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The prevalence of multiple sclerosis in the North of Scotland

Background: Multiple sclerosis (MS) is a common, disabling neuro-inflammatory disorder, whose prevalence seems to be increasing. Objectives: The main aims of this thesis were to: (i) systematically review good quality MS prevalence studies and assess heterogeneity in prevalence rates; (ii) conduct a new prevalence study in Aberdeen, Orkney and Shetland to assess temporal trends, compare rates to other areas and describe demographic, clinical and disability data in prevalent MS patients. Methods: The systematic review used defined search strategies to identify references that satisfied inclusion criteria. The influence of time, latitude, diagnostic criteria, quality of case ascertainment and methods of classifying patients on age-gender standardised prevalence rates and sex ratios were analysed by uni- and multivariate regression. The new prevalence study identified all MS patients alive on 24/9/09 from defined general practices through multiple sources. Primary and secondary care records were used to confirm the diagnosis. Prevalence rates were standardised to 2009 Scottish population. A postal questionnaire survey was conducted to gain additional data, which allowed a randomised factorial trial of the effect of envelope colour/address labelling on response rates to be performed. Results: The review identified marked heterogeneity (I2 99.7%) in prevalence rates, partially explained by latitude (p<0.0001), prevalence date (p=0.009) and number of ascertainment sources (p=0.04). High and rising prevalence was recorded in Orkney [402/100,000 (95% CI 319-500)], the highest worldwide, Shetland [295/100,000 (95%CI 229-375)] and Aberdeen city [229/100,000 (95%CI 208-250)]. Male-to-female ratio was 1:2.55 (95%CI 2.26-2.89). Postal response rates to brown/white envelopes were not different [OR 1.17 (95% CI 0.81 to 1.68)] but hand-written address labels had a higher response than computer-generated labels [OR 1.22 (95% CI 1.06-1.40)]. Conclusions: This research showed that MS prevalence remains very high in northern Scotland and confirmed international observations of rising prevalence. Explanations include increased survival, improved diagnosis and probably increasing incidence.
Date January 2013
CreatorsVisser, Elizabeth Magdalena
PublisherUniversity of Aberdeen
Source SetsEthos UK
Detected LanguageEnglish
TypeElectronic Thesis or Dissertation

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