Multiple Sclerosis In China Research Articles

Prevalence and Burden of Multiple Sclerosis in China, 1990-2019: Findings From the Global Burden of Disease Study 2019.

Multiple sclerosis (MS) is the leading cause of neurologic disability in young adults, but the burden caused by MS in China is lacking. We aimed to comprehensively describe the prevalence and health loss due to MS by demographic and geographical variables from 1990 to 2019 across China. Data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). We used GBD methodology to systematically analyze the prevalence, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) due to MS by age, sex, and location from 1990 to 2019 in mainland China and its provinces. We also compared the MS burden in China with the world and other Group of 20 (G20) countries. In 2019, 42,571 (95% uncertainty interval [UI] 33,001-53,329) individuals in China had MS, which doubled from 1990. The age-standardized prevalence rate of MS was 2.32 per 100,000 (95% UI 1.78-2.91), which increased by 23.31% (95% UI 20.50-25.89) from 1990, with most of the growth occurring after 2010. There was a positive latitudinal gradient with the increasing prevalence from south to north across China. The total DALYs caused by MS were 71,439 (95% UI 58,360-92,254) in 2019, ranking China third among G20 countries. Most of the MS burden in China derived from premature mortality, with the higher fraction of YLLs than that at the global level and most other G20 countries. From 1990 to 2019, the age-standardized DALY and YLL rate had nonsignificant changes; however, the age-standardized YLD rate substantially increased by 23.33% (95% UI 20.50-25.89). The geographic distribution of MS burden varied at the provincial level in China, with a slight downward trend in the age-standardized DALY rates along with increasing Socio-Demographic Index over the study period. Although China has a low risk of MS, the substantial and increasing prevalent cases should not be underestimated. The high burden due to premature death and geographic disparity of MS burden reveals insufficient management of MS in China, highlighting the needs for increased awareness and effective intervention.

Estimating the Prevalence and Burden of Multiple Sclerosis in China Using the Global Burden of Disease Study: Challenges and Future Directions.

Estimating the Prevalence and Burden of Multiple Sclerosis in China Using the Global Burden of Disease Study: Challenges and Future Directions.

PCR143 Diagnostic Delay of Multiple Sclerosis in China: A Nationwide Cross-Sectional Study

PCR143 Diagnostic Delay of Multiple Sclerosis in China: A Nationwide Cross-Sectional Study

Gender differences in the burden of multiple sclerosis in China from 1990 to 2019 and its 25-year projection: An analysis of the Global Burden of Diseases Study.

Multiple sclerosis (MS) is a crippling, chronic, gender-related disease that causes burdens to individuals and society. China has a considerable and increasing population of MS. We aim to analyze the gender disparities in the burden of MS in China and predict the trends. The study was conducted based on the Global Burden of Disease Study 2019. Data on incidence, prevalence, deaths, and disability-adjusted life years (DALYs) of MS in China from 1990 to 2019 was descriptively analyzed by year, gender, and age group. The Nordpred package in R (version 4.2.2) was used for age-period-cohort analysis to predict the all-ages numbers and age-standardized rates of incidence, prevalence, deaths, and DALYs in China from 2020 to 2044. The number of prevalent cases of MS in 2019 reached 18,143.56 (95% uncertainty intervals [UI]: 13,997.71-22,658.60) in males and 24,427.11 (95% UI: 18,906.02-30,530.21) in females in China. The peak age of prevalence was shifted from 40-44 years in 1990 to 45-49 years in 2019 in females but remained unchanged in males. In contrast to the increased age-standardized prevalence rate, the age-standardized death rate (ASDR) and age-standardized DALYs rate showed downward trends, which were more significant in females. Different from the global, Chinese males showed lower prevalence but higher deaths and DALYs than females for age-standardized rates and numbers. In the next 25 years, the patient population will remain large and peak around 44,599.78 in 2025-2029. The ASDR, age-standardized DALYs rate, and DALYs number were expected to decrease. The improvements in deaths and DALYs will be more significant in females. Males with MS had a lower prevalence but higher deaths and DALYs than females in China. The ASDR and age-standardized DALYs rate have reduced over the past 30 years and were expected to continue decreasing, especially in females. The burden of MS will remain notable in the next 25 years.

Male and female are not the same: a multicenter study of static and dynamic functional connectivity in relapse-remitting multiple sclerosis in China.

