The frequency of multiple sclerosis in jewish and arab populations in greater jerusalem

A comparison of the incidence rate (IR) and the prevalence rate (PR) of multiple sclerosis (MS) in subgroups of the same ethnic origin, but born and living in different geographical areas, may delineate the relationship between environmental and genetic risk factors for MS. Previous epidemiological studies of MS in Israel did not include the Arab population and used diagnostic criteria that did not include MRI findings. Therefore, we studied the age-adjusted IR and PR of MS in a more recent sample in different population groups, including Arabs, of Greater Jerusalem. We found that the PR of MS in Israeli Jews is higher than previously described. Furthermore, the PR was significantly lower among immigrant Jews from Asia/Africa (A/A) than among native-born Jews of Asian/African origin (I-A/A). Since these groups have similar genetic susceptibilities to MS, the higher PR in the latter is probably due to environmental factors. Our study does not support the effect of latitude on the risk of developing MS since no difference in the PR was found between immigrant Jews from Europe/America (E/A) and native-born Jews of European/American origin (I-E/A). Among Arabs, the PR was similar to that among A/A. Therefore, we hypothesized similarity in environmental etiologic factors for MS between the countries of origin of A/A immigrants and of Arabs communities in Greater Jerusalem. The IR of I-E/A was higher than that of I-A/A and Arabs, although this difference did not reach statistical significance.     

The risk of motor neurone disease and multiple sclerosis is different in Estonians and Russians. Data from South Estonia

Epidemiological studies were performed in South Estonia to establish the prevalence rate of multiple sclerosis (MS) and motor neurone disease (MND). The case finding method included information from the hospital records of the central hospital in the region-the University Hospital (for MS from 1942 to 1989), from all neurologists in the region, from the Estonian MS Society and Association of Muscular Disorders, and from nursing homes in the region. The prevalence day was 31 December 1989. MND incidence was established for the period of 1986-1995. The results demonstrated high prevalence rates of MS among native Estonians (55.3 per 100 000), somewhat lower prevalence among native-born representatives of other nationalities (43.6 per 100 000) and the lowest prevalence rate of MS among non-Estonian immigrants (26.6 per 100 000). The differences were not statistically significant. The results for MND demonstrated the opposite pattern. The mean annual incidence rate of MND for 10 years was statistically significantly higher among people of other nationalities (2.5 per 100 000) and Russians (2.6 per 100 000), and lower in native-born Estonians (1.1 per 100 000). No differences in health care or clinical picture were established. The reasons for the demonstrated differences in MND incidence remain unclear.     

Multiple sclerosis in Malta in 1999: an update

OBJECTIVES: To ascertain the prevalence of multiple sclerosis (MS) in the islands of Malta and compare it with a previous study undertaken 21 years earlier, when a remarkably low prevalence was found. METHOD: Deaths with MS on the death certificate since the last study were reviewed. Sources of information about new patients were the Hospital Activity Analysis scheme, the MS Society of Malta, the records of the state hospitals, long stay private hospitals and nursing homes, lists provided by the state pharmacies, and magnetic resonance imaging, cerebrospinal fluid, and evoked response studies. Prevalence day was 1 January 1999. The Poser classification was used. RESULTS: Since 1978, 17 patients had died with a verified diagnosis of MS on the death certificate. They included all 10 deaths with MS from the original study and two immigrants. Fifty patients had clinically definite MS (CDMS) and 13 clinically probable MS (CPMS). The prevalence of CDMS was 13.2/100 000 (male 11.2, female 15.2). The prevalence of CDMS and CPMS combined was 16.7/100,000 (male 13.3, female 19.9). The annual incidence was 0.7/100,000. Twelve patients were found with CDMS among the 7213 immigrants resident in Malta (166/100,000). The expected rate was 1/100,000, determined at Maltese born rates. There were major changes in the population distribution during the 21 years between the two studies, with a big increase in the age groups with a high risk of MS. There is a longer expectation of life and the diagnosis in now made earlier. CONCLUSION: Malta still has a low MS prevalence. In comparison with Sicily and other Mediterranean countries of Europe it offers an opportunity to ascertain the genetic and environmental factors responsible for the disease.     

