Prevalence of Multiple Sclerosis in a Turkish City Bordering an Iron and Steel Factory

Abstract

Background and PurposeMultiple sclerosis (MS) is an autoimmune disease characterized by inflammatory demyelination. Recent studies have shown that long-term exposure to air pollutants (including PM10 particulates) is potentially an environmental risk factor for MS. We aimed to determine the prevalence rates of MS in two cities with different levels of air pollution.MethodsThis door-to-door population-based study was conducted between April 2014 and June 2015. Two cities were screened for the prevalence rates of MS: 1) Karabük, which borders an iron-and-steel factory, and 2) Akçakoca, which is a coastal city located in the same region. A validated survey form was used for screening MS. The 2010 McDonald Criteria were used for diagnosing MS. The patients were examined twice, first by a neurology assistant in the field and then by a senior neurologist in public health centers in the cities.ResultsThe prevalence of MS was 95.9/100,000 in Karabük and 46.1/100,000 in Akçakoca. In total, 33 patients were diagnosed with clinically definite MS. The female/male ratio was 1.5, and 21 patients were diagnosed with relapsing-remitting MS, 9 with secondary progressive MS, and 3 with primary progressive MS.ConclusionsWe found that the prevalence of MS was more than two fold higher in Karabük than in Akçakoca, which supports a link between air pollution and the pathogenesis of MS. However, larger etiological and epidemiological studies are needed to confirm this hypothesis.

Multiple sclerosis prevalence study

“…[ 3 – 6 ] Previously, Turkey was considered to have a low prevalence of MS. [ 7 ] Recent studies from Turkey (Istanbul, Kandıra, Geyve, Erbaa, Kars, Karabük, and Akçakoca) suggest prevalence of 41.1 to 101.4 per 100,000 population. [ 8 – 11 ] These recently conducted studies highlight that Turkey now has a high prevalence rate. MS prevalence in Turkey is shown in supplementary file table.…”

Evidence of an Increased Prevalence of Multiple Sclerosis: A Population-Based Study of Tehran Registry during 1999–2018

“…Moreover, the sex ratio has been reported to be 3.06 in Eskandarieh et al's study [6]. A study conducted in Turkey [33] revealed that the prevalence of MS in Karabük and Akçakoca were 95.9 and 46.1 per 100,000 people, respectively [34]. In addition, the mentioned study indicated that the prevalence of MS in the Middle East and North Africa was 51.52 cases per 100,000 people [34].…”

Air pollution, a possible risk factor for multiple sclerosis

“…A previous study carried out in Karabük in Turkey, which is also home to an iron and steel factory and has proven air pollution, supports this claim. The prevalence was found to be 95.9/100 000 …”

“…[5][6][7] An epidemiological study conducted in Karabük city, which has proven air pollution and is home to an iron and steel factory, highlighted almost a twofold prevalence when compared to other cities. 8 On the other hand, another study showed the lowest ever national MS prevalence recorded, which was in Artvin city, the cleanest city in Turkey. 5 In light of these studies, we aimed to assess the prevalence of Ereğli city which also has an iron and steel factory as well as proven air pollution and to compare the results with a control population in neighboring Devrek city, a city without any air pollution.…”

“…Studies carried out on MS epidemiology in Turkey indicate that the prevalence of MS is changing in variety according to cities characteristics . An epidemiological study conducted in Karabük city, which has proven air pollution and is home to an iron and steel factory, highlighted almost a twofold prevalence when compared to other cities . On the other hand, another study showed the lowest ever national MS prevalence recorded, which was in Artvin city, the cleanest city in Turkey…”