Prevalence of Parkinson's disease in Estonia

OBJECTIVES: To investigate the prevalence of idiopathic Parkinson's disease (PD) in Tartu district of South Estonia, with a population of 153,240 on prevalence day, 1 January 1996. METHODS: The community-based method of case ascertainment was used, followed by neurologic examination. RESULTS: The age-adjusted prevalence was 152 per 100,000 population, 159 for urban and 139 for the rural group, 154 for men and 153 for women. The age-specific prevalence increased from 22 per 100,000 population in the age group 40-49 years up to 1232 per 100,000 population in the age group 70-79 years. The mean age of PD patients was 71.4 years, the mean age at onset of the symptoms - 66.9 years. CONCLUSIONS: When comparing the prevalence rates with other studies of Caucasian populations in Europe, the results are similar except for slightly but not significantly higher prevalence rates in the urban population in Estonia.     

Sunday July 2, 2006 9:30–11:30Hall 3A Discussion Group SessionLessons learned from local epidemiological studies

¹ A. Õun (   ¹ Department of Neurology and Neurosurgery, University of Tartu, Estonia )
Epidemiological data about epilepsy from central and eastern Europe is controversial. A modern study on prevalence and incidence of epilepsy in Estonia has been carried out on children–prevalence of active epilepsy was 3.6/1,000, and incidence 45/100,000 person-years being essentially similar to those in developed countries. In an adult populaton review of all databases and lists related to epilepsy in Tartu supplemented by re-examination of patients to identify all persons with active epilepsy aged ≥20 years on January 1, 1997. Special attention was paid to extensive adoption of definitions and criteria proposed by Guidelines for epidemiologic studies. The incidence rate was 35/100,000 person-years. The age-specific rates tended to increase with advancing age. The prevalence rate was 5.3/1,000. The largest syndromic categories were localization-related symptomatic and cryptogenic epilepsies, which are very likely due to the age-distribution of the study. The risk factors for epilepsy were identified in 39.6% cases of the prevalent cases. Of the subjects 19% did not take an entiepileptic drug on the prevalence day, 83% of them were taking a single drug. The most common agent was carbamazepine (68%), followed by barbiturates. Epidemiologic rates in the adult, as well as in the total population of Tartu was comparable to those reported from the developed countries. The large percentage of medication-free epileptics, notably small figures for polytherapy, and the associating low aggregate antiepileptic drug sales in Estonia, indicate a tendency for moderate medication in the epileptic population.     

Motor neurone disease in South Estonia Diagnosis and incidence rate

The current study evaluated the diagnostic standards of MND and epidemiological markers of MND in Estonia. A total of 108 patients were referred to the University Hospital from 1986 to 1995 with the first suggested diagnosis or final diagnosis of amyotrophic syndrome, amyotrophic lateral sclerosis (ALS), progressive bulbar paralysis (PBP) or progressive muscular atrophy (PMA). In addition neurologists of the region and the National Society of Neuromuscular disorders were contacted. Some 94 patients satisfied the diagnostic criteria. The annual incidence rate in South Estonia and in the city of Tartu ranged from 0.5 to 2.8 per 100,000. The mean annual incidence rate in Tartu is 1.98 and in South Estonia in general 1.3. The highest incidence rate was 8.3 for men in the age group 60 to 64 years and 7.49 in the age group 70–74; among female patients the highest incidence rate -4.6 was in the age group from 65 to 69.     

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.     

First-year results of the third stroke registry in Tartu, Estonia

BACKGROUND: The main goal of the Third Stroke Registry in Tartu was to determine the incidence and 28-day case-fatality rates for first-ever stroke in an Estonian population. METHODS: The data collection started on 01.12.2001. All patients with first-ever stroke living in Tartu were registered. RESULTS: During the first year, 234 first-ever stroke cases were registered. The incidence rate of first-ever stroke age-standardised to the European population was 195/100,000, 214 (95% CI, 185-243) for men and 181 (95% CI, 155-208) per 100,000 for women. Sixty-eight patients (29%) died within 28 days of stroke onset. CONCLUSIONS: The incidence and 28-day case-fatality rate of stroke in Estonia are high compared to other countries. It might be related to higher risk factor prevalence, stress and socioeconomic status.     

