MS also less common among men in China, but more disabling

Fewer men than women are diagnosed with multiple sclerosis (MS) in China — as elsewhere — but more male patients have faster MS disability progression and higher death rates, a study found.

Over the next 25 years, the burden of MS is expected to persist in China, the researchers noted, despite encouraging trends in death and disability rates, particularly for female patients.

“China places a high premium on the prevention, control, and insurance of rare diseases and has introduced many policies to improve [disease] treatment ability and protect patients,” the researchers wrote. “The progress in MS management has been proven.”

The study, “Gender differences in the burden of multiple sclerosis in China from 1990 to 2019 and its 25-year projection: An analysis of the Global Burden of Diseases Study,” was published in Health Science Reports.

Recommended Reading

December 15, 2023 News by Marisa Wexler, MS

NK cells may hold key to link between viral infections, MS

Multiple sclerosis less common in men, but progressive forms more frequent

MS is caused by mistaken and damaging immune system attacks on the protective covering of nerve cell fibers in the brain and spinal cord. Each attack brings new damage that builds over time, worsening disability.

Many factors can affect a patient’s disease course and life expectancy. For example, while MS typically affects fewer men than women, men tend to have a poorer recovery after a disease symptom flare and are more likely to develop progressive forms of MS.

Researchers at two medical science universities in Beijing drew on 2019 data from the Global Burden of Disease study to compare the burden of MS in men and women in China, a country with “a considerable and increasing population of MS.”

“It is essential to evaluate and predict the burden due to MS and take active measures to improve healthcare,” they wrote. Such data “are needed to assist policymakers, researchers, and healthcare professionals with better recommendations and decisions.”

In 2019, the age-standardized prevalence rate — a weighted mean of MS prevalence by five-year age groups in this study — was lower in men than in women (1.96 vs. 2.98 cases per 100,000 people). The total number of cases amounted to 42,570, including 18,143 men and 24,427 women.

Across the country’s entire MS population, “prevalence began its upward trend from the 15–19 age group and peaked at the 45–49 age group,” the researchers wrote.

“Although MS is at a low level of prevalence in China, there is a large number of patients due to the huge population base, leading to high disability and economic burden,” they added.

MS also resulted in a higher age-standardized death rate in men than in women (0.1 vs. 0.08 cases per 100,000 people), again in line with a reported generally shorter life expectancy with MS for male patients.

Women with MS tend to be diagnosed at later age group than men

The number of disability-adjusted life years, a measure of disease burden calculated as the sum of years of life lost due to early death or years lived with a disability, also was higher in men than in women (3.8 vs. 3.6 years per 100,000 people).

To offer a picture of the MS landscape over time, the researchers looked at trends from 1990 to 2019. They found that the peak age of disease prevalence shifted from 40-44 years old in 1990 to 45-49 in 2019 among women, but remained unchanged for men.

But the age-standardized death rate showed a downward trend for both sexes, decreasing by 0.22 in men and by 0.35 in women. The rate of disability-adjusted life years also tended to decrease, by 0.2 in men and 0.3 in women.

The patient population is projected to increase slowly over the next 25 years, peaking at around 44,599 in 2025–29, the researchers wrote. Both death and disability rates are expected to decline, but more so in women than in men.

“Although the burden is projected to remain large over the next 25 years, the age-standardized rates of death and [disability-adjusted life years] are expected to decline,” the researchers wrote.

Understanding the natural history of MS in men and women and their response to medications may support sex-specific treatment, the team added, noting that “further improvements are needed in policies, medical level, and scientific research.”