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Prevalence and Incidence of Multiple Sclerosis in Russian Federation: 30 Years of Studies

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Prevalence and Incidence of Multiple Sclerosis in Russian Federation: 30 Years of Studies brain sciences Review Prevalence and Incidence of Multiple Sclerosis in Russian Federation: 30 Years of Studies Alexey Boyko 1,2,3 and Mikhail Melnikov 1,2,4,* 1 Department of Neurology, Neurosurgery and Medical Genetic, Prirogov Russian National Research Medical University, 1 Ostrovityanova st., Moscow 117997, Russia; [email protected] 2 Department of Neuroimmunology, Federal Center of Brain and Neurotechnology, Federal Medical-Biological Agency of Russia, 1-10 Ostrovityanova st., Moscow 117997, Russia 3 Scientific-Practical Center of Pediatric Psychoneurology, Michurinsky Prospekt 74, Moscow 119602, Russia 4 Laboratory of Clinical Immunology, National Research Center Institute of Immunology, Federal Medical-Biological Agency of Russia, Kashirskoe shosse 24, Moscow 115478, Russia * Correspondence: [email protected]; Tel.: +7-926-331-89-46 Received: 14 April 2020; Accepted: 15 May 2020; Published: 18 May 2020 Abstract: In the Russian Federation, multiple sclerosis prevalence rates vary from 10 to 80 cases per 100,000, depending on region and the nationality of the population. The main characteristics of multiple sclerosis epidemiology in the XX century in this big territory are: (1) steady increase in multiple sclerosis prevalence and incidence rates, maybe because of better diagnosis and treatment, but also changes in environmental/epigenetic risk profile and/or lifestyle factors; (2) increase of the female to male ratio, increase in multiple sclerosis incidence mainly in females; (3) appearance and increasing frequency of multiple sclerosis in ethnic groups, previously free of multiple sclerosis (Northern Tribes, Yakuts and others). The latest data show that in European Russia, the multiple sclerosis prevalence varies from 30 to 80 cases, in Siberia—from 20 to 70 cases, with steady increases, especially in women. Keywords: multiple sclerosis; epidemiology; prevalence; incidence 1. Introduction Multiple sclerosis (MS) is characterized by uneven distribution worldwide, with increasing prevalence and incidence indexes in many countries [1]. The Russian Federation is located on area of 17,000,000 km2, where 191 ethnic groups live. Previous reviews of epidemiology of MS in Russia were published at the end of previous century, with some recent additions [2–4]. Although the methodology of epidemiological studies has improved significantly in recent years, many of them still do not provide sufficient data for analysis. The majority of studies were published only in Russian. The objective for this review was to evaluate temporary changes in the prevalence of MS in various regions of the Russian Federation over a period of 30 years—from 1988 to 2018. Special attention is planned to be paid to the ratio of female to male (F/M) and ethnic origin of patients. 2. Materials and Methods According to the All-Russian National Bibliography, 328 articles on the clinical epidemiology of MS in the Russian Federation were published from 1988 up to now, including data collected from the late 1980s to 2018. All articles and abstracts were in Russian and mainly based on hospital cases, or had some problems in the calculation of widely used epidemiological indexes. The majority of studies used Poser criteria for MS diagnosis; only McDonald criteria of the last 10 years were dominating [5,6]. Brain Sci. 2020, 10, 305; doi:10.3390/brainsci10050305 www.mdpi.com/journal/brainsci Brain Sci. 2020, 10, x FOR PEER REVIEW 2 of 13 Brain Sci. 2020, 10, 305 2 of 12 [5,6]. We selected the most qualified studies performed during this period, using these diagnostic Wecriteria selected of MS, the mostvalidated qualified in Russia studies [7]. performed One hundred during and this thirty-nine period, usingpublications these diagnostic were selected, criteria some of MS,of which validated did innot Russia contain [7 ].sufficient One hundred data. Finally, and thirty-nine only 69 articles publications and theses were with selected, data somefrom of40 whichstudies did(some not containof them suin ffidynamics)cient data. were Finally, finally only included 69 articles in this and review theses ( withFigure data 1). fromWe used 40 studies only the (some average of themannual in dynamics)rates of prevalence were finally and includedincidence in rate this am reviewong these (Figure populations1). We used at onlydifferent the averagetime periods. annual rates of prevalence and incidence rate among these populations at different time periods. Figure 1. Methodology of the data selection. 3. Results Figure 1. Methodology of the data selection. 