Prevalence of multiple sclerosis in the Lazio region, Italy: use of an algorithm based on health information systems.

Anna Maria Bargagli,Marina Davoli,Viviana Nociti,Graziella Filippini,Nera Agabiti,Diego Centonze,Manuela Giuliani,Marta Di Folco,Flavia Mayer,Fabio Buttari,Simonetta Galgani,Massimiliano Mirabella,Paola Colais,Claudio Gasperini,Ada Francia,Carlo Pozzilli

doi:10.1007/s00415-016-8049-8

Abstract

Compared with other areas of the country, very limited data are available on multiple sclerosis (MS) prevalence in Central Italy. We aimed to estimate MS prevalence in the Lazio region and its geographical distribution using regional health information systems (HIS). To identify MS cases we used data from drug prescription, hospital discharge and ticket exemption registries. Crude, age- and gender-specific prevalence estimates on December 31, 2011 were calculated. To compare MS prevalence between different areas within the region, we calculated age- and gender-adjusted prevalence and prevalence ratios using a multivariate Poisson regression model. Crude prevalence rate was 130.5/100,000 (95 % CI 127.5–133.5): 89.7/100,000 for males and 167.9/100,000 for females. The overall prevalence rate standardized to the European Standard Population was 119.6/100,000 (95 % CI 116.8–122.4). We observed significant differences in MS prevalence within the region, with estimates ranging from 96.3 (95 % CI 86.4–107.3) for Latina to 169.6 (95 % CI 147.6–194.9) for Rieti. Most districts close to the coast showed lower prevalence estimates compared to those situated in the eastern mountainous area of the region. In conclusion, this study produced a MS prevalence estimate at regional level using population-based health administrative databases. Our results showed the Lazio region is a high-risk area for MS, although with an uneven geographical distribution. While some limitations must be considered including possible prevalence underestimation, HIS represent a valuable source of information to measure the burden of SM, useful for epidemiological surveillance and healthcare planning.

Highlights

Multiple sclerosis (MS) is the most common disabling neurological disorder of young adults around the world
The principal aims of this study were to estimate the prevalence of multiple sclerosis (MS) in the Lazio region using populationbased health administrative databases and to describe the geographical distribution of MS across Local Health Units (LHUs) and districts within the region
Through the regional health information systems (HIS) we identified a total of 7377 MS patients residing in the Lazio region on the prevalence day, 2427 males and 4950 females (Fig. 1)

Summary

Introduction

Multiple sclerosis (MS) is the most common disabling neurological disorder of young adults around the world. It is typically diagnosed between the ages of 20 and 40, affecting individuals in their most productive years. A number of studies have been conducted in different Italian cities and provinces, mainly based on data of patients recruited in neurological/rehabilitation clinics or MS centers, showing an uneven distribution of MS within the country [4]. It is well known that Sardinia and Sicily (the two largest Italian islands) represent very high-risk areas [5, 6] a prevalence higher than 100/100,000 has been estimated in some North Italian cities such as Verona, Padova, Ferrara and Genoa [7,8,9,10]. Most studies have been carried out at municipal/provincial level while to date prevalence estimates at larger geographic areas (i.e. region) are not common in Italy

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