Analysis of amyotrophic lateral sclerosis as a multistep process: a population-based modelling study.

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  • Additional Information
    • Source:
      Publisher: Lancet Pub. Group Country of Publication: England NLM ID: 101139309 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1474-4465 (Electronic) Linking ISSN: 14744422 NLM ISO Abbreviation: Lancet Neurol Subsets: MEDLINE
    • Publication Information:
      Original Publication: London, UK ; New York, NY : Lancet Pub. Group, 2002-
    • Subject Terms:
      Disease Progression* ; Models, Theoretical* ; Registries*/statistics & numerical data; Amyotrophic Lateral Sclerosis/*epidemiology ; Population Surveillance/*methods; Adult ; Aged ; Amyotrophic Lateral Sclerosis/diagnosis ; England/epidemiology ; Female ; Finland/epidemiology ; Humans ; Ireland/epidemiology ; Italy/epidemiology ; Linear Models ; Male ; Middle Aged ; Scotland/epidemiology
    • Abstract:
      Background: Amyotrophic lateral sclerosis shares characteristics with some cancers, such as onset being more common in later life, progression usually being rapid, the disease affecting a particular cell type, and showing complex inheritance. We used a model originally applied to cancer epidemiology to investigate the hypothesis that amyotrophic lateral sclerosis is a multistep process.
      Methods: We generated incidence data by age and sex from amyotrophic lateral sclerosis population registers in Ireland (registration dates 1995-2012), the Netherlands (2006-12), Italy (1995-2004), Scotland (1989-98), and England (2002-09), and calculated age and sex-adjusted incidences for each register. We regressed the log of age-specific incidence against the log of age with least squares regression. We did the analyses within each register, and also did a combined analysis, adjusting for register.
      Findings: We identified 6274 cases of amyotrophic lateral sclerosis from a catchment population of about 34 million people. We noted a linear relationship between log incidence and log age in all five registers: England r(2)=0·95, Ireland r(2)=0·99, Italy r(2)=0·95, the Netherlands r(2)=0·99, and Scotland r(2)=0·97; overall r(2)=0·99. All five registers gave similar estimates of the linear slope ranging from 4·5 to 5·1, with overlapping confidence intervals. The combination of all five registers gave an overall slope of 4·8 (95% CI 4·5-5·0), with similar estimates for men (4·6, 4·3-4·9) and women (5·0, 4·5-5·5).
      Interpretation: A linear relationship between the log incidence and log age of onset of amyotrophic lateral sclerosis is consistent with a multistage model of disease. The slope estimate suggests that amyotrophic lateral sclerosis is a six-step process. Identification of these steps could lead to preventive and therapeutic avenues.
      Funding: UK Medical Research Council; UK Economic and Social Research Council; Ireland Health Research Board; The Netherlands Organisation for Health Research and Development (ZonMw); the Ministry of Health and Ministry of Education, University, and Research in Italy; the Motor Neurone Disease Association of England, Wales, and Northern Ireland; and the European Commission (Seventh Framework Programme).
      (Copyright © 2014 Elsevier Ltd. All rights reserved.)
    • Comments:
      Comment in: Lancet Neurol. 2014 Nov;13(11):1067-8. (PMID: 25300935)
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    • Grant Information:
      089701 United Kingdom Wellcome Trust; MR/L501529/1 United Kingdom MRC_ Medical Research Council; G0600974 United Kingdom MRC_ Medical Research Council; MC_G1000733 United Kingdom MRC_ Medical Research Council; G0500289 United Kingdom MRC_ Medical Research Council; G0900688 United Kingdom MRC_ Medical Research Council
    • Publication Date:
      Date Created: 20141011 Date Completed: 20150210 Latest Revision: 20220408
    • Publication Date:
      20240628
    • Accession Number:
      PMC4197338
    • Accession Number:
      10.1016/S1474-4422(14)70219-4
    • Accession Number:
      25300936