Sex-related effects have been observed in relapsing-remitting multiple sclerosis (RRMS), but their impact on functional networks remains unclear. To investigate the sex-related differences in connectivity strength and time variability within large-scale networks in RRMS. This is a multi-center retrospective study. A total of 208 RRMS patients (135 females; 37.55 ± 11.47 years old) and 228 healthy controls (123 females; 36.94 ± 12.17 years old) were included. All participants underwent clinical and MRI assessments. Independent component analysis was used to extract resting-state networks (RSNs). We assessed the connectivity strength using spatial maps (SMs) and static functional network connectivity (sFNC), evaluated temporal properties and dynamic functional network connectivity (dFNC) patterns of RSNs using dFNC, and investigated their associations with structural damage or clinical variables. For static connectivity, only male RRMS patients displayed decreased SMs in the attention network and reduced sFNC between the sensorimotor network and visual or frontoparietal networks compared with healthy controls [P<0.05, false discovery rate (FDR) corrected]. For dynamic connectivity, three recurring states were identified for all participants: State 1 (sparse connected state; 42%), State 2 (middle-high connected state; 36%), and State 3 (high connected state; 16%). dFNC analyses suggested that altered temporal properties and dFNC patterns only occurred in females: female patients showed a higher fractional time (P<0.001) and more dwell time in State 1 (P<0.001) with higher transitions (P=0.004) compared with healthy females. Receiver operating characteristic curves revealed that the fraction time and mean dwell time of State 1 could significantly distinguish female patients from controls (area under the curve: 0.838-0.896). In addition, female patients with RRMS also mainly showed decreased dFNC in all states, particularly within cognitive networks such as the default mode, frontoparietal, and visual networks compared with healthy females (P < 0.05, FDR corrected). Our results observed alterations in connectivity strength only in male patients and time variability in female patients, suggesting that sex-related effects may play an important role in the functional impairment and reorganization of RRMS.

EE493 Equity in Healthcare Utilization and Reimbursement for Patients with Multiple Sclerosis in China: A Benefit Incidence Analysis Using Nationwide Patient-Reported Outcome Data

Multiple sclerosis (MS) is a chronic, autoimmune neurologic disorder resulting in substantial economic burden. With cost of illness research on MS being extensively studied worldwide, however, little is known about the equity concern of utilization and reimbursement. This study aimed to evaluate the distribution of utilization, cost, and reimbursement received by MS patients with different socio-economic status (SES) in China.

The effectiveness of teriflunomide in patients with multiple sclerosis in China: a real-world comparison to no DMT treatment in the first year after diagnosis.

Teriflunomide is a first-line oral immunomodulatory agent approved in China for the treatment of relapsing multiple sclerosis. To compare the treatment outcomes of teriflunomide and no disease-modifying therapy (DMT) treatment (in first year) in multi-center real-world Chinese multiple sclerosis patients. Retrospective study. This study was conducted in five tertiary hospitals in different geographical regions of China. We collected clinical data of patients treated with teriflunomide and no DMT treatment (in first year) between 1 January 2017 and 31 August 2021. The effectiveness of teriflunomide was described. Potential factors influencing the effectiveness of teriflunomide were investigated. A total of 372 patients treated with teriflunomide and 148 no DMT treatment patients were included. A total of 292 patients were treated with teriflunomide for at least 6 months, described as a stable teriflunomide cohort. The annualized relapse rate was significantly lower in the stable teriflunomide cohort than in the no DMT treatment cohort (0.23 ± 0.47 versus 0.87 ± 0.67, p < 0.001). The mean Expanded Disability Status Scale (EDSS) score of the stable teriflunomide cohort (1.77 ± 1.62) was slightly different from that of the no DMT treatment cohort (2.09 ± 2.00). A previous annualized relapse rate of ⩾1, a previous EDSS score of ⩾2, and a long disease duration of ⩾5 years were associated with better clinical effectiveness. Teriflunomide is associated with a lower relapse rate and less disability accumulation in Chinese patients with multiple sclerosis.

Recent progress in epidemiology, clinical features, and therapy of multiple sclerosis in China.

