed to determine the prevalence and incidence of type 2 diabetes in Fars province, Iran, using prescription data and a stepwise approach to ascertain the results. METHODS A dataset of 3,113 insured individuals aged ≥35 years were selected. Their Prescription Data Centre records were reviewed for all drugs frequently used in controlling type 2 diabetes available in the Iranian pharmacopeia. Then we used a stepwise method for case-finding. In step one, each individual with a positive drug history for type 2 diabetes was labeled as an individual with diabetes. The next two steps were implemented for ascertainment of step one estimations. RESULTS Prevalence of type 2 diabetes based on prescription, internist opinion, and phone call verification in 2015 and 2016 was 9.3% and 10.3%, 8.5% and 9.8%, and 7.2% and 8.7%, respectively. An incidence of 1.9% was determined for 2016. CONCLUSIONS We obtained a realistic estimation of prevalence and incidence of treated type 2 diabetes, using prescription data which are large-scale, low cost, and real-time.
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Affiliation(s)
- Alireza Mirahmadizadeh
- Noncommunicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Sanaz Amiri
- Shiraz University of Medical Sciences, Shiraz, Iran
| | - Suzan Basir
- Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Heiran
- Noncommunicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Keshavarzian
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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Colais P, Cascini S, Balducci M, Agabiti N, Davoli M, Fusco D, Calandrini E, Bargagli AM. Impact of the COVID-19 pandemic on access to healthcare services amongst patients with multiple sclerosis in the Lazio region, Italy. Eur J Neurol 2021; 28:3403-3410. [PMID: 33896086 PMCID: PMC8250799 DOI: 10.1111/ene.14879] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/05/2021] [Accepted: 04/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) is a complex chronic, autoimmune inflammatory disease involving multidisciplinary assessments and interventions. Access to outpatient specialist and home healthcare services was explored during the pandemic outbreak and the lockdown amongst MS patients in the Lazio region. Adherence to disease-modifying therapies (DMTs) is also described. METHODS A population-based study was conducted using regional healthcare administrative databases. A validated algorithm was used to identify MS cases over the period 2011-2018. The numbers of specialist and home-based services were compared between 2019 and 2020. The medication possession ratio was used to measure adherence to DMTs. RESULTS A total of 9380 MS patients were identified (68% women). A decline in the number of outpatient care services between March and June 2020 compared to the previous year was observed, in particular for rehabilitation (-82%), magnetic resonance imaging (-56%) and neurological specialist services (-91%). Important year-to-year variations were observed in May and June 2020 in home-based nursing and medical care (-91%) and motor re-education services (-74%). Adherence to DMTs was higher in the first 4 months of 2019 compared to the same period of 2020 (67.1% vs. 57.0%). CONCLUSIONS A notable disruption of rehabilitative therapy and home-based services as well as in DMT adherence was observed. Since the pandemic is still ongoing and interruption of healthcare services could have a major impact on MS patients, it is necessary to monitor access of MS patients to healthcare resources in order to ensure adequate treatments, including rehabilitative therapies.
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Affiliation(s)
- Paola Colais
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Silvia Cascini
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Maria Balducci
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Danilo Fusco
- Department of Health Information Systems, Lazio Regional Health Service, Rome, Italy
| | - Enrico Calandrini
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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11
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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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12
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Gnavi R, Picariello R, Alboini PE, Cavalla P, Grasso MF, Richiardi P, Bertolotto A, Barizzone N, Cantello R, Leone MA, D'Alfonso S, Golini N. Validation of an Algorithm to Detect Multiple Sclerosis Cases in Administrative Health Databases in Piedmont (Italy): An Application to the Estimate of Prevalence by Age and Urbanization Level. Neuroepidemiology 2021; 55:119-125. [PMID: 33691323 DOI: 10.1159/000513763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/12/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Italy is considered a high-risk country for multiple sclerosis (MS). Exploiting electronic health archives (EHAs) is highly useful to continuously monitoring the prevalence of the disease, as well as the care delivered to patients and its outcomes. The aim of this study was to validate an EHA-based algorithm to identify MS patients, suitable for epidemiological purposes, and to estimate MS prevalence in Piedmont (North Italy). METHODS MS cases were identified, in the period between January 1, 2012 and December 31, 2017, linking data from 4 different sources: hospital discharges, drug prescriptions, exemptions from co-payment to health care, and long-term care facilities. Sensitivity of the algorithm was tested through record linkage with a cohort of 656 neurologist-confirmed MS cases; specificity was tested with a cohort of 2,966,293 residents presumably not affected by MS. Undercount was estimated by a capture-recapture method. We calculated crude, and age- and gender-specific prevalence. We also calculated age-adjusted prevalence by level of urbanization of the municipality of residence. RESULTS On December 31, 2017, the algorithm identified 8,850 MS cases. Sensitivity was 95.9%, specificity was 99.97%, and the estimated completeness of ascertainment was 91.9%. The overall prevalence, adjusted for undercount, was 152 per 100,000 among men and 286 among women; it increased with increasing age and reached its peak value in the 45- to 54-year class, followed by a progressive reduction. The age-adjusted prevalence of residents in cities was 15% higher than in those living in the countryside. DISCUSSION/CONCLUSION We validated an algorithm based on EHAs to identify cases of MS for epidemiological use. The prevalence of MS, adjusted for undercount, was among the highest in Italy. We also found that the prevalence was higher in highly urbanized areas.