Multiple sclerosis in Nord-Trøndelag County, Norway: a prevalence and incidence study

Objective – To calculate the prevalence and incidence of multiple sclerosis (MS) in Nord‐Trøndelag County, Norway. Material and methods – The study comprised everyone diagnosed with MS according to the Poser criteria. On 1 January 2000 a total of 208 were identified: 130 women (62.5%) and 78 men (37.5%). We calculated the crude and age‐adjusted annual incidence rates from 1974 to 1999. Results – The prevalence on 1 January 2000 was 163.6 of 100,000, 204.8 of 100,000 for women and 122.6 of 100,000 for men. The age‐adjusted annual incidence increased from 3.9 to 5.6 per 100,000 from 1974 to 1999; women from 4.6 to 6.3 and men from 2.2 to 4.4. After 1984, the incidence among women increased most, peaking at 10.2 per 100,000 in 1984–88. Conclusions – MS incidence is increasing in Nord‐Trøndelag County. The prevalence is among the highest ever in Norway.     

Incidence of Parkinson's disease in estonia

The incidence of Parkinson's disease (PD) was studied over a 9-year period (1990-1998) in Tartu county, Estonia, with a mean population of 156,417. Based on 264 patients, the average crude incidence rate of PD was 18.8 per 100,000 person-years. The age-adjusted incidence was 16.8/100,000; 18.3 for the urban group and 14.0 for the rural group; 16.6 for men and 17.1 for women. The age-specific incidence was 1.0/100,000 in the age range 30-39 years, reached a maximum of 117.2/100,000 in the age range 70-79 years and declined in the elderly. The incidence of PD was comparable with that found in developed countries, except for a slightly higher (not significant) incidence rate in the urban compared with the rural population in Estonia.     

A reappraisal of the epidemiology of multiple sclerosis in Olmsted County, Minnesota

A review of multiple sclerosis (MS) case reports, using the unified record system at the Mayo Clinic for the Olmsted County population, revealed age- and sex-adjusted prevalence rates per 100,000 persons of 160 for Olmsted County and 173 for Rochester, Minnesota, on January 1, 1985. The annual age- and sex-adjusted incidence rate per 100,000 person-years from 1975 to 1984 for Olmsted County was 6.2 and for Rochester, 6.3. This incidence rate is significantly higher than what had been reported previously in Rochester (3.6/100,000) or in other communities. The estimated 25-year survival of the MS population was 76.2% +/- 4.5% compared with 87.7% for the general US white population of a similar age and sex. Survival for men was less than for women. There was no increase in survival for patients diagnosed with MS in more recent decades. No significant increase was found in cancer or autoimmune disease rates in the MS patients.     

Multiple sclerosis prevalence and possible lead exposure

This study was conducted to estimate the current prevalence of multiple sclerosis (MS) in Jefferson County, Missouri, USA, and to address community concerns about a perceived excess of MS around an active lead smelter. The study population consisted of the residents of Jefferson County, Missouri between 1998 and 2002. An aggressive MS case finding with capture–recapture analysis was used. The spatial clustering was examined using a spatial scan statistic.

The capture–recapture analysis showed the case ascertainment to be 95%. The crude five-year period prevalence of MS in Jefferson County was 105 per 100,000 population (95% confidence interval [CI], 91–121), and 107 per 100,000 (95% CI, 95–119) when age-standardized to the 2000 U.S. population. No significant spatial clusters of MS cases were identified in the study area.

The estimates of MS prevalence in Mid-western community of USA appeared to be comparable to estimates from other areas of similar latitude in the United States and Western Europe. The MS cases did not appear to cluster around the lead smelter.     

Incidence of adult epilepsy in Estonia

PURPOSE: To estimate the main incidence-related characteristics of epilepsy in an adult population in Estonia. Epidemiologic data about epilepsy from central and eastern Europe is controversial. METHODS: All existing databases and lists in the area were reviewed to identify all persons with newly diagnosed epilepsy aged > or =20 years during 3 years. Special attention was paid to extensive adoption of definitions and criteria proposed by Guidelines for epidemiologic studies. RESULTS: Crude and age-adjusted incidence rates were 35 per 100,000 person-years. The age-specific rates tended to increase with advancing age. Of the seizure types, partial seizures had highest rates, 27 per 100,000. The largest syndromic categories were localization-related epilepsies. Risk factors for epilepsy were identified in 55.5% cases. CONCLUSIONS: Incidence-related characteristics in the adult population of Tartu was comparable with those reported from the developed countries. The predominance of localization-related syndromes and partial seizures is the result of age distribution of the study.     

The increasing prevalence of Parkinson's disease in Estonia

Objectives

A previous epidemiological study of Parkinson's disease (PD) in the county of Tartu, Estonia, found an adjusted prevalence rate of 152/100 000 persons. We aimed to determine PD prevalence almost 20 years later, as well as evaluate any dynamic changes in disease frequency compared to the first study.

Methods

A cross‐sectional, community‐based study was conducted over 2010‐2016 in the county of Tartu, Estonia. Multiple case‐finding sources, including information from neurologists, family doctors, the local PD Society, nursing institutions, and the database of the Estonian Health Insurance Fund were used to identify patients with PD of all ages.