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system characterized by inflammation, demyelination, and neurodegeneration. It mainly affects young adults, imposing a heavy burden on families and society. The epidemiology, clinical features, and management of MS are distinct among different countries. Although MS is a rare disease in China, there are 1.4 billion people in China, so the total number of MS patients is not small. Because of the lack of specific diagnostic biomarkers for MS, there is a high misdiagnosis rate in China, as in other regions. Due to different genetic backgrounds, the clinical manifestations of MS in Chinese are different from those in the West. Herein, this review aims to summarize the disease comprehensively, including clinical profile and the status of disease-modifying therapies in China based on published population-based observation and cohort studies, and also to compare with data from other countries and regions, thus providing help to develop diagnostic guideline and the novel therapeutic drugs. Meanwhile, we also discuss the problems and challenges we face, specifically for the diagnosis and treatment of MS in the middle- and low-income countries.

Burden and trends of multiple sclerosis in China from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

ObjectiveTo compare the burden of multiple sclerosis disease indicators in the Asia-Pacific countries, China and globally through the Global Burden of Disease 2019 (GBD2019) Database, and to analyse the changes...

Cost-effectiveness analysis of prolonged-release fampridine to treat walking disability of multiple sclerosis in China.

Objectives: This study evaluates the cost-effectiveness of adding prolonged-release (PR)-fampridine to best supportive care (BSC) versus BSC alone in adult multiple sclerosis patients with walking disability in China. Materials & methods: A hybrid decision tree and Markov model from both the societal and healthcare perspectives were constructed. Parameters were derived from clinical trials of PR-fampridine, published sources and clinical expert interviews. Results: Over a 10-year time horizon, adding PR-fampridine to BSC led to 0.15 quality-adjusted life year (QALY) gain and lower costs, with incremental cost-effectiveness ratios of -238,806 Chinese Yuan/QALY and -113,488 Chinese Yuan/QALY from the societal and healthcare perspectives, respectively. Conclusion: Compared with BSC alone, PR-fampridine plus BSC is considered an economically dominant strategy for the treatment of multiple sclerosis-related walking disability in China.

EE62 Direct and Indirect Costs of Multiple Sclerosis in China

Multiple sclerosis (MS) is a chronic disabling neurological disease affecting both physical and mental functions, resulting in impaired quality of life for patients and their caregivers. Although studies in Western countries have demonstrated that MS imposes considerable direct and indirect costs on healthcare systems and societies, empirical research in China is limited regarding the economic burden of MS. This study aimed to describe the direct and indirect costs due to MS in China, stratified by Expanded Disability Status Scale (EDSS) score.

A multicenter study to evaluate the disease burden and health economics of inpatients with multiple sclerosis in China

To assess the disease burden and health economics of inpatients with multiple sclerosis (MS) in China by evaluating the direct, indirect, and intangible costs. A total of 863 patients were included for a cross-sectional retrospective study in 50 centers. The direct economic burden was measured by the cost of hospitalization and out-of-hospital application drugs, and the indirect economic burden was measured by the human capital method. The disability-adjusted life year (DALY) was used to express the intangible economic burden. Cost-utility analysis (CUA) using DALYs as indicators of health benefits was performed by calculating the incremental cost-utility ratio. The mean direct economic burden/year, daily medication expenses/year, DALY, indirect economic burden, and indirect economic burden/year were 27,655.57 Yuan, 17,944.97 Yuan, 10.89 Yuan, 512,041.7 Yuan, and 11,299.85 Yuan, respectively. For the study period of two years, the direct economic burden, daily medication expense, and indirect economic burden were 48.6%, 31.5%, and 19.85% of the total economic burden, respectively. Disease burden and the number of episodes of remission were not statistically significant (p>0.001). The direct economic burden and total economic burden of the disease-modifying therapy (DMT) group were higher than those of the non-DMT group, but DALYs had no statistical significance (p>0.001). CUA showed that inpatients with MS in the DMT group received a DALY every time compared with the non-DMT group. The DALY losses are concentrated in young and middle-aged Chinese people. In this two-year study, CUA prompted the application of DMT drugs to increase the economic burden and DALYs. However, follow-up time is still short, and further follow-up observation is required.

Urban prevalence of multiple sclerosis in China: A population-based study in six provinces.