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Affiliation(s)
- Roberto Gnavi
- Epidemiology Unit, ASL TO3 Regione Piemonte, Grugliasco, Italy,
| | | | - Paolo Emilio Alboini
- Neurology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Paola Cavalla
- Department of Neuroscience and Mental Health, Neurologia I U and Multiple Sclerosis Center, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Paola Richiardi
- UO Neurologia, ASL Città di Torino, Ospedale San Giovanni Bosco, Turin, Italy
| | - Antonio Bertolotto
- Neurologia-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi Gonzaga, Turin, Italy
| | - Nadia Barizzone
- Department of Translational Medicine, Neurology Unit, University of Piemonte Orientale, Novara, Italy
| | - Roberto Cantello
- Department of Health Sciences, and CAAD, University of Eastern Piedmont, Novara, Italy
| | - Maurizio Angelo Leone
- Neurology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Sandra D'Alfonso
- Department of Health Sciences, and CAAD, University of Eastern Piedmont, Novara, Italy
| | - Natalia Golini
- Epidemiology Unit, ASL TO3 Regione Piemonte, Grugliasco, Italy
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Zafar A, AlShamrani FJG. No evidence of disease activity-3 (NEDA-3) status in patients with relapsing remitting multiple sclerosis: Evidence from Saudi cohort receiving mainly Interferon. Mult Scler Relat Disord 2021; 51:102875. [PMID: 33691260 DOI: 10.1016/j.msard.2021.102875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND No evidence of disease activity (NEDA) is a composite surrogate assessing the responsiveness to various disease-modifying treatments (DMTs) in patients with relapsing and remitting multiple sclerosis (RRMS), addressing clinical as well as radiological disease activity. Despite the rising prevalence of multiple sclerosis in Saudi Arabia (SA), there is a lack of evidence focusing on this important aspect in the management of RRMS. This study aimed to identify the prevalence of NEDA-3 status achievement in patients with RRMS on DMTs (mainly the interferon) and to describe the factors affecting its attainment. METHOD This was a retrospective, cross-sectional study carried out at King Fahd University Hospital after obtaining institutional ethical approval. The electronic records of 119 patients diagnosed with RRMS were reviewed. Clinical manifestations at initial presentation, relapse after starting treatment, disability progression, and development of new lesions on follow-up magnetic resonance imaging were all documented to assess NEDA-3 status. Data were analyzed using Statistical Package for Social Sciences, version 22. RESULTS NEDA-3 status was achieved in 41 (33.6%) patients. The female-to-male ratio for all patients was 1.5:1. Interferon (IFN) was the most commonly prescribed DMT. NEDA-3 status was achieved in 30.9% of patients receiving IFN. Mean baseline Expanded Disability Status Scale in patients who did not achieve NEDA-3 was 2.8±1.8. Patients with ataxia (P = <0.001), sphincter disturbances (P=0.002) and infra-tentorial brain lesions (P=0.03) were less likely to achieve NEDA-3 status. Involvement of pyramidal, cerebellar and more than one system at initial presentation was more frequent in patients who could not achieve NEDA-3 status (P=0.002) CONCLUSION: Less than one third of total patients on IFN as DMT could achieve NEDA-3 status in our cohort of patients which is in agreement with the literature published in the West. We could not properly asses NEDA-3 status for other DMTs in our center due to the very small sample size of patients on these DMTs, and recommend future studies including larger number of patients on DMTs other than IFN. Significant differences were identified between the two groups of patients with respect to attainment of NEDA-3 status, which requires further verification by multicenter prospective studies.