A prevalence estimate of pervasive developmental disorder among Immigrants to Israel and Israeli natives

BACKGROUND: The prevalence rates of pervasive developmental disorder (PDD) have risen in the West over the last 10 years. There is argument over the etiology of this change in rates. Social and cultural processes including migration have been hypothesized. Israel, as a country of ongoing immigration with a national registry of children diagnosed with PDD, offers an opportunity to compare rates of PDD among immigrants from developing countries and native Israelis. METHOD: A Social Security national registry of 1004 children diagnosed with PDD was reviewed and rates were calculated using data extracted from the Israel National Bureau of Statistics. Of all Jewish children that were born in the years 1983-1997 and who are currently living in Israel, we defined four groups: (1). native Israelis of non-Ethiopian extraction (N = 1198, 300), (2). native Israelis of Ethiopian extraction (N = 15600), (3). immigrants of non-Ethiopian extraction (N = 110300) and (4). children born in Ethiopia (N = 11800). A further breakdown of groups 1 and 3 by well-characterized ethnic or geographical origins was not possible. RESULTS: The rate of PDD was significantly elevated in native Israelis as compared to all immigrant children. Among immigrants, the rate of PDD in Ethiopian-born children was lower than that of those born in other countries. The rate of PDD in immigrant Ethiopian children was much lower than in native Israeli children of Ethiopian extraction. CONCLUSIONS: Birth in Israel, an industrialized country, is a marker for an environmental risk factor for PDD. This may indicate that gestation, birth or infancy in industrialized countries exposes children to environmental insults that increase the risk for contracting PDD.     

Point prevalence of schizophrenia in immigrant groups in Rotterdam: data from outpatient facilities.

OBJECTIVE: Reports of an increased incidence of schizophrenia in some immigrant groups to The Netherlands are based exclusively on hospital data. The aims of our study were: 1) to determine the treated point prevalence of schizophrenia at outpatient mental health services in Rotterdam and to compare the results for immigrants to those for natives; and 2) to compare groups born in The Netherlands and immigrant groups in terms of the proportions of patients with a previous hospital admission. METHOD: We included all patients aged between 20 and 64 who were treated for a non-affective psychosis at any of the outpatient mental health services in Rotterdam on October 1, 1994. The mental health professionals responsible reported on the socio-demographic and clinical characteristics of each patient. RESULTS: Seven hundred and thirteen patients with a diagnosis of schizophrenia (DSM-III-R) were identified (rate: 2.1 per 1000). The (treated) prevalence of schizophrenia in male immigrants from Surinam and Morocco and in female immigrants from Surinam, the Netherlands Antilles and Cape Verde was significantly higher than that in their native-born counterparts (odds ratios between 2 and 3). The (treated) prevalence was not significantly higher in immigrants from Turkey, female immigrants from Morocco or male immigrants from the Antilles. Proportions of patients with a previous hospital admission were similar in each ethnic group (81-93%). CONCLUSION: These findings are generally in line with earlier studies, based on the Dutch psychiatric registry, which has reported an increase in the (treated) incidence of schizophrenia in immigrants from Surinam and the Netherlands Antilles and in male immigrants from Morocco, and no increase in the (treated) incidence in immigrants from Turkey or female immigrants from Morocco.     

Multiple sclerosis among the United Kingdom-born children of immigrants from the West Indies.

Multiple sclerosis has been reported to be very uncommon in the West Indies. In previous studies immigrants from the West Indies resident in Greater London had only one-eighth the likelihood of being diagnosed in hospital as having multiple sclerosis compared with those born in the United Kingdom. No studies of the incidence and prevalence of multiple sclerosis were available for London or South East England but there is evidence that it is much the same as occurs in Ireland. In the age groups studied the United Kingdom-born children of West Indian immigrants had an incidence and prevalence of probable multiple sclerosis of the same order as has been reported in Northern Ireland and in the Irish Republic. Although there is evidence that genetic factors play a part, our findings are strong evidence that the cause of the disease is mainly environmental and is therefore potentially preventable.     