Multiple sclerosis (MS) is a rare neurological disease addressed by only few epidemiological studies in China. This population-based study aimed to estimate the prevalence of MS in China by using national medical insurance databases. Data from the Urban Employee Basic Medical Insurance database and the Urban Residence Basic Medical Insurance database, which were collected during 2012 to 2016 and included approximately 0.20 billion residents in six provinces, were used in this population-based study. The prevalent patients with MS were identified via diagnostic text or disease codes. The crude prevalence in 2016 was 2.44 per 100,000 population (95% confidence interval (CI) 2.18-2.72), with the prevalence in females being higher than that in males. The standardized prevalence (based on 2010 Chinese census data) was 2.29 (95% CI 2.21-2.38). The prevalence in both sexes in 2016 increased up to the age range of 30-34 years. Subsequently, the female prevalence declined with increasing age, but male prevalence stabilized with increasing age. During the 5-year time period, prevalence ranged from 2.32 (95% CI 2.06-2.60) in 2015 to 2.91 (95% CI 2.39-3.47) in 2012. The prevalence of MS in China was lower than that in Europe and North America. The temporal trend of prevalence in China was also observed to be stable. As the first prevalence study of MS in mainland China, this population-based study can provide useful information for worldwide healthcare services and prevention of MS.

Incidence of multiple sclerosis in China: A nationwide hospital-based study

BackgroundMultiple sclerosis (MS) is a leading cause of disability among young adults and effects considerable social and economic burdens. Data of MS incidence in China at the national level is lacking. We conducted the first nationwide hospital-based study to estimate the incidence and hospitalization burden of MS in China. MethodsThis study is based on an administrative database of the National Hospital Quality Monitoring System, which covers all 1665 tertiary hospitals in mainland China. The “Medical Record Homepage” of all patients, including 346 variables including demographic characteristics, diagnoses, procedures, and expenses etc., were uniformly collected across each tertiary hospital via standard protocol. MS was defined by the 2010 International Panel criteria for MS and was identified by ICD-10 code (G35•0). FindingsWe identified 27,336 hospital admissions for 15,060 MS patients from 2016 to 2018; amongst these patients, 9,879 were newly diagnosed. The age- and sex-adjusted incidence per 100,000 person-years is 0•235 (95% confidence interval [CI] 0•230–0•240), with 0•055 (0•050–0•060) in children and 0•288 (0•282–0•294) in adults, respectively. The female to male ratio is 2•02; the peak disease onset is age of 40–49 years. Residents in high-latitude and high-altitude areas are more likely to develop MS (F = 8•99; p < 0•001). Prevalent comorbidities include hypertension (18•8%), diabetes (7•2%), stroke (14•7%), depression or anxiety (3•7%), and autoimmune disease (2•3%). Through 2016–2018, 104 adults and 2 children died, with a hospital mortality rate of 9•9 per 1,000 person-years. InterpretationFor the first time, we obtain the national incidence of MS as 0.055 in children and 0.288 in adults per 100,000 in China. The geographical distribution of MS incidence presented a north-south latitude gradient and a west-east altitude gradient. FundingNational Science Foundation of China (81801199, 91642205, and 81830038); Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing.

Sleep disorders in patients with multiple sclerosis in China.

Poor sleep is common in patients with multiple sclerosis (MS). This study assessed the prevalence of poor sleep and investigated the potential impact factors that influence sleep quality of patients with MS. A cross-sectional self-report survey of 231 patients with MS and 265 sex- and age-matched controls was conducted. Good sleepers and poor sleepers were separated by their global score on the Pittsburgh Sleep Quality Index (PSQI). Sociodemographic parameters, such as age, gender, and marital status, and clinical-demographic parameters, such as excessive daytime sleepiness (measured by the Epworth Sleepiness Scale), snoring, insomnia, obstructive sleep apnea, drugs, pain, depression, fatigue, and quality of life, were registered. Clinical and sociodemographic parameters were compared between patients with MS and controls and between good and poor sleepers among patients with MS. The prevalence of poor sleep in patients with MS was 64.9. Univariate analysis found that gender (p<0.001), antidepressant drugs (p<0.001), insomnia (p<0.001), fatigue (p<0.001), Epworth Sleepiness Scale (ESS) (p<0.001), pain (p<0.001), and depression (p<0.001) were associated with sleep disorders. Multivariate analysis revealed that female gender, antidepressant drug treatment, and a high psychological burden of MS may be risk factors for poor sleep among patients with MS. Poor sleep is more common in patients with MS than in the general population. Sleep disorders should routinely be evaluated in patients with MS to improve the quality of sleep among them.

Sleep disorders in multiple sclerosis in China: clinical, polysomnography study, and review of the literature.