3.1. European Russia 3. Results At the Northern Regions of the European part of Russia in the 1980s and 1990s, the prevalence of MS was near 30–40 cases per 100,000 population. In the Leningrad Region, the prevalence of MS was 3.1. European Russia 28.8 cases per 100,000 population, with the incidence ratio varying from 0.9 in 1990 to 2.2 cases per 100,000At population the Northern in 1994 Regions [8,9]. of Later, the inEuropean the Smolensk part of Region, Russia the in the prevalence 1980s and of MS1990s, at 2006–2008 the prevalence was 47.4of MS cases was per near 100,000 30–40 population, cases per reaching100,000 population. a maximum In in the GlinkovskyLeningrad Region, district ofthe the prevalence Region—up of MS to 73.2was cases. 28.8 cases For the per F /100,000M ratio, population, there was, on with average, the inci 1.6.dence For theratio period varying 2005–2010, from 0.9 the in average1990 to 2.2 annual cases prevalenceper 100,000 of MSpopulation there reached in 1994 55.4 [8,9]. cases Later, and thein the incidence Smolensk rate—4.5 Region, cases the per prevalence 100,000 population of MS at with2006– F/2008M ratio was 1.6 47.4 [10 cases,11]. Theper prevalence100,000 population, of MS in reaching the Republic a maximum of Karelia in for the the Glinkovsky period 2013–2018 district of was the 61.2Region—up cases per 100,000to 73.2 cases. population, For the the F/M average ratio, there annual wa incidence—2.7s, on average, cases1.6. For per the 100,000 period population 2005–2010, [12 the]. averageIn the annual Central prevalence regions of of European MS there Russia, reached MS 55.4 prevalence cases and was the 36 casesincidence per 100,000 rate—4.5 population cases per in100,000 the Nizhny population Novgorod with Region F/M ratio, and 1.6 61 [10,11]. cases—in The the prevalence Ryazan Regionof MS in [13 the,14 Republic]. In the of city Karelia of Nizhny for the Novgorod,period 2013–2018 the prevalence was 61.2 of cases MS in per 2000–2002 100,000 waspopula reportedtion, the to beaverage 38 cases annual per 100,000 incidence—2.7 population cases with per F/100,000M ratio population of 1.7. The [12]. average annual incidence rate was 1.6 cases per 100,000 population [15]. In the KalugaIn region the Central in 2009–2012, regions MSof European prevalence Russia, was 54.7 MS casesprevalence per 100,000 was 36 population, cases per 100,000 with F/ Mpopulation ratio of 2.03in the [16 ].Nizhny A longitudinal Novgorod study Region in, theand Yaroslavl 61 cases—in Region the showed Ryazan an Region increase [13,14]. in the prevalenceIn the city ratesof Nizhny from 42.6Novgorod, cases per the 100,000 prevalence population of MS in in 2004 2000–2002 to 56.2 cases was perreported 100,000 to population be 38 cases in per 2015 100,000 and 78.5 population cases in 2019.with TheF/M incidence ratio of 1.7. increased The average from annual 0.51 in 1975incidence to 1.58 rate in 2015was 1.6 and cases 3.28 per in 2019 100,000 [17– population20]. [15]. In the InKaluga the Moscowregion in 2009–2012, Region in MS 2001–2005, prevalence the was MS 54.7 prevalence cases per 100,000 rates were population, 28.7–31.8 with cases F/M perratio 100,000of 2.03 [16]. population, A longitudinal with study a F/M in ratiothe Yaroslavl of 2.0 Region and an showed incidence an increase rate of in 2.1–2.6the prevalence cases rates per 100,000from 42.6 population cases per 100,000 [21–23]. population In Moscow, in 2004 the to 56.2 first cases epidemiological per 100,000 population population-based in 2015 and study 78.5 conductedcases in 2019. in 1989–1993 The incidence (Central increased District from of 0.51 Moscow, in 1975 120,000 to 1.58 inhabitants) in 2015 and 3.28 showed in 2019 the [17–20]. rate of MS prevalence—44.8In the Moscow cases Region per 100,000 in 2001–2005, population the MS with prevalen mean incidencece rates were rate—3.39 28.7–31.8 [3]. cases The nextper 100,000 study, coveringpopulation, the periodwith a fromF/M ratio 2008 of to 2.0 2012, and was an carriedincidence out rate in another of 2.1–2.6 district cases of per Moscow 100,000 (North-Western population [21– 23]. In Moscow, the first epidemiological population-based study conducted in 1989–1993 (Central Brain Sci. 2020, 10, 305 3 of 12 District, 927,000 inhabitants). The data obtained were standardized for the European population. At this period the annual prevalence rate of MS was 55.6 per 100,000 population (the standardized rate—48.2) with a F/M ratio 2.6 and mean incidence rate—2.16 (the standardized index—1.88) [24,25]. In the South-Western Bryansk Region, the prevalence of MS increased from 40.6 cases in 2004–2008 to 48.1 cases per 100,000 population in 2012–2016. The average incidence rate in 2012–2016 was 1.9 cases, and F/M ratio—3.0 [26,27].
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