Results

Total crude PD prevalence was 283 and age‐adjusted prevalence (standardized to the 2014 age structure of the Estonian population) 314/100 000. No significant differences in age‐adjusted prevalence rates were found between men and women, nor people living in urban and rural areas. After adjustment to the same standard population used in the previous prevalence study, the overall age‐adjusted prevalence rate was 197/100 000. Patients in the current study were older and often had a more severe form of PD and a longer disease duration, compared to those reported in the first epidemiological study 20 years ago.

Conclusions

The age‐specific crude rates in oldest age‐groups have risen substantially, and the age‐adjusted prevalence has moderately increased compared to 20 years ago in Estonia. We hypothesize that the increased life expectancy of the Estonian population and improved diagnosis of PD contributed most to the increase in disease frequency.     

Population frequency of HLA haplotypes contributes to the prevalence difference of multiple sclerosis in Ireland

BACKGROUND: A recent epidemiological study of multiple sclerosis in County Donegal in the northwest of Ireland and County Wexford in the southeast found a significant prevalence difference of 63.9/100,000 (95% CI 49.3-82.7/100,000) between the two regions (Z = 3.94, p 相似文献   

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.     

Multiple sclerosis in New Zealand

New Zealand (NZ) is a high risk country for multiple sclerosis (MS) with an overall age and sex standardised prevalence of 73.1 per 100,000 population. The age and sex standardised prevalence within the Māori population is substantially lower at 24.2 per 100,000 population. A latitudinal gradient exists with MS prevalence increasing threefold from the North (37°S) to the South (48°S) of NZ. Over 1600 (56.8%) persons with MS experience moderate to severe disability. Despite the high prevalence of MS and the significant degree of disability experienced by people with MS, the availability and prescribing guidelines for MS disease modifying treatments are more restrictive in NZ than in other developed nations.     

Epidemiological investigations into multiple sclerosis in Southern Hesse I.

An epidemiological field-survey on multiple sclerosis (MS) was carried out in the southern part of the state of Hesse (West Germany). Out of 472 patients primarily ascertained, 75% could finally be accepted as definite or probable MS cases. Cross-checking of the 3 sources for case-finding (practitioners and specialists, neurological hospital, MS society) revealed that case-finding in all and especially that of definite and probable MS cases was rather complete. The overall prevalence rate was 58.3, the annual incidence 2.15 and the mortality rate 2.0 per 100,000. Male patients showed a faster course than females. The prevalence in immigrants who mostly originated from Mediterranean countries, was significantly lower (14.3 per 100,000) than the prevalence in the German population (63.1 per 100,000).     

Prevalence of adult epilepsy in Estonia

Epidemiological data about epilepsy from central and eastern Europe is scarce and results are controversial. The aim of this study was to estimate the main prevalence-related characteristics of active epilepsy in an adult population in Estonia. Review of all databases and lists related to epilepsy in Tartu supplemented by re-examination of patients to identify all persons with active epilepsy aged >/=20 years on January 1, 1997. Special attention was paid to the extensive adoption of definitions and criteria proposed by ILAE guidelines for epidemiologic studies. Both, crude and age-adjusted (to the 1970 US population) prevalence rates were 5.3 per 1000. The age-specific rates were constant in age groups 30-69 years and declined in the oldest age groups. Of the seizure types, partial seizures had highest rates, over half were secondarily generalized seizures. The largest syndromic categories were localization-related symptomatic and cryptogenic epilepsies. Risk factors for epilepsy were identified in 39.6% cases. Some 22% of all subjects did not take antiepileptic medication. Prevalence of active epilepsy and other prevalence-related characteristics in the adult population of Tartu was comparable to those reported from the developed countries. The predominance of localization-related syndromes and partial seizures is due to the age distribution of the study.     

Epidemiology of dementia in a Finnish population

An epidemiological study of dementia was carried out in the city of Turku (population 164,568) in Finland. A total of 421 patients with moderate to severe dementia were found. Degenerative dementia, i.e. presenile and senile dementia, was present in 218 patients (51.8 %), and in 152 patients (36.1 %) the dementia was associated with arteriosclerosis, including multi-infarct and combined dementia. The prevalence rate of dementia, all types, was 256 per 100,000 population, and 1,961 per 100,000 population over 65 years old. The age-specific prevalence rates of dementia increased with advancing age from 0.1 % in the age group 55–64 years to 11 % in the age group over 85 years. The peak annual incidence rate for all types of dementia was 58 per 100,000 population, and 447 per 100,000 population over 65 years old. Both prevalence and incidence figures suggested a female preponderance in dementia of degenerative origin and in dementia with associated arteriosclerosis.     

