Temporal trend of mortality from Multiple Sclerosis in Brazil by sex, ethnicity, and age group, between 2001 and 2022
DOI:
https://doi.org/10.33448/rsd-v14i10.49772Keywords:
Multiple Sclerosis, Mortality, Time Series.Abstract
Introduction: Multiple sclerosis (MS) is the most prevalent demyelinating disease of the central nervous system (CNS). It is estimated to affect approximately 2 to 2.5 million people globally, with higher prevalence in women and a peak incidence around 30 years of age. Objective: This study aims to analyze the temporal trend of MS mortality rates in Brazil between 2001 and 2022, stratified by sex, ethnicity, and age group. Methods: This is an ecological time-series study of MS mortality rates in Brazil, stratified by sex, ethnicity, and age group. Mortality data were collected from the Department of Informatics of the Unified Health System (DATASUS), in the Mortality Information System (SIM) section. Results: A total of 6,848 deaths were reported in Brazil between 2001 and 2022. Women accounted for most deaths (60.48%). White individuals had the highest mortality rate (66.41%), followed by brown/mixed (23.41%) and black individuals (5.10%). Mortality was higher in older age groups, with 28.8% of deaths occurring in individuals over 70 years old, possibly reflecting the impact of associated comorbidities. Conclusion: This study revealed a relatively low MS mortality rate compared to countries with predominantly Caucasian populations. The findings corroborate previous research, showing higher MS mortality among women, white individuals, and older adults. The national trend indicates stability in MS mortality.
References
Amezcua, L., Rivas, E., Joseph, S., Zhang, J., & Liu, L. (2018). Multiple sclerosis mortality by race/ethnicity, age, sex, and time period in the United States, 1999–2015. Neuroepidemiology, 50(1-2), 35–40. https://doi.org/10.1159/000484213
Amezcua, L., Rivera, V. M., Vazquez, T. C., Baezconde-Garbanati, L., & Langer-Gould, A. (2021). Health disparities, inequities, and social determinants of health in multiple sclerosis and related disorders in the US: A review. JAMA Neurology, 78(12), 1515–1524. https://doi.org/10.1001/jamaneurol.2021.3416
Bezzini, D., Kundisova, L., Gori, F., Martini, A., Giovannetti, L., Stoppa, G., et al. (2020). Mortality trend for multiple sclerosis in Italy during the period 1980-2015. Multiple Sclerosis and Related Disorders, 44, 102240. https://doi.org/10.1016/j.msard.2020.102240
Bizjak, N., Osredkar, D., Perković Benedik, M., & Šega Jazbec, S. (2017). Epidemiological and clinical characteristics of multiple sclerosis in paediatric population in Slovenia: A descriptive nation-wide study. Multiple Sclerosis and Related Disorders, 18, 56–59. https://doi.org/10.1016/j.msard.2017.09.017
Burkill, S., Montgomery, S., Hajiebrahimi, M., Hillert, J., Olsson, T., & Bahmanyar, S. (2017). Mortality trends for multiple sclerosis patients in Sweden from 1968 to 2012. Neurology, 89(6), 555–562. https://doi.org/10.1212/WNL.0000000000004216
Comi, G., Radaelli, M., & Soelberg Sørensen, P. (2017). Evolving concepts in the treatment of relapsing multiple sclerosis. Lancet, 389(10076), 1347–1356. https://doi.org/10.1016/S0140-6736(16)32388-1
Conselho Nacional de Saúde. (2013). Resolução CNS nº 466/2012: Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. http://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//resolucao-cns-466-12.pdf
Correia, I., Cunha, C., Bernardes, C., Nunes, C., Macário, C., Sousa, L., & Batista, S. (2024). Prevalence, incidence, and mortality of multiple sclerosis in Coimbra, Portugal. Neuroepidemiology, 58(1), 57–63. https://doi.org/10.1159/000535960
Costa Neto, P. L. O. & Bekman, O. R. (2009). Análise estatística da decisão. Editora Blücher
Cristiano, E., & Rojas, J. I. (2017). Multiple sclerosis epidemiology in Latin America: An updated survey. Multiple Sclerosis Journal - Experimental, Translational and Clinical, 3(2), 2055217317715050. https://doi.org/10.1177/2055217317715050
Diógenes, V. H. D., Pinto Júnior, E. P., Gonzaga, M. R., Queiroz, B. L., Lima, E. E. C., Costa, L. C. C. D., et al. (2022). Differentials in death count records by databases in Brazil in 2010. Revista de Saúde Pública, 56, 92. https://doi.org/10.11606/s1518-8787.2022056004282