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Affiliation(s)
- Azra Zafar
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam. King Fahd University Hospital, Khobar, 31952, Kingdom of Saudi Arabia.
| | - Foziah Jabbar Gossab AlShamrani
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam. King Fahd University Hospital, Khobar, 31952, Kingdom of Saudi Arabia.
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Orlando V, Rea F, Savaré L, Guarino I, Mucherino S, Perrella A, Trama U, Coscioni E, Menditto E, Corrao G. Development and validation of a clinical risk score to predict the risk of SARS-CoV-2 infection from administrative data: A population-based cohort study from Italy. PLoS One 2021; 16:e0237202. [PMID: 33471809 PMCID: PMC7816996 DOI: 10.1371/journal.pone.0237202] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The novel coronavirus (SARS-CoV-2) pandemic spread rapidly worldwide increasing exponentially in Italy. To date, there is lack of studies describing clinical characteristics of the people at high risk of infection. Hence, we aimed (i) to identify clinical predictors of SARS-CoV-2 infection risk, (ii) to develop and validate a score predicting SARS-CoV-2 infection risk, and (iii) to compare it with unspecific scores. METHODS Retrospective case-control study using administrative health-related database was carried out in Southern Italy (Campania region) among beneficiaries of Regional Health Service aged over than 30 years. For each person with SARS-CoV-2 confirmed infection (case), up to five controls were randomly matched for gender, age and municipality of residence. Odds ratios and 90% confidence intervals for associations between candidate predictors and risk of infection were estimated by means of conditional logistic regression. SARS-CoV-2 Infection Score (SIS) was developed by generating a total aggregate score obtained from assignment of a weight at each selected covariate using coefficients estimated from the model. Finally, the score was categorized by assigning increasing values from 1 to 4. Discriminant power was used to compare SIS performance with that of other comorbidity scores. RESULTS Subjects suffering from diabetes, anaemias, Parkinson's disease, mental disorders, cardiovascular and inflammatory bowel and kidney diseases showed increased risk of SARS-CoV-2 infection. Similar estimates were recorded for men and women and younger and older than 65 years. Fifteen conditions significantly contributed to the SIS. As SIS value increases, risk progressively increases, being odds of SARS-CoV-2 infection among people with the highest SIS value (SIS = 4) 1.74 times higher than those unaffected by any SIS contributing conditions (SIS = 1). CONCLUSION Conditions and diseases making people more vulnerable to SARS-CoV-2 infection were identified by the current study. Our results support decision-makers in identifying high-risk people and adopting of preventive measures to minimize the spread of further epidemic waves.
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Affiliation(s)
- Valentina Orlando
- CIRFF, Center of Drug Utilization and Pharmacoeconomics, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Federico Rea
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Laura Savaré
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Ilaria Guarino
- CIRFF, Center of Drug Utilization and Pharmacoeconomics, University of Naples Federico II, Naples, Italy
| | - Sara Mucherino
- CIRFF, Center of Drug Utilization and Pharmacoeconomics, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Alessandro Perrella
- Infectious Disease of Healthcare Direction, AORN Antonio Cardarelli, Naples, Italy
| | - Ugo Trama
- Regional Pharmaceutical Unit, Campania Region, Naples, Italy
| | - Enrico Coscioni
- Division of Cardiac Surgery, AOU San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Enrica Menditto
- CIRFF, Center of Drug Utilization and Pharmacoeconomics, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
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Ciaffi J, Morabito MF, Ruscitti P, D'Angelo S, Mancarella L, Brusi V, Abignano G, Pucino V, Giacomelli R, Meliconi R, Ursini F. Incidence, prevalence and mortality of systemic sclerosis in Italy: a nationwide population-based study using administrative health data. Rheumatol Int 2020; 41:129-137. [PMID: 33052445 DOI: 10.1007/s00296-020-04720-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023]
Abstract
To study incidence, prevalence and mortality of systemic sclerosis (SSc) in Italy, assessing epidemiological differences between men and women and in distinct age groups. We performed a nationwide population-based study using administrative health data from regional co-payment exemption registries. Patients entitled with SSc-specific co-payment exemption were included. Fourteen of the 20 Italian regions contributed data covering a population of over 45 million individuals. Crude annual incidence rate, annual prevalence, crude annual mortality rate and standardised mortality ratio (SMR) were calculated. In 2016, the overall crude incidence rate of SSc was 18.5 (95% CI 16.9-20.2) per million per year. Incidence rate was 31.0 (95% CI 28.1-34.1) per million in women, and 4.3 (95% CI 3.2-5.6) per million in men. Peak incidence was observed in the age range 55-69 years. Overall annual prevalence was 306.1 (95% CI 301.1-311.2) per million. Prevalence was 530.8 (95% CI 521.5-540.2) per million in women and 67.8 (95% CI 64.4-71.3) per million in men, with a female to male ratio of 7.8:1. Highest prevalence was observed in the range 70-84 years. Crude annual mortality rate was 27.9 (95% CI 24.9-31.1) per 1000 patients. Overall SMR in patients with SSc was 2.8 (95% CI 1.9-3.8). SMR was 3.8 (95% CI 2.9-5.1) in men and 2.6 (95% CI 1.8-3.6) in women. We provided updated estimates on epidemiology of SSc in Italy. Our findings on incidence, prevalence and mortality of SSc are consistent with previously published literature.
