Epidemiology of Multiple Sclerosis in Kuwait: New Trends in Incidence and Prevalence

Al-Shubaili, Asmahan; Alramzy, K.; Ayyad, Y.M.; Gerish, Y.

doi:10.1159/000085556

Cited by 76 publications

(87 citation statements)

References 35 publications

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“…However, it has been suggested that stress could produce cerebrovascular alterations which might be etiologically related to plaque formation [26], or such patients could develop MS in the context of protracted emotional arousal including anger [27,28]. Alternatively, environmental pollution, exposure to toxins and chemicals as a result of the Iraqi occupation might be associated with an increased MS risk in our target population as suggested earlier [7,29]. …”

Section: Discussionmentioning

confidence: 76%

“…In Kuwait, MS is also more common in females and displays a much higher prevalence among Kuwaitis (31.2/100,000) than non-Kuwaitis (5.6/100,000) [10]. Furthermore, Kuwait has experienced an increase in the incidence of MS (from 1.1/100,000 population in 1993 to 2.6/100,000 in 2000) and in the prevalence of MS (from 6.7/100,000 in 1993 to 14.8/100,000 in 2000).…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Multiple Sclerosis in Kuwait: A Population-Based Case-Control Study

et al. 2012

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Multiple sclerosis (MS) is a chronic and progressively disabling inflammatory autoimmune disorder of the central nervous system. MS has a multifactorial etiology and is triggered by environmental factors in individuals with complex genetic risk profiles. The epidemiology of MS changes with the spatial and temporal distribution of these genetic and nongenetic risk factors. This population-based matched case-control study aimed to determine the risk factors for MS in Kuwait. From May 2 to 9, 2010, we enrolled 101 confirmed MS cases using the list frame maintained by the Multiple Sclerosis Association of Kuwait. For each case, two population controls individually matched for age (±2 years), gender and nationality were selected. Data on demographic, socioeconomic variables, potential genetic and environmental factors were collected using a structured questionnaire. For a case, the questions were directed to the period that preceded the recognition of the disease, while for each of the two matched controls, a date of ‘pseudodiagnosis’ of MS was established, i.e. the date on which the control subject was of the same age as his/her matched case was at MS diagnosis and accordingly questions were directed to the preceding period. The multivariable conditional logistic regression model showed that compared with controls, the cases were significantly more likely to have a family history of MS [matched odds ratio (OR)_adj = 6.7; 95% confidence interval (95% CI): 2.5–18.0; p < 0.001] or have suffered from a head trauma in the past before MS diagnosis (matched OR_adj = 2.6; 95% CI: 1.2–5.5; p = 0.014). Furthermore, compared with controls, cases were significantly more likely to have stayed in Kuwait during the Iraqi invasion of 1990 (matched OR_adj = 1.8; 95% CI: 1.1–3.5; p = 0.022). This study showed that a family history of MS, a history of head injury, and presence in Kuwait at the time of the Iraqi invasion of 1990 were associated with a significantly increased MS risk. Future retrospective cohort studies by using existing biological and epidemiological databases may provide a clue to MS etiology.

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Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Multiple Sclerosis in Kuwait: A Population-Based Case-Control Study

et al. 2012

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“…Overall, there have been an increasing prevalence and incidence of MS over the past few decades in this region [42,43]. Within the country of Kuwait, there has been a twofold increase in both the prevalence and incidence of MS between 1993 and 2000 [44]. Some of this increase can be attributed to better ascertainment with the availability of MRI imaging.…”

Section: Discussionmentioning

confidence: 99%

Multiple Sclerosis in Gulf War Era Veterans. 2. Military Deployment and Risk of Multiple Sclerosis in the First Gulf War