Multiple sclerosis in Oslo, Norway: prevalence on 1 January 1995 and incidence over a 25-year period

The Oslo Multiple Sclerosis (MS) Registry was established in 1990, and this is the first report on the prevalence and incidence of MS in the city of Oslo, Norway. The prevalence rate of definite MS on 1 January 1995 was 120.4/10(5). Inclusion of patients of native Norwegian ancestry only and exclusion of non-Norwegian immigrants yielded a prevalence rate of 136.0/10(5). A similar prevalence rate (136.5/10(5)) was found when patients and immigrants from the other Nordic countries (Finland, Sweden, Denmark) were included. Segregation of the native Norwegian patients according to the counties where they were born showed no significant differences except for a disproportionate increase of patients born in the inland county of Oppland. A total of 794 cases were resident in Oslo at the time of a diagnosis of definite MS in the period 1972-99. The crude average annual incidence rate for each 5-year period, between 1972 and 1996, increased significantly from 3.7/10(5) in the 1972-76 to 8.7/10(5) in the 1992-96 period. The increase was more marked in relapsing-remitting (RR) than in primary progressive disease and in female cases.     

Prevalence of multiple sclerosis in Iranian emigrants: review of the evidence

Iran has the highest prevalence of multiple sclerosis (MS) in the Middle East and Asia. Rate of emigration has been significantly raised among Iranians and though, multiple studies have been published on prevalence of MS among Iranian emigrants. Here we systematically reviewed these publications. We performed a comprehensive literature search was performed on April 30, 2015 in data bases of MEDLINE, EMBASE, Scopus and Google Scholar for the terms ‘multiple sclerosis’, ‘incidence’, ‘prevalence’, ‘epidemiology’, ‘migration’, ‘emigrant’, ‘immigrant’, ‘Iran’, ‘Parsis’ and ‘Persian’. Study location, prevalence day or period, and age of at disease onset were recorded for all the included publications. Nine publications from Sweden, Canada, Norway, UK, and India were included. Only three reported age-adjusted prevalence and six reported age of disease onset. MS prevalence among Iranian emigrants varied from 21 per 100,000 people in Bombay, India in 1985 to 433 per 100,000 people in British Columbia, Canada in 2012. Five studies reported the prevalence in the region of interest, ranging from 1.33 in Bombay, India to 240 in British Columbia, Canada. Five studies also reported the prevalence of MS in the population of the destination country, and in all of them, the prevalence of MS was higher in Iranian immigrants compared to native people. Prevalence studies performed in Iran and also on Iranian emigrants indicate roles for both genetic and environmental factors in MS susceptibility. Data might indicate that living in a high-risk area increases the susceptibility to MS.     

Differences in age of first hospitalization for schizophrenia among immigrants and nonimmigrants in a national case registry

While previous studies have found an increased incidence of schizophrenia in some immigrant groups, differences in age of onset in these groups has not been examined. The purpose of this study was to compare age of first hospitalization of (1) native-born people versus immigrants, (2) immigrants from different countries of origin, and (3) first generation immigrants versus second generation immigrants; and to reexamine gender differences in age of first hospitalization. Data were extracted on all first hospital admissions nationally for the years 1978-1992 (n = 10,902) from the National Psychiatric Hospitalization Case Registry of the State of Israel Ministry of Health. Immigrants were older at time of first hospitalization than nonimmigrants, with considerable variations between different countries of origin. Second generation immigrants (i.e., born in Israel to immigrant parents) had ages of first hospitalization similar to people with native-born parents. Males had earlier ages at first hospitalization than females. The results suggest that immigration may have a delaying effect on age of first admission and support previous findings regarding gender difference in age of onset.     

The higher prevalence of multiple sclerosis among Iranian Georgians; new clues to the role of genetic factors

BackgroundMultiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) with varied prevalence rates among populations with different ethnic backgrounds. Therefore, studies done on minorities have shed more light on the risk factors.ObjectiveComparing MS prevalence in Georgian-based population immigrated to Iran and other Iranians.MethodsAll records of MS patients enrolled in the two biggest registry systems were investigated. All of the patients born in Fereydunshahr and Buin va Miandasht (2 biggest cities with Georgian immigrants) were interviewed and their baseline characteristics were obtained. Patients’ ethnic background information were obtained from the Iran National organization for civil registration.ResultsForty-one patients from Fereydunshahr and Buin va Miandasht were identified. The population of the two cities combined and the estimated number of Georgian-based patients in both cities were reported 59817 and 12000, respectively. The estimated ethnicity-adjusted prevalence among the Georgian-based individuals was 2.3 times higher than the non-Georgian ones. Baseline characteristics were also compared.ConclusionThere was a higher prevalence of multiple sclerosis among the Georgian minority of Isfahan. Due to the ethnic background of the Georgian minority, genetic risk factors should be considered more as a risk factor.     

