Sunday, 15 September 2013

What can studying MS in Kuwait teach us?

An MS epidemic in Kuwait. Why? #MSBlog #MSResearch

"What can Kuwait teach us about MS? It is a small country with a population of ~2.8 million people on the Persian Gulf. It is a very sunny and warm country. If lack of sunlight exposure, and hence vitamin D deficiency, is a trigger for MS then the MS should be rare in Kuwait. The opposite is seen. This is not unique to Kuwait; a similar trend is seen in other Gulf states, in particular Iran were the incidence and prevalence of MS is soaring. Why? Could it be due to another environmental factor? Or could it be due to cultural changes? I suspect the latter. Kuwaiti woman and men spend less time outdoors than they used to do and they also cover up. Vitamin D deficiency is endemic across the region. I have been told by a neurologist who works in Kuwait that a vD supplements are becoming the norm in the country. Another change is that the demographic profile of country is changing; a larger proportion of the population are entering the so called at risk age. It is important to study epidemics of this nature as it provides an opportunity to pin down causative factors. Who is going to fund MS causation research in Kuwait? Someone should as this is the country where it will be easier to test hypotheses about MS causation. This is more difficult in countries in which the incidence (number of new cases) and prevalence (total number of cases) of MS is relatively constant; we refer to the latter as endemic."



Epub: Alroughani et al. Increasing prevalence and incidence rates of multiple sclerosis in Kuwait. Mult Scler. 2013 Sep 11.

BACKGROUND: Kuwait was considered as low to intermediate risk area for MS.

OBJECTIVES: To determine the prevalence and incidence rates of MS among Kuwaiti nationals based on 2011 population census.

METHODS: This cross-sectional study was conducted between October 2010 and April 2013 using the newly developed national MS registry in Kuwait. People with a diagnosis of MS according to 2010 revised McDonald criteria were identified. The crude, age- and sex-specific prevalence and incidence rates among Kuwaiti MSers were calculated.

RESULTS: 1176 MSers were identified of which 927 (78.8%) were Kuwaitis and 249 (21.2%) were expatriates. Among Kuwaiti MSers, female to male ratio was 1.8:1 with a mean age of 35.40 ± 10.99 years. The prevalence rate of MS was 85.05 per 100,000 persons (95% CI: 82.80 - 87.04). There was a peak in prevalence among patients aged 30-39 years. The incidence of MS was 6.88 per 100,000 persons (95% CI 5.52-8.55). Between 2003 and 2011, the incidence increased 3.22 and 2.54 times in women and men respectively.

CONCLUSION: Kuwait is considered a high-risk area for MS. The significant increase in prevalence and incidence rates may represent a true increase despite the improvement in case ascertainment and case definition.

4 comments:

  1. My money would be on the revised measurement scale. However, having "neighbours" such as Iran and Iraq, would provide a constant cause of stress. Caught between a rock and a hard place.

    Interesting that the peak prevalence (30-39) increase coincides with the Iraq-Kuwait war 1990 when this age group would have been in early teen-adolescent age which seems to spike catching glandular fever.

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  2. Did US/British bring in MS in the gulf war...the faroes in WWII

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  3. I have MS and live in Tehran. My neurologist believes MS is due to some kind of toxin or agent that was released by people working in the oil industry. Prior to oil there was virtually no MS in Iran. What do you think of his theory?

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    1. I am not sure about this theory I will ask an Iranian colleague of ours for his opinion. If I am correct the early oil industry was dominated by Western Europeans and Americans expatriates so they may have brought something into Iran that has triggered MS; not to dissimilar to MDs reference to the Gulf War. This is a theory and I am sure there is data to refute this. I will ask Hadi his opinion on this to.

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