Objective: To estimate prevalence of essential tremor (ET) using population-based community screening studies in defined geographical areas that ascertain disease using in-person interview and confirmation by qualified neurological examination.

Background: ET is an incurable neurological movement disorder with bimodal incidence that affects quality of life but not survival [1,2]. It is often misdiagnosed, relying on exclusion of diseases with similar symptoms [3,4]. Thus, estimating prevalence using administrative data is challenging.

Method: We conducted a comprehensive literature review in PubMed and EMBASE of English language studies with age-stratified estimates published from January 2000 to March 2022. From 652 identified publications, 16 studies from 12 countries were included in our analysis [5-20]. Age categories varied from study to study. We set the most frequently reported as target categories (18-30, 31-40, 41-49, 50-59, 60-64, 65-74, 75-84, 85+ years) and calculated prevalence estimates within these. Estimates from each study were extracted and assigned to the midpoint of the reported age category. Poisson regression with log-transformation was used to model age-category specific prevalence estimates (dependