60/30: 60% of the Morbidity-Associated Multiple Sclerosis Disease Burden Comes From the 30% of Persons With Higher Impairments

• Main Authors: Marco Kaufmann, Milo Alan Puhan, Anke Salmen, Christian P. Kamm, Zina-Mary Manjaly, Pasquale Calabrese, Sven Schippling, Stefanie Müller, Jens Kuhle, Caroline Pot, Claudio Gobbi, Nina Steinemann, Viktor von Wyl, Swiss Multiple Sclerosis Registry (SMSR)
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2020-03-01
• Series: Frontiers in Neurology
• Subjects: burden; DALY; morbidity; mortality; SMSR; epidemiology
• Online Access: https://www.frontiersin.org/article/10.3389/fneur.2020.00156/full

Background: Multiple sclerosis (MS) is the most common chronic, non-traumatic, neurologic disease in young adults. While approximate values of the disease burden of MS are known, individual drivers are unknown.Objective: To estimate the age-, sex-, and disease severity-specific contributions to the disease burden of MS.Methods: We estimated the disease burden of MS using disability-adjusted life years (DALYs) following the Global Burden of Disease study (GBD) methodology. The data sources consisted of the Swiss MS Registry, a recent prevalence estimation, and the Swiss mortality registry.Results: The disease burden of MS in Switzerland in 2016 was 6,938 DALYs (95%-interval: 6,018-7,955), which corresponds to 97 DALYs per 100,000 adult inhabitants. Morbidity contributed 59% of the disease burden. While persons in an asymptomatic (EDSS-proxy 0) and mild (EDSS-proxy >0–3.5) disease stage represent 68.4% of the population, they make up 39.8% of the MS-specific morbidity. The remaining 60.2% of the MS-specific morbidity stems from the 31.6% of persons in a moderate (EDSS-proxy 4–6.5) or severe (EDSS-proxy ≥7) disease stage.Conclusions: Morbidity has a larger influence on the disease burden of MS than mortality and is shared in a ratio of 2:3 between persons in an asymptomatic/mild and moderate/severe disease stage in Switzerland. Interventions to reduce severity worsening in combination with tailored, symptomatic treatments are important future paths to lower the disease burden of MS.