First admission rates for schizophrenia in immigrants to the Netherlands

Data from the Dutch national register were examined in order to determine first admission rates for schizophrenia in the four largest immigrant groups to the Netherlands (from the countries of Surinam, the Netherlands Antilles, Turkey and Morocco). Rates for immigrants from Surinam and the Netherlands Antilles exceeded by far those of the antive-born population. Differences in proportions of compulsory first admissions between young male immigrants from these countries and their native-born counterparts were small and statistically not significant. Rates of first admissions for young male immigrants from Morocco were also much higher than those for the native-born population, but rates for female immigrants from Morocco and for immigrants from Turkey were not increased. These results support British studies reporting an increased incidence of schizophrenia in Caribbean immigrants to the United Kingdom.Published in part by the Nederlands Tijdschrift voor Geneeskunde (in Dutch): 1994, 138: 345–350     

STUDIES ON THE CLUSTERING OF MULTIPLE SCLEROSIS IN FINLAND II: MICROEPIDEMIOLOGY IN ONE HIGH-RISK COUNTY WITH SPECIAL REFERENCE TO FAMILIAL CASES

The epidemiology of multiple sclerosis (MS) was investigated in a small selected area within the western high-risk county of Finland. The investigation was extended to the level of single communes, villages and even houses, together with the search for all familial cases born in this district. The results were compared to those obtained for Helsinki, a city of medium-risk for MS. Prevalences by present domicile that exceeded 100 per 1000,000 inhabitants were recorded in several communes of the western high-risk county. The highest prevalence was 174.2. Seventy patients were born in the small high-risk area. This was 25% of the MS patients born in the whole county and much higher than expected (16%). A positive familial history of another MS patient was recorded in 8 cases (11%). They were all living, first-degree relatives. A similar history was found in only 2 cases (2%) among the 99 MS patients born in Helsinki. The birthplaces of the 123 parents of these 70 MS cases could be confirmed. All villages with high MS frequencies were located along the rivers, running through the area. The birthplaces of the patients showed a similar accumulation to the valleys. No conjugal cases were found. If the preponderance of familial cases in the small high-risk area reflects the role of genetic factors in the aetiology of MS, it is only of polygenic nature. The pronounced clustering of the birthplaces in the small high-risk area and, especially, along the rivers also suggests the importance of environmental influences in early childhood.     

High incidence of Creutzfeldt-Jakob disease in North African immigrants to France

During the 15-year period 1968-1982, 328 French residents died of Creutzfeldt-Jakob disease (CJD); 273 had been born in France (annual mortality rate of 0.38 per million inhabitants). Of the 55 foreign-born cases, 12 came from Tunisia and 11 from Algeria (mortality rates of 4.53 and 0.95 per million). Nearly all of the Tunisians were Jews, and six belonged to two families. These findings complement earlier observations on Libyan-born Israelis, but still do not discriminate between genetic or environmental causal factors, which will require epidemiologic investigation of CJD in North Africa.     

Cancer in schizophrenia: is the risk higher or lower?

Studies exploring the relationship between schizophrenia and cancer have shown conflicting results. Our study explores this association in three Jewish-Israeli population groups defined by their continent/place of birth (Israel, Europe-America, and Africa-Asia). The identification of the patients was made through the linkage of the nationwide psychiatric and cancer registries. The incidence of cancer in patients diagnosed with schizophrenia was compared with the incidence in the general population. The results showed that the cancer standardized incidence ratios (SIRs) for all sites were significantly lower among men and women with schizophrenia, 0.86 [95% confidence interval (CI) 0.80-0.93] and 0.91 (95% CI 0.85-0.97), respectively. This reduced overall risk was clearest for those born in Europe-America, both men (SIR 0.85, 95% CI 0.74-0.97) and women (SIR 0.86, 95% CI 0.77-0.94). Among women diagnosed with schizophrenia, the SIR was statistically higher for cancer in the breast among those born in Asia-Africa (1.37, 95% CI 1.12-1.63) and in the corpus uteri among the Israel-born (2.75, 95% CI 1.69-3.81) than among their counterparts in the general population. Lung cancer was significantly higher in men born in Asia-Africa diagnosed with schizophrenia than in the respective comparison population group (1.58, 95% CI 1.13-2.2). Our findings, and those of the literature, justify conducting a multinational study that includes identification of cancer-related risk factors among patients with schizophrenia and their families, and information on the use of psychotropic medications. This effort may clarify an epidemiological puzzle that remains outstanding.     

