The organisation of health care and epidemiology of multiple sclerosis in France |
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| Authors: | Debouverie M Rumbach L Clavelou P |
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| Affiliation: | 1. Service de neurologie, Hôpital central, Nancy, France;2. EA 4003, université de Nancy, école de santé publique, faculté de médecine, Vandœuvre-Lès-Nancy, France;3. Service de neurologie, hôpital Jean-Minjoz, Besançon, France;4. Service de neurologie, Hôpital Gabriel Montpied, Clermont-Ferrand;1. Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille, France;2. EA1046, université Lille Nord de France, 1, place de Verdun, 59000 Lille, France;1. Réseau SLA Île-de-France, bâtiment clinique médicale, hôpital de la Salpêtrière, 47/83, boulevard de l’Hôpital, 75651 Paris cedex 13, France;2. Service de neurologie 2, hôpital de la Salpêtrière, 47/83, boulevard de l’Hôpital, 75651 Paris cedex 13, France;3. Institut de la mémoire et de la maladie d’Alzheimer, pavillon François-Lhermitte, groupe hospitalier Pitié-Salpêtrière, 47/83, boulevard de l’Hôpital, 75651 Paris cedex 13, France;4. Service de neuro-oncologie, hôpital de la Salpêtrière, 47/83, boulevard de l’Hôpital, 75651 Paris cedex 13, France;5. Centre de médecine physique et de réadaptation de Bobigny, CMPR 359, avenue Paul-Vaillant-Couturier, 93000 Bobigny, France;6. Département de neurologie, hôpital de la Salpêtrière, 47/83, boulevard de l’Hôpital, 75651 Paris cedex 13, France;7. Direction de la politique médicale, Assistance publique–Hôpitaux de Paris, avenue Victoria, 75004 Paris, France;1. Université Nord de France, 1, rue du Professeur-Calmette, 59000 Lille, France;2. UC de Lille, 60, boulevard Vauban, 59800 Lille, France;3. Groupe hospitalier de l’institut catholique de Lille, 59000 Lille, France;4. Service de médecine physique et de réadaptation fonctionnelle, centre hospitalier Saint-Philibert, 115, rue du Grand But, BP 249, 59462 Lomme cedex, France;1. Centre de réadaptation Lucie-Bruneau, 2275, Laurier est, Montréal, H2H 2N8 Canada;2. Département de psychologie, faculté des lettres et sciences, université de Sherbrooke, 2500, boulevard de l’Université, Sherbrooke, QC J1K 2R1 Canada;1. CHRU de Brest, secteur hospitalo-universitaire de psychiatrie adulte, 29609 Brest cedex, France;2. CHRU de Brest, service de neurologie, 29609 Brest cedex, France;3. CHU Pontchaillou, université de Rennes-1, faculté de médecine, service de neurologie, 35033 Rennes cedex 9, France;4. Université de Bretagne Occidentale, UFR médecine et science de la santé, 29238 Brest cedex 3, France |
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| Abstract: | STATE OF THE ART: According to the available previous studies, France is considered a zone of medium to high risk of multiple sclerosis (MS) with an estimated overall prevalence of at least 50/100,000 inhabitants, incidence rates were stable in some areas but increased over time in others and a strong ethnic effect on the incidence, clinical presentation, and course of MS is reported. RESULTS: Based on two health insurance survey the prevalence has been deduced. At January 1, 2003 from the data of agricultural health insurance the prevalence is evaluated at 65.5/100,000 inhabitants (95p.cent CI=62.5-67.5) with a gradient of North East towards South-West. The data from the national health insurance were very near. During the period 2000-2004, recent studies in Auvergne and Brittany demonstrated an annual incidence comprising between 4.2 and 5.1 per 100,000 inhabitants. In Lorraine, in a large population-based study, in December 31, 2004 the prevalence rate was 120/100,000 (95p.cent CI: 119 to 121). During the period 1990-2002, the average age- and sex-adjusted annual incidence rate was 5.5/100,000 (95p.cent CI: 4.4-6.6). In Lorraine, we found that the age-adjusted incidence rate increased during the period 1990-2002. The incidence of MS in women increased, whereas that in men did not change significantly during this period. Similarly, in Norway, North Ireland and Denmark, the incidence among women increased the most. The clinical features of MS were compared in 211 North Africans patients and 2 945 Europeans patients in two French MS centres (Lorraine and Nice) with definite MS according to McDonald's criteria. The course of MS appears more aggressive in North Africans than in Europeans patients. For example, we demonstrated a shorter time to reach the Expanded Disability Status Scale score of 4.0 (p=0.001) or 6.0 (p<0.0001) in North Africans patients. PERSPECTIVES AND CONCLUSIONS: The incidence rates found in these studies were comparable to those reported in several European populations. This undoubtedly places France in the category of regions with a high risk zone of MS. The incidence of MS in women increased; thus, exogenous (or epigenetic) factors vary over time and may affect men and women differently. The course of MS appears more aggressive in North Africans than in Europeans patients. |
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