Sleep disorders are common in multiple sclerosis (MS). The aim of this study was to assess the subjective and objective sleep disturbances in patients with MS and to investigate their relationships with fatigue and excessive daytime sleepiness. All participants completed standardized questionnaires and underwent nocturnal polysomnography. English literature regarding MS and sleep disorders was systematically reviewed through PubMed searches. Eleven patients with MS with fatigue, 10 patients with MS without fatigue, and 11 controls were included in the study. According to the Pittsburg sleep quality index, 61.9% of the patients with MS were poor sleepers and based on the Epworth sleepiness scale, 38.1% of the patients with MS met the criteria of excessive daytime sleepiness. Additionally, patients with MS had more disturbed sleep with higher total arousal index (P < 0.01) and periodic limb movement arousal index (P < 0.001) than controls. None of the patients or controls had an apnea/hypopnea index greater than five. One patient had restless legs syndrome and four had rapid eye movement sleep behavior disorder. Our study shows that sleep disorders and excessive daytime sleepiness are frequent in MS.

Multiple sclerosis in China—history and future

Background Multiple sclerosis (MS) is considered rare in China and reports on MS in the English literature are few. Methods A systematic literature search for articles with MS was made, particularly for papers published in the Chinese medical journals from mainland China. Results In China, the first case of MS was described in the medical records from Xiehe hospital in 1926, and the first autopsy case of MS was reported from Huashan hospital in 1957. Although reports on MS based on the information from hospital case-series have been increased gradually in the recent decades, there is no national surveillance on MS frequency in the population and population-based surveys on MS were few in China. Generally for Chinese patients with MS the mean age at onset of MS is around 30 years, with a few cases younger than 20 years; the most frequent site of the lesions in the central nervous system, based on the clinical symptoms or signs, is the spinal cord (usually more than 60%); there are few patients with a family history of MS; almost all patients are treated with corticosteroids. Reported prevalence rates of MS from population surveys in China are rather low (1–2 per 100,000) and higher in females than in males, which are comparable with the results from other populations in Asia. Conclusion The clinical and epidemiological aspects of MS in China are, in general, similar to that from other populations in Asia. Epidemiological studies and national surveillance on MS are required in China.

Reliability and validity of Chinese version of the multiple sclerosis quality of life-54 questionnaire

Objective To translate and adapt the multiple sclerosis quality of life-54 questionnaire and evaluate the reliability and validity of this scale. Methods Using translation, back-translation, cross-cultural adaptation and protest we got the adaptation of the scale.Thirty multiple sclerosis patients were examined by the Chinese version of the scale, and their data were used to evaluate reliability and validity of the scale. Results The evaluation of the reliability of the scale showed the test-retest correlation coefficients of total scale and 13 aspects were above 0.7, the Cronbach of total scales and 12 aspects were above 0.7, the split-half coefficients was 0.96.The evaluation of validity of this scale showed the construct validity was good as indicated by factor analysis.Except health perceptions aspect, other aspects showed significant correlation to total scale(r =0.40～0.84);the correlation coefficient of criteria validity was 0.98.Except sexual function and satisfaction with sexual function aspects, there were statistical differences in aspect scores of this scale between multiple sclerosis patients and normal persons. Conclusion The reliability and validity of Chinese version of the multiple sclerosis quality of life-54 questionnaire are good enough for meeting psychometric standard, and can be applied to assess quality of life for patients with multiple sclerosis in China. Key words: Multiple sclerosis; Quality of life; Reliability; Validity

Review of the diagnosis and clinical features of multiple sclerosis in China.

This review focused on the diagnosis and clinical features of multiple sclerosis (MS) in China. We have identified the published researching information from 1976 to 2008 in China. The key issues related to the diagnosis and clinical features of MS in China were summarized. The first patient with MS in China was reported in 1926 from Xiehe hospital. Case reports on MS have been increasing during recent decades. Almost all the patients with MS were confirmed by the McDonald criteria (1977) before 1984. After the year of 1992, even to this day, the Poser criteria were widely used in China. Although the new diagnostic criteria, McDonald criteria (2001), were presented in 2001, only few papers published in Chinese were reported. The most frequent initial symptoms or signs of the patients with MS were optic nerve, motor weakness and sensory symptoms. The most frequent location of MS lesions over the course was found to be the spinal cord, followed by the cerebrum and optic nerves. Almost all patients had been treated with corticosteroids. This review supported previous observations in Chinese patients with MS. However, further studies are needed to understand epidemiologic features of MS in China.