Ekestern, E., & Lebhart, G. (2004). Mortality from multiple sclerosis in Austria 1970-2001: Dynamics, trends, and prospects. European Journal of Neurology, 11(8), 511–520. https://doi.org/10.1111/j.1468-1331.2004.00818.x
Filippi, M., Amato, M. P., Centonze, D., Gallo, P., Gasperini, C., Inglese, M., et al. (2022). Early use of high-efficacy disease modifying therapies makes the difference in people with multiple sclerosis: An expert opinion. Journal of Neurology, 269(10), 5382–5394. https://doi.org/10.1007/s00415-022-11193-w
França, E., Ishitani, L. H., Teixeira, R., Duncan, B. B., Marinho, F., & Naghavi, M. (2020). Changes in the quality of cause-of-death statistics in Brazil: Garbage codes among registered deaths in 1996-2016. Population Health Metrics, 18(Suppl 1), 20. https://doi.org/10.1186/s12963-020-00221-4
Gajofatto, A., & Benedetti, M. D. (2015). Treatment strategies for multiple sclerosis: When to start, when to change, when to stop? World Journal of Clinical Cases, 3(7), 545–555. https://doi.org/10.12998/wjcc.v3.i7.545
Gama Pereira, A. B., Sampaio Lacativa, M. C., da Costa Pereira, F. F., & Papais Alvarenga, R. M. (2015). Prevalence of multiple sclerosis in Brazil: A systematic review. Multiple Sclerosis and Related Disorders, 4(6), 572–579. https://doi.org/10.1016/j.msard.2015.08.004
Harding, K., Zhu, F., Alotaibi, M., Duggan, T., Tremlett, H., & Kingwell, E. (2020). Multiple cause of death analysis in multiple sclerosis: A population-based study. Neurology, 94(8), e820–e829. https://doi.org/10.1212/WNL.0000000000008907
Kim, H. J., Fay, M. P., Feuer, E. J., & Midthune, D. N. (2000). Permutation tests for joinpoint regression with applications to cancer rates. Statistics in Medicine, 19(3), 335–351. https://doi.org/10.1002/(sici)1097-0258(20000215)19:3<335::aid-sim336>3.0.co;2-z
Kurtzke, J. F., Beebe, G. W., Nagler, B., Auth, T. L., Kurland, L. T., & Nefzger, M. D. (1972). Studies on the natural history of multiple sclerosis. 6. Clinical and laboratory findings at first diagnosis. Acta Neurologica Scandinavica, 48(1), 19–46. https://doi.org/10.1111/j.1600-0404.1972.tb07525.x
Krajnc, N., Oražem, J., Rener-Primec, Z., & Kržan, M. J. (2018). Multiple sclerosis in pediatric patients in Slovenia. Multiple Sclerosis and Related Disorders, 20, 194–198. https://doi.org/10.1016/j.msard.2018.01.026
Leray, E., Vukusic, S., Debouverie, M., Clanet, M., Brochet, B., de Sèze, J., et al. (2015). Excess mortality in patients with multiple sclerosis starts at 20 years from clinical onset: Data from a large-scale French observational study. PLoS ONE, 10(7), e0132033. https://doi.org/10.1371/journal.pone.0132033
Marrie, R. A., Patten, S. B., Tremlett, H., Wolfson, C., Warren, S., Svenson, L. W., et al. (2016). Sex differences in comorbidity at diagnosis of multiple sclerosis: A population-based study. Neurology, 86(14), 1279–1286. https://doi.org/10.1212/WNL.0000000000002481
Moreira, M. A., Felipe, E., Mendes, M. F., & Tilbery, C. P. (2000). Esclerose múltipla: Estudo descritivo de suas formas clínicas em 302 casos. Arquivos de Neuro-Psiquiatria, 58(2B), 460–466. https://doi.org/10.1590/S0004-282X2000000300010
Morettin, P. A. & Toloi, C. M. C. (2006). Análise de séries temporais. (2.ed). Editora Blücher
Misnaza-Castrillón, S. P., Martinez Angarita, J. C., & Martínez Gomez, V. M. (2018). Distribución geográfica de la mortalidad por esclerosis múltiple en adultos Colombia (2010–2015). Revista de Salud Pública, 21(4), 1–8. https://doi.org/10.15446/rsap.V21n4.76176
Multiple Sclerosis International Federation. (2013). Atlas of MS 2013: Mapping multiple sclerosis around the world. Multiple Sclerosis International Federation. http://www.msif.org/about-ms/publications-and-resources/
Nakken, O., Lindstrøm, J. C., & Holmøy, T. (2018). Sex ratio in multiple sclerosis mortality over 65 years: An age-period-cohort analysis in Norway. Journal of Neurology, 265(6), 1295–1302. https://doi.org/10.1007/s00415-018-8832-9
Oliveira, L. C. (2016). Análise espaco-temporal da mortalidade por esclerose múltipla no Brasil [Dissertação, Universidade Federal do Espírito Santo].