The epidemiology of multiple sclerosis: the Iceland model. Onset-adjusted prevalence rate and other methodological considerations.

The epidemiology of multiple sclerosis (MS) is characterized by the fact that there is an uneven distribution of the disease throughout the world. The two most commonly used indices of its frequency are the incidence and prevalence rates. The incidence rate reflects, to a great extent, the influence of environmental factors in triggering the clinical manifestations of the disease, if it is based upon the actual date of the initiation of symptoms, rather than the date of diagnosis. The prevalence rate is currently based on the date of diagnosis and includes all MS patients who are alive on a particular date, without regard to their ethnic origin, the site and the duration of residence or any other factors that may have influenced the acquisition of the disease. We propose that in order to make the concept of the prevalence rate possibly more meaningful, the term should refer, retrospectively, to all patients whose symptoms eventually led to the diagnosis of MS, even though the diagnosis was not yet established on an earlier prevalence day. In addition, only patients of the same ethnic background who have spent their prepuberal years in the geographical area under study should be included. We are calling this measure the onset-adjusted prevalence rate. Another problem encountered in epidemiological studies of MS relates to the common practice of adjusting prevalence data obtained for age and sex in one area to what is referred to as a "standard" American (or world) population, groups of great ethnic and age diversity. It is also curious that in many studies the bases for comparison of populations are census data obtained many years previously. We suggest that age and sex adjustment should be applied only to similar ethnic groups born and raised under different environmental conditions. We believe that data obtained by calculating an onset-adjusted prevalence rate restricted to a homogeneous group of patients sharing the same environment during the prepuberal years may provide valuable etiological clues.     

Genetic and environmental factors and the distribution of multiple sclerosis in Europe

Background: The observation that the incidence of multiple sclerosis (MS) increases further from the equator has prompted considerable interest in the factors that might underlie this latitude gradient. Potential candidates include population frequencies of disease‐associated Human Leukocyte Antigen (HLA) alleles which are the major genetic component of MS susceptibility. Ultraviolet (UV) exposure and smoking have also been implicated as key environmental risk factors. Methods: We used multiple sources of published data on MS prevalence, HLA allele frequencies, UV index and cigarette smoking to assess the contributions of both nature and nurture to the distribution of MS within Europe. Results: We observed that HLA alleles unequivocally interact with a population‐wide level to determine disease risk. The UV index and smoking behaviour was also shown to correlate with disease distribution in Europe. For countries with HLA, UV and smoking data, these three factors were shown to account for 75% of the variance in MS prevalence. Conclusions: Genetic (HLA) and environmental (UV and smoking) risk factors thus interact in a complex manner with each other to determine a large proportion of MS susceptibility within Europe.     

A systematic review of the epidemiology of multiple sclerosis in South America

Hundreds of publications dealing with the prevalence of multiple sclerosis (MS) throughout the world exist, but little data have been published from South America. Epidemiological studies of MS vary according to environmental, racial and genetic factors; a better understanding of MS in South America would help us to elucidate the disease pattern in this population. The aim of this study is to review the evidence relevant to MS epidemiology in South America. We performed a systematic review of articles of MS epidemiology in South America, with special emphasis on those providing information on the incidence and prevalence of MS (population‐based studies). Six papers provided information on MS epidemiology. One paper used the capture‐recapture methodology, while the remainder employed traditional methods to collect the data. Population‐based studies showed an MS prevalence rate ranging from 1.48 to 17 per 100 000 inhabitants. Available data suggest that the prevalence of MS is lower in South America than in developed countries. The reason for this observation is unknown. Some investigators suggest that certain environmental factors like sun exposure and vitamin D supplementation or the called ‘hygiene hypothesis’ may protect this population. Future studies will contribute to elucidate the etiology of that difference.     