Psychotropic drug use in non-psychiatric departments of three European university hospitals

The use of psychotropic drugs in the university hospitals in Tartu, Estonia; Huddinge, Sweden; and Badajoz, Spain, were studied, using the defined daily doses per 100 bed-days (DDD/100 bed-days) method. The total amount of drugs used in the surgical and medical departments was 50 DDD/100 bed-days in Huddinge, versus 33 and 14 DDD/100 bed-days in Tartu and Badajoz, respectively. Barbiturates accounted for 35% of all psychotropics in Tartu but were practically not used in Huddinge. In contrast, antidepressants were practically not used in Tartu. The use of psychotropic drugs in the intensive care units was highest in Huddinge (320 DDD/100 bed-days), compared with Tartu and Badajoz (177 and 96 DDD/100 bed-days, respectively). The frequency of psychotropic drug use were strikingly different in the three hospitals studied.     

Migration and multiple sclerosis in Alaskan military veterans

The objective is to provide the first estimates of the prevalence of multiple sclerosis (MS) in Alaskan white males including those migrant to and from the state. A case–control cohort design was utilized with a nationwide series of United States (US) veterans service-connected for MS and matched to pre-illness controls who had entered military service between 1960 and 1994. Among 3,758 white male MS cases and their 7,426 controls were 7 MS and 28 controls resident in Alaska at service entry, who provided an adjusted case/control (C/C) risk ratio for developing MS of 0.47 and an estimated prevalence rate of 22/100,000 population, but only 1 of the 7 had also been born in Alaska, for an estimated prevalence rate of 3.2 per 100,000 (95% confidence interval (CI): 0.08–17.80). The other 6 MS patients and their 26 controls, who migrated from another state to Alaska before onset, had an adjusted C/C ratio of 0.44 for a prevalence rate of 20.6 (95% CI: 7.56–44.90), significantly lower than the reported rate of 45.23 per 100,000 for all US white males in 1976. Another 9 MS patients and 7 controls born in Alaska, who had migrated to another state before entering service, provided an adjusted C/C risk ratio for developing MS of 2.44, with a highly significant elevated prevalence rate of 115 per 100,000 (95% CI: 52.6–218.1). In conclusion, these data suggest that Alaska is not a high-risk area for MS and indicate that migration before onset to Alaska from the high-risk coterminous US decreases the risk of MS and the opposite migration increases it. A formal prevalence survey of MS in Alaska is needed to support or refute these findings.     

The prevalence of multiple sclerosis in the north–west Italian province of Genoa

The objective of this study was to assess the prevalence of multiple sclerosis (MS), calculated as point prevalence on 31 December 1997, in the province of Genoa, North–western Italy. Methods The province of Genoa is located in North–western Italy, an area of 1835 km². On the point prevalence day the population consisted of 913,218 inhabitants. MS cases were identified by analysing archives of the hospitals with neurological or rehabilitation wards, neurologists serving the community, files of local chapters of the Italian MS society, all requests for oligoclonal bands analysis on CSF in the studied area. Patients included in the study were MS cases diagnosed before 31 December 1997 according to the Poser criteria resident in the province under study. Results A total of 857 subjects were alive and residing in the province of Genoa on the prevalence day. The overall crude prevalence rate was 94 per 100,000 (95% CI 88–100); 291 were males (34%) with a crude prevalence of 67 per 100,000 (95 % CI 60–76) and 566 were females (66%) with a prevalence of 118 per 100,000 (95% CI 108–128). The female/male ratio was 1.9. When age and sex were adjusted to the Italian standard population of 1991 prevalence was 85 per 100,000. Five hundred and thirty two out of the 857 patients agreed to be interviewed. The interviewed sample was representative of the prevalence sample: sex and gender distributions were identical in the two samples. The overall mean age was 48 (± 13) years (48 ± 12 years in males; 48 ± 14 years in females). Mean disease duration was 15 (± 10) years for males and 16 (± 11) years for females. Two hundred and ninety one (55 %) subjects had a relapsing remitting (RR) clinical course, 150 (28%) were secondary progressive (SP) and 91 (17%) were primary progressive (PP). Mean EDSS score was 5 (± 2; median 5). The mean age at time of onset was 33 (±10) years for males and 32 (± 11) years for females. The disease onset was monosymptomatic in 76% (n = 407) patients and polysymptomatic in 24% (n = 125). The mean length of time between clinical onset and diagnosis was 5 (± 6) years. Conclusion We confirmed that the province of Genoa is a very high risk area for MS. We found a high rate of patients with a PP course; also the proportion of patients with high disability scores is greater compared to previous studies.