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Affiliation(s)
- Jacopo Ciaffi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Via Pupilli 1, 40136, Bologna, Italy.
| | - Maria Francesca Morabito
- Department of Economics, Statistics and Finance "Giovanni Anania", University of Calabria, Cosenza, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Salvatore D'Angelo
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania (IReL), San Carlo Hospital of Potenza, Madonna Delle Grazie Hospital of Matera, Potenza, Italy
| | - Luana Mancarella
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Via Pupilli 1, 40136, Bologna, Italy
| | - Veronica Brusi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Via Pupilli 1, 40136, Bologna, Italy
| | - Giuseppina Abignano
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania (IReL), San Carlo Hospital of Potenza, Madonna Delle Grazie Hospital of Matera, Potenza, Italy
| | - Valentina Pucino
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Riccardo Meliconi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Via Pupilli 1, 40136, Bologna, Italy.,Section of Rheumatology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Francesco Ursini
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Via Pupilli 1, 40136, Bologna, Italy.,Section of Rheumatology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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16
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Moccia M, Brescia Morra V, Lanzillo R, Loperto I, Giordana R, Fumo MG, Petruzzo M, Capasso N, Triassi M, Sormani MP, Palladino R. Multiple Sclerosis in the Campania Region (South Italy): Algorithm Validation and 2015-2017 Prevalence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103388. [PMID: 32414017 PMCID: PMC7277756 DOI: 10.3390/ijerph17103388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022]
Abstract
We aim to validate a case-finding algorithm to detect individuals with multiple sclerosis (MS) using routinely collected healthcare data, and to assess the prevalence of MS in the Campania Region (South Italy). To identify individuals with MS living in the Campania Region, we employed an algorithm using different routinely collected healthcare administrative databases (hospital discharges, drug prescriptions, outpatient consultations with payment exemptions), from 1 January 2015 to 31 December 2017. The algorithm was validated towards the clinical registry from the largest regional MS centre (n = 1460). We used the direct method to standardise the prevalence rate and the capture-recapture method to estimate the proportion of undetected cases. The case-finding algorithm including individuals with at least one MS record during the study period captured 5362 MS patients (females = 64.4%; age = 44.6 ± 12.9 years), with 99.0% sensitivity (95% CI = 98.3%, 99.4%). Standardised prevalence rate per 100,000 people was 89.8 (95% CI = 87.4, 92.2) (111.8 for females [95% CI = 108.1, 115.6] and 66.2 for males [95% CI = 63.2, 69.2]). The number of expected MS cases was 2.7% higher than cases we detected. We developed a case-finding algorithm for MS using routinely collected healthcare data from the Campania Region, which was validated towards a clinical dataset, with high sensitivity and low proportion of undetected cases. Our prevalence estimates are in line with those reported by international studies conducted using similar methods. In the future, this cohort could be used for studies with high granularity of clinical, environmental, healthcare resource utilisation, and pharmacoeconomic variables.
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Affiliation(s)
- Marcello Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (V.B.M.); (R.L.); (M.P.); (N.C.)
- Correspondence: or ; Tel./Fax: +39-081-7462670
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (V.B.M.); (R.L.); (M.P.); (N.C.)
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (V.B.M.); (R.L.); (M.P.); (N.C.)
| | - Ilaria Loperto
- Department of Public Health, Federico II University, 80131 Naples, Italy; (I.L.); (M.T.); (R.P.)
| | - Roberta Giordana
- Campania Region Healthcare System Commissioner Office, 80131 Naples, Italy;
| | | | - Martina Petruzzo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (V.B.M.); (R.L.); (M.P.); (N.C.)
| | - Nicola Capasso
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; (V.B.M.); (R.L.); (M.P.); (N.C.)
| | - Maria Triassi
- Department of Public Health, Federico II University, 80131 Naples, Italy; (I.L.); (M.T.); (R.P.)
| | - Maria Pia Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, 16121 Genoa, Italy;
| | - Raffaele Palladino
- Department of Public Health, Federico II University, 80131 Naples, Italy; (I.L.); (M.T.); (R.P.)