et al. 2014

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Background: Concern has been raised that US veterans of the 1990-1991 Gulf War (GW1) may be at increased risk to develop neurologic disease. Methods: An incident cohort of multiple sclerosis (MS) and other demyelinating disease (ODD) was assembled from the US military comprising the Gulf War era (1990-2007). Cases of MS and ODD meeting standard diagnostic criteria were matched to a database of all active duty personnel from the Department of Defense. Relative risk (RR) estimates for MS and all demyelinating disease based on onset, deployment status, and exposures were calculated. Results: For GW1, a total of 1,841 incident cases of definite MS and ODD were identified, with 387 among 696,118 deployed and 1,454 among 1,786,215 nondeployed personnel. The RR for MS alone among those deployed compared to those nondeployed was 0.69 (confidence interval, CI: 0.61-0.78), with 0.72 (CI: 0.62-0.83) in men and 0.96 (CI: 0.75-1.22) in women. Deployment was also nonsignificant or protective as an MS risk factor across racial groups, all age groups, and each military service. RRs for MS by service were: Air Force 0.71 (CI: 0.53-0.96), Army 0.80 (CI: 0.67-0.96), Marines 0.96 (CI: 0.63-1.47), and Navy 0.56 (CI: 0.43-0.74). Conclusion: Military deployment to GW1 was not a risk factor for developing MS.

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“…Alternatively, it could be real increase in MS risk in our setting due to the increasing magnitude of specific environmental factors and/or adaptation of dietary and lifestyles patterns precipitating MS risk. Kuwait has moved from a low to a moderately high-risk setting for MS and aforementioned factors have been implicated for this steady increase of MS risk in Kuwait [12, 28]. …”

Section: Discussionmentioning

confidence: 99%

“…Majority of the migrants are men with a low educational attainment [9-11]. Among nationals, the male and female literacy rates (defined as individuals aged 10 years or more and who can read and write) are 98.5 and 91.2%, respectively, with a gender ratio (male: female) of 1.04 at birth [12]. Petroleum and petrochemical products constitute the major industry.…”

Section: Methodsmentioning

confidence: 99%

Age-Period-Cohort Modeling of Multiple Sclerosis Incidence Rates in Kuwait: 1980–2014

Akhtar¹,

Al-Abkal

Al-Hashel

et al. 2017

Neuroepidemiology

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Background: Multiple sclerosis (MS) is a complex immune-mediated disorder of the central nervous system with undefined etiology. Genetic predisposition and environmental factors play an imperative role in MS causation and its sustained increasing burden worldwide. This study examined the age, period, and cohort effects on MS incidence rates in Kuwait. Methods: In this retrospective cohort study, data on MS cases diagnosed between January 1, 1980 and December 31, 2014 and registered in National MS Registry and reference population were obtained. Age-period-cohort (APC) analysis was conducted using a loglinear Poisson regression model to supplement the descriptive and graphical presentation. Descriptive statistics were complemented with APC parameters’ estimates including net drift, local drift, age at onset curve, and longitudinal age trend. Age effect was presented as incidence rates (per 10⁵ person-years), whereas period and cohort effects were presented as adjusted relative rates. Results: A total of 1,131 cases were diagnosed in 1,385,923 person-years. Overall age-standardized MS incidence rate was 64.5 (95% CI 52.4–79.8). An estimated annual percentage change revealed 7.4% annual increase in MS incidence rate during the study period (Net drift = 7.4%; 95% CI 4.1–10.8%). APC “fitted” age-at-onset curve showed a bimodal pattern with peaked incidence rates at 20–24 years and 45–49 years of age. Compared with the referent period (1980–1984) and cohort (1970–1974), MS incidence rates progressively and significantly (p < 0.001) increased during subsequent time periods and in successive cohorts. Results of APC analysis are descriptive in nature and specific etiological hypotheses were not evaluated. However, the findings of this study substantiated the notion of multiplicity of genetic and/or environmental risk factors’ contributions. Conclusion: A substantial increase in MS incidence rates was recorded, which significantly varied in all 3 temporal dimensions during the study period. Future studies may contemplate biological basis for recorded temporal increase in MS risk.

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Epidemiology of Multiple Sclerosis in Kuwait: New Trends in Incidence and Prevalence

Cited by 76 publications

References 35 publications

Risk Factors for Multiple Sclerosis in Kuwait: A Population-Based Case-Control Study

Risk Factors for Multiple Sclerosis in Kuwait: A Population-Based Case-Control Study

Multiple Sclerosis in Gulf War Era Veterans. 2. Military Deployment and Risk of Multiple Sclerosis in the First Gulf War

Age-Period-Cohort Modeling of Multiple Sclerosis Incidence Rates in Kuwait: 1980–2014

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