Interactive influences of family and school ecologies on the depression status among children in marital immigrant families

The incidence of transnational marriage has increased significantly in Taiwan in recent years. Children born in immigrant families are predisposed to acculturation and learning problems. We aimed to determine if the children of marital immigrants are more depressed than children from native families, and examine the individual and joint effects of various factors on their depression risk. A cross-sectional study was performed to investigate the depression status of elementary school children in MiaoLi County, Taiwan. A total of 676 participants, including 157 children from families in which the mother was an immigrant and the father native to Taiwan, were recruited from 29 schools. A modified depression scale "Depression Screen Scale for Children and Adolescents" for domestic school children was used to determine depression status. Data which might relate to depression, including demographic, family and school variables, were collected with a structured questionnaire and analyzed with multivariate and stratification methods. The results show that 20.4% of children from immigrant mother families and 17.1% of children from native families exhibited depressive symptoms. The child-parent relationship, peer relationship and academic performance in school were found by logistic regression to be the main predictors of depression in immigrant family children. With further stratification analysis, synergistic effects in immigrant families were found between child-parent relationship and family climate and between peer relationship and academic performance, raising the risk of depression in children of marital immigrants by 7.26- and 7.71-fold, respectively. This synergistic effect was not observed in native families. This study provides significant evidence of synergistic effects between family variables and school variables which increase, up to more than 7-fold, the risk of depression in children of marital immigrants. The results provide hints to parents and teachers for improving the mental health of children in immigrant families by reducing the occurrence of depression.     

Multiple sclerosis complexity in selected populations: the challenge of Sardinia, insular Italy.

Several lines of evidence indicate a genetic contribution to multiple sclerosis (MS) both in terms of predisposition to the disease and of immunological mechanisms which are known to play crucial roles in MS pathogenesis. The presence of high- and low-risk areas for MS in neighbouring regions supports the theory that MS predisposition is influenced by a complex interaction of genetic and environmental factors. Therefore, the use of genetically homogeneous and geographically isolated populations becomes an increasing requirement to reduce biasing biological variables. Sardinians fulfil these conditions well because of their different phylogeny from Europeans and the unique selective pressures which shaped their genome. Sardinians display amongst the highest MS prevalence rates world-wide and increasing MS incidence rates over time. Also, MS in Sardinia is linked to distinct human leucocyte antigen (HLA) alleles and associated to different patterns of cytokine production from lymphoid cells of different HLA subtypes. In this context, recent findings and future perspectives on the peculiarities of Sardinian MS concerning genetic, immunological and epidemiological aspects are presented. So far, our results indicate that variations at the level of territorial distribution and HLA-association are present which render MS heterogeneous even in this ethnically homogeneous population.     

Marked differences in prevalence of multiple sclerosis between ethnic groups in Oslo,Norway

Objectives

Oslo, the capital of Norway, has a high prevalence of multiple sclerosis (MS). In recent decades there has been substantial immigration to Oslo from Asia, the Middle East and Africa. The aim of the study was to estimate the prevalence of MS among non-Western immigrants living in Oslo, adjusted for duration of residence.

Methods

Data were obtained from the MS registry at Ullevål University Hospital. The prevalence of MS was adjusted for ethnicity, age and duration of residence in Norway.

Results

A total of 786 definite MS patients were alive and resident in Oslo on 31 December 2005, yielding a crude prevalence of 148/10⁵. Twentyseven patients were of non-Western origin: Middle East 14, Asia 9, Africa 4. The non-Western patients' mean age at migration was 20. The crude prevalence (95 % CI) of MS patients was 170/10⁵ (159–182) for the Norwegian/Western, 85/10⁵ (50–143) for the Middle East, 21/10⁵ (11–41) for the Asian, and 20/10⁵ (7–53) for the African cohorts. The high MS prevalence in the Middle East cohort and the low prevalence among Asian/African immigrants were also pronounced after adjustment for age and duration of residence.

Conclusions

The Middle East immigrants had a markedly higher prevalence of MS despite a shorter duration of residence than other non-Western patients. These findings suggest that people from the Middle East have a greater genetic disposition for MS. Furthermore, the high age at migration among the non-Western immigrants indicates that possible environmental factors affecting MS risk may also act on adults.