- Department of Primary Care and Public Health, Imperial College, London SW7 2AZ, UK
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17
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Marino C, Ferraro PM, Bargagli M, Cascini S, Agabiti N, Gambaro G, Davoli M. Prevalence of chronic kidney disease in the Lazio region, Italy: a classification algorithm based on health information systems. BMC Nephrol 2020; 21:23. [PMID: 31992222 PMCID: PMC6986004 DOI: 10.1186/s12882-020-1689-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/14/2020] [Indexed: 01/13/2023] Open
Abstract
Background Estimating CKD prevalence is difficult. Information on CKD prevalence is rather scanty in Italy and available figures come from surveys in selected geographical areas. Administrative data have been already demonstrated to be an effective tool in estimating the epidemiological burden of diseases, however there is limited experience in literature as far as CKD is concerned. Methods The aim of this study is to develop an algorithm based on regional Health Administrative Databases to identify individuals with CKD and provide estimates of disease prevalence in Lazio Region (Italy); about 5.500.000 inhabitants in 2017. A population-level analysis based on a record-linkage strategy using data from Health Administrative Databases has been applied in Lazio Region. CKD cases were identified between January 1, 2012 and December 31, 2017 using Outpatient Specialist Service Information System, Hospital Discharge Registry, Ticket Exemption Registry and Drug Dispensing Registry. Age-specific and standardized prevalence rates were calculated by gender. CKD cases were classified as higher and lower severity. Results The algorithm identified 99,457 individuals with CKD (mean age 71 years, 55.8% males). The exclusive contributions of each regional source used were: 35,047 (35.2%) from Outpatient Specialist Service Information System, 27,778 (27.9%) from Hospital Discharge Registry, 4143 (4.2%) from Ticket Exemption Registry and 463 (0.5%) from Drug Dispensing Registry; 5.1% of cases were found in all databases. The standardized prevalence rate at December 31, 2017 was 1.76, 2.06% for males and 1.50% for females. The prevalence increased with age, rising from 0.33% (age 0–18) up to 14.18% (age 85+) among males and from 0.25% up to 8.18% among females. The proportion of CKD individuals with lower severity disease was 78.7% in both genders. Conclusions The proposed algorithm represents a novel tool to monitor the burden of CKD disease, that can be used by the regional government to guide the development and implementation of evidence-based pathways of care for CKD patients. The high prevalence of people with CKD of lower severity should be carefully considered in order to promote diagnosis and optimal management at early stages.
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Affiliation(s)
- Claudia Marino
- Department of Epidemiology Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Roma, Italy.
| | - Pietro Manuel Ferraro
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Matteo Bargagli
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Silvia Cascini
- Department of Epidemiology Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Roma, Italy
| | - Nera Agabiti
- Department of Epidemiology Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Roma, Italy
| | - Giovanni Gambaro
- Department of Medicine, Renal Unit, Division of Nephrology and Dialysis, University of Verona, Piazzale Ludovico Antonio Scuro 10, 37134, Verona, Italy
| | - Marina Davoli
- Department of Epidemiology Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Roma, Italy
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18
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Farcomeni A. Population size estimation with interval censored counts and external information: Prevalence of multiple sclerosis in Rome. Biom J 2020; 62:945-956. [PMID: 31957128 DOI: 10.1002/bimj.201900268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022]
Abstract
We discuss Bayesian log-linear models for incomplete contingency tables with both missing and interval censored cells, with the aim of obtaining reliable population size estimates. We also discuss use of external information on the censoring probability, which may substantially reduce uncertainty. We show in simulation that information on lower bounds and external information can each improve the mean squared error of population size estimates, even when the external information is not completely accurate. We conclude with an original example on estimation of prevalence of multiple sclerosis in the metropolitan area of Rome, where five out of six lists have interval censored counts. External information comes from mortality rates of multiple sclerosis patients.
