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Meta-Analysis
. 2017 Feb 1;46(1):57-74.
doi: 10.1093/ije/dyw061.

Variation in worldwide incidence of amyotrophic lateral sclerosis: a meta-analysis

Benoît Marin  1   2   3   4   5   6 , Farid Boumédiene  1   2   3 , Giancarlo Logroscino  5   6 , Philippe Couratier  1   2   7 , Marie-Claude Babron  8   9 , Anne Louise Leutenegger  8   9 , Massimilano Copetti  10 , Pierre-Marie Preux  1   2   3 , Ettore Beghi  4
Affiliations
Meta-Analysis

Variation in worldwide incidence of amyotrophic lateral sclerosis: a meta-analysis

Benoît Marin et al. Int J Epidemiol. .

Abstract

Background: To assess the worldwide variation of amyotrophic lateral sclerosis (ALS) incidence, we performed a systematic review and meta-analysis of population-based data published to date.

Methods: We reviewed Medline and Embase up to June 2015 and included all population-based studies of newly diagnosed ALS cases, using multiple sources for case ascertainment. ALS crude and standardized incidence (on age and sex using the US 2010 population) were calculated. Random effect meta-analysis and meta-regression were performed using the subcontinent as the main study level covariate. Sources of heterogeneity related to the characteristics of the study population and the study methodology were investigated.

Results: Among 3216 records, 44 studies were selected, covering 45 geographical areas in 11 sub-continents. A total of 13 146 ALS cases and 825 million person-years of follow-up (PYFU) were co-nsidered. The overall pooled worldwide crude ALS incidence was at 1.75 (1.55-1.96)/100 000 PYFU; 1.68 (1.50-1.85)/100 000 PYFU after standardization. Heterogeneity was identified in ALS standardized incidence between North Europe [1.89 (1.46-2.32)/100 000 PYFU] and East Asia [0.83 (0.42-1.24)/100 000 PYFU, China and Japan P = 0.001] or South Asia [0.73 (0.58-0.89)/100 000/PYFU Iran, P = 0.02]. Conversely, homogeneous rates have been reported in populations from Europe, North America and New Zealand [pooled ALS standardized incidence of 1.81 (1.66-1.97)/100 000 PYFU for those areas].

Conclusion: This review confirms a heterogeneous distribution worldwide of ALS, and sets the scene to sustain a collaborative study involving a wide international consortium to investigate the link between ancestry, environment and ALS incidence.

Keywords: Amyotrophic lateral sclerosis; epidemiology; ethnic groups; incidence.

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Figures

Figure 1.
Figure 1.
Flow chart eligibility criteria of articles on ALS incidence.
Figure 2.
Figure 2.
Distribution of ALS worldwide: crude incidence and age- and sex-standardized incidence on USA 2010 population.
Figure 3.
Figure 3.
Meta-analysis: forests plots and pooled estimates for ALS crude incidence by sub-continents.
Figure 4.
Figure 4.
Meta-analysis: forests plots and pooled estimates for ALS age- and sex-standardized incidence on USA 2010 population, by subcontinents.
See this image and copyright information in PMC

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