Ostolaza, A., Corroza, J., & Ayuso, T. (2021). Multiple sclerosis and aging: Comorbidity and treatment challenges. Multiple Sclerosis and Related Disorders, 50, 102815. https://doi.org/10.1016/j.msard.2021.102815
Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. [free ebook]. Santa Maria. Editora da UFSM
Pérez, C., López, H. M., Holger, N. O., Rondón, M. R., & Rovira, J. M. A. (2003). Tasa de mortalidad de la esclerosis múltiple en Venezuela según edad y género. Gaceta Médica de Caracas, 111(3), 227–230. https://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0367-47622003000300008&lang=es
Qian, Z., Li, Y., Guan, Z., Guo, P., Zheng, K., Du, Y., Yin, S., Chen, B., Wang, H., Jiang, J., Qiu, K., & Zhang, M. (2023). Global, regional, and national burden of multiple sclerosis from 1990 to 2019: Findings of global burden of disease study 2019. Frontiers in Public Health, 11, 1073278. https://doi.org/10.3389/fpubh.2023.1073278
Renoux, C., Vukusic, S., Mikaeloff, Y., Edan, G., Clanet, M., Dubois, B., et al. (2007). Natural history of multiple sclerosis with childhood onset. New England Journal of Medicine, 356(25), 2603–2613. https://doi.org/10.1056/NEJMoa067597
Ropper, A. H., Samuels, M. A., Klein, J. P., & Prasad, S. (2019). Adams and Victor's principles of neurology (11th ed.). McGraw-Hill Education.
Sacramento, T. de O., Nascimento, R. J. M., Lemaire, D. C., & Bendicho, T. F. (2018). Associação entre esclerose múltipla e alelos HLA-DRB1* em uma população miscigenada de Salvador, Ba, Brasil. cmbio, 17(1), 9–15. https://periodicos.ufba.br/index.php/cmbio/article/view/22695
Sharmin, S., Roos, I., Simpson-Yap, S., Malpas, C., Sánchez, M. M., Ozakbas, S., et al. (2023). The risk of secondary progressive multiple sclerosis is geographically determined but modifiable. Brain, 146(11), 4633–4644. https://doi.org/10.1093/brain/awad218
Shitsuka, R. et al. (2014). Matemática fundamental para a tecnologia. (2.ed.). Editora Érica
Thormann, A., Sørensen, P. S., Koch-Henriksen, N., Laursen, B., & Magyari, M. (2017). Comorbidity in multiple sclerosis is associated with diagnostic delays and increased mortality. Neurology, 89(16), 1668–1675. https://doi.org/10.1212/WNL.0000000000004508
Vieira, S. (2021). Introdução à bioestatística. Editora GEN/Guanabara Koogan
Waldman, A., Ness, J., Pohl, D., Simone, I. L., Anlar, B., Amato, M. P., & Ghezzi, A. (2016). Pediatric multiple sclerosis: Clinical features and outcome. Neurology, 87(9 Suppl 2), S74–S81. https://doi.org/10.1212/WNL.0000000000003028
Wallin, M. T., Culpepper, W. J., Nichols, E., Bhutta, Z. A., Gebrehiwot, T. T., Hay, S. I., et al. (2019). Global, regional, and national burden of multiple sclerosis 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 18(3), 269–285. https://doi.org/10.1016/S1474-4422(18)30443-5
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Luídi Neves Nascimento, Deivisson Caldas Pereira, Émile de Carvalho Morais Fraga, Érica Otoni Pereira Miranda, Guilherme Rocha Cardoso, Isaac Esdras Silva Souza, Luciele Sousa Morais, Naila Maria Magalhães da Silva, Rebeca Gabrielle Almeida Maciel
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