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Affiliation(s)
- Alessio Farcomeni
- Department of Economics and Finance, University of Rome "Tor Vergata,", Rome, Italy
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19
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Increasing prevalence of multiple sclerosis in Tuscany, Italy. Neurol Sci 2019; 41:397-402. [PMID: 31691867 DOI: 10.1007/s10072-019-04090-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND RATIONALE An increase of prevalence and incidence of multiple sclerosis (MS) has been reported in several countries, especially taking into account a long-term evaluation. This increasing trend often reflects improved case identification and ascertainment due to the refinement of diagnostic criteria. The aim of this study was to update the prevalence rate of MS in Tuscany (central Italy) as of 2017, and to assess if there has been an increasing trend of prevalence in this Region considering a short period of analysis, from 2014 to 2017. METHODS To capture prevalent cases, a case-finding algorithm based on administrative data, previously created and validated, was used. As data sources, we considered hospital discharge records, drug-dispensing records, disease-specific exemptions from copayment to health care, home and residential long-term care, and inhabitant registry. RESULTS As of January 1, 2017, 7809 cases were identified, of which 69.4% were females and 30.6% were males. Considering temporal variation, an increasing trend was observed, with standardized rates rising from 189.2 in 2014 to 208.7 per 100,000 in 2017. CONCLUSIONS Results confirm that prevalence increases every year, probably mainly due to the difference between incidence and mortality, resulting in an increasing trend. Moreover, administrative data may accurately identify MS patients in a routinary way and monitor this cohort along disease care pathways.
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20
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Campbell JA, Simpson S, Ahmad H, Taylor BV, van der Mei I, Palmer AJ. Change in multiple sclerosis prevalence over time in Australia 2010–2017 utilising disease-modifying therapy prescription data. Mult Scler 2019; 26:1315-1328. [DOI: 10.1177/1352458519861270] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Determine the prevalence of multiple sclerosis (MS) in Australia in 2017 using MS-specific disease-modifying therapy (DMT) prescription data and estimate the change in prevalence from 2010. Methods: DMT prescriptions were extracted from Australia’s Pharmaceutical Benefits Scheme (PBS) data for January–December 2017. Percentages of people with MS using DMTs (DMT penetrance) were calculated using data from the Australian MS Longitudinal Study. Prevalence was estimated by dividing the total number of monthly prescriptions by 12 (except alemtuzumab), adjusted for DMT penetrance and Australian population estimates. Prevalences in Australian states/territories were age-standardised to the Australian population. Comparisons with 2010 prevalence data were performed using Poisson regression. Results: Overall DMT penetrance was 64%, and the number of people with MS in Australia in 2017 was 25,607 (95% confidence interval (CI): 24,874–26,478), a significant increase of 4324 people since 2010 ( p < 0.001). The prevalence increased significantly from 95.6/100,000 (2010) to 103.7/100,000 (2017), with estimates highest in Tasmania in 2017 (138.7/100,000; 95% CI: 137.2–140.1) and lowest in Queensland (74.6/100,000; 95% CI: 73.5–75.6). From 2010 to 2017 using the median latitudes for each state/territory, the overall latitudinal variation in MS prevalence was an increase of 3.0% per degree-latitude. Conclusion: Consistent with global trends, Australia’s MS prevalence has increased; this probably reflecting decreased mortality, increased longevity and increased incidence.
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Affiliation(s)
- Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
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21
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Urru SAM, Antonelli A, Sechi GM. Prevalence of multiple sclerosis in Sardinia: A systematic cross-sectional multi-source survey. Mult Scler 2019; 26:372-380. [DOI: 10.1177/1352458519828600] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Partial surveys in sub-regions of Sardinia have suggested a high prevalence of multiple sclerosis (MS) on the island, relative to other Mediterranean populations. We assessed the island-wide prevalence of MS and its detailed distribution in Sardinia. Methods: The study population consisted of 5677 MS patients, 1735 men and 3942 women, living in Sardinia. Neurologists retrospectively examined electronic and paper-based records of patients with a diagnosis of MS. The data were then linked to the administrative health information systems. Crude, age-, and sex-specific prevalence estimates of disease were calculated. Results: The overall age-adjusted MS prevalence was 330 per 100,000 (95% confidence interval (CI) 321–338) in individuals older than 15 years, 447 in women (95% CI 433–461), and 205 in men (95% CI 195–214). The prevalence was highest in the Ogliastra and Nuoro districts, respectively, 425 (95% CI 372–478) and 419 (95% CI 387–451), and lowest in the Olbia-Tempio district, 217 (95% CI 195–239). Most cases had relapsing–remitting MS (79.3%), 16.3% had secondary-progressive MS, and 4.4% had primary-progressive MS. Conclusion: These prevalence are among the highest reported so far worldwide. They provide estimates for comparative analyses in other populations and are essential for public health interventions.
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Affiliation(s)
- Silvana AM Urru
- Biosciences Sector, CRS4, Science and Technology Park Polaris—Piscina Manna, Pula, Italy
| | - Antonello Antonelli
- Department of Clinical Governance, Sardinia Region Health Service, Cagliari, Italy
| | - Giuseppe M Sechi
- Department of Clinical Governance, Sardinia Region Health Service, Cagliari, Italy
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22
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Bezzini D, Policardo L, Profili F, Meucci G, Ulivelli M, Bartalini S, Francesconi P, Battaglia MA. Multiple sclerosis incidence in Tuscany from administrative data. Neurol Sci 2018; 39:1881-1885. [DOI: 10.1007/s10072-018-3513-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
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23
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Healthcare resources utilisation in primary progressive multiple sclerosis. Neurol Sci 2018; 39:1169-1174. [DOI: 10.1007/s10072-018-3404-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/31/2018] [Indexed: 11/30/2022]
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24
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Farcomeni A, Cortese A, Sgarlata E, Alunni Fegatelli D, Marfia GA, Buttari F, Mirabella M, De Fino C, Prosperini L, Pozzilli C, Grasso MG, Iasevoli L, Di Battista G, Millefiorini E. The Prevalence of Multiple Sclerosis in the Metropolitan Area of Rome: A Capture-Recapture Analysis. Neuroepidemiology 2018; 50:105-110. [PMID: 29502114 DOI: 10.1159/000487005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/18/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Limited data are available on the prevalence of multiple sclerosis (MS) in central Italy. The objective of this study is to estimate MS prevalence in the metropolitan area of Rome. METHODS We used the capture-recapture method to calculate prevalence estimates in the study area. The selected prevalence day was December 31, 2015. A total of 1,007 patients, with a definite diagnosis of MS according to the revised McDonald's criteria, were considered for crude, age- and sex-specific prevalence estimation. RESULTS The overall crude prevalence rate was 146.2 cases per 100,000 (95% CI 119.9-172.5). A higher prevalence rate was recorded in females (194.1, 95% CI 149.6-238.6) than in males (93.0, 95% CI 67.2-118.8) with a female to male ratio of 1.8. Age-specific prevalence peaked in the 25-34 , 35-44 and 45-54 years class; moreover, it was found to increase up to the 45-54 years age group in females and the 35-44 years age group in males, decreasing thereafter. CONCLUSION The results confirm that the metropolitan area of Rome is a high-risk area for MS.
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Affiliation(s)
- Alessio Farcomeni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonio Cortese
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Eleonora Sgarlata
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Gerolama Alessandra Marfia
- Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Fabio Buttari
- Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Chiara De Fino
- Multiple Sclerosis Center, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Luca Prosperini
- Multiple Sclerosis Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy.,Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Luigi Iasevoli
- Multiple Sclerosis Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Enrico Millefiorini
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
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25
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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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26
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Salhofer-Polanyi S, Cetin H, Leutmezer F, Baumgartner A, Blechinger S, Dal-Bianco A, Altmann P, Bajer-Kornek B, Rommer P, Guger M, Leitner-Bohn D, Reichardt B, Alasti F, Temsch W, Stamm T. Epidemiology of Multiple Sclerosis in Austria. Neuroepidemiology 2017; 49:40-44. [PMID: 28848208 DOI: 10.1159/000479696] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 07/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To assess the incidence rate and prevalence ratio of multiple sclerosis (MS) in Austria. METHODS Hospital discharge diagnosis and MS-specific immunomodulatory treatment prescriptions from public health insurances, covering 98% of Austrian citizens with health insurance were used to extrapolate incidence and prevalence numbers based on the capture-recapture method. RESULTS A total of 1,392,629 medication prescriptions and 40,956 hospitalizations were extracted from 2 data sources, leading to a total of 13,205 patients. The incidence rate and prevalence ratio of MS in Austria based on the capture-recapture method were 19.5/100,000 person-years (95% CI 14.3-24.7) and 158.9/100,000 (95% CI 141.2-175.9), respectively. Female to male ratio was 1.6 for incidence and 2.2 for prevalence. CONCLUSIONS Incidence rates and prevalence ratios of MS in our study are within the upper range of comparable studies across many European countries as well as the United States.
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27
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Colais P, Agabiti N, Davoli M, Buttari F, Centonze D, De Fino C, Di Folco M, Filippini G, Francia A, Galgani S, Gasperini C, Giuliani M, Mirabella M, Nociti V, Pozzilli C, Bargagli A. Identifying Relapses in Multiple Sclerosis Patients through Administrative Data: A Validation Study in the Lazio Region, Italy. Neuroepidemiology 2017; 48:171-178. [PMID: 28793295 DOI: 10.1159/000479515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Relapse is frequently considered an outcome measure of disease activity in relapsing-remitting multiple sclerosis (MS). The objectives of this study were to identify relapse episodes in patients with MS in the Lazio region using health administrative databases and to evaluate the validity of the algorithm using patients enrolled at MS treatment centers. METHODS MS cases were identified in the period between January 1, 2006 and December 31, 2009 using data from regional Health Information Systems (HIS). An algorithm based on HIS was used to identify relapse episodes, and patients recruited at MS centers were used to validate the algorithm. Positive and negative predictive values (PPV, NPV) and the Cohen's kappa coefficient were calculated. RESULTS The overall MS population identified through HIS consisted of 6,094 patients, of whom 67.1% were female and the mean age was 41.5. Among the MS patients identified by the algorithm, 2,242 attended the centers and 3,852 did not. The PPV was 58.9%, the NPV was 76.3%, and the kappa was 0.36. CONCLUSIONS The proposed algorithm based on health administrative databases does not seem to be able to reliably detect relapses; however, it may be a helpful tool to detect healthcare utilization, and therefore to identify the worsening condition of a patient's health.
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Affiliation(s)
- Paola Colais
- Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy
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Giorda CB, Carnà P, Romeo F, Costa G, Tartaglino B, Gnavi R. Prevalence, incidence and associated comorbidities of treated hypothyroidism: an update from a European population. Eur J Endocrinol 2017; 176:533-542. [PMID: 28179450 DOI: 10.1530/eje-16-0559] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 01/19/2017] [Accepted: 02/07/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Estimates of the prevalence of hypothyroidism in unselected populations date from the late 1990s. We present an update on the prevalence and incidence of overt hypothyroidism in Piedmont, northwest Italy and examine the association between hypothyroidism and multiple chronic comorbidities. DESIGN AND METHODS Data were obtained from drug prescription and hospital discharge databases. Individuals who had received at least two levothyroxine prescriptions in 2012 were defined as having hypothyroidism; those who had undergone thyroidectomy or I131 irradiation in the previous 5 years were defined as having iatrogenic hypothyroidism and those who had either obtained exemption from treatment co-payment or had been discharged from hospital with a chronic comorbidity (diabetes and connective tissue diseases) were identified as having one of these conditions. RESULTS The overall crude prevalence was 31.1/1000 (2.3/1000 for iatrogenic hypothyroidism) and the overall crude incidence was 7/1000. The average daily dose of thyroxine (122 µg) roughly corresponded to 1.7 µg/kg. There was a strong association between hypothyroidism and diabetes (type 1, type 2 or gestational) and with autoimmune diseases, with the odds ratio ranging from 1.43 (1.02-1.99) for psoriatic arthritis to 4.99 (3.06-8.15) for lupus erythematosus. CONCLUSIONS As compared with previous estimates, the prevalence of hypothyroidism rose by about 35%, driven mainly by non-iatrogenic forms. The increase may be due to either population aging or improved diagnostic capability or both. The frequent co-occurrence of hypothyroidism with other multiple chronic conditions characterizes it more as a comorbidity rather than an isolated chronic disease.
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Affiliation(s)
| | - Paolo Carnà
- Epidemiology UnitRegione Piemonte, Grugliasco, Italy
| | | | - Giuseppe Costa
- Epidemiology UnitRegione Piemonte, Grugliasco, Italy
- Department of Public HealthUniversity of Torino, Torino, Italy
| | | | - Roberto Gnavi
- Epidemiology UnitRegione Piemonte, Grugliasco, Italy
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Abstract
Multiple sclerosis is characterized by a non-homogeneous distribution around the world. Some authors in past described a latitude gradient, with increasing risk from the equator to North and South Poles, but this theory is still controversial. Regarding Europe, there are many articles in the literature concerning the epidemiology of this disease but, unfortunately, they are not always comparable due to different methodologies, they do not cover all countries in the continent, and most of them reported data of small areas and rarely at a national level. In 2012 there were 20 national registries that could help to describe the epidemiology of the disease and, in addition, there is an European Register for Multiple Sclerosis that collect data from already existing national or regional MS registries and databases. Another valid alternative to obtain epidemiological data, also at national level, in a routinely and cost-saving way is through administrative data that are of increasing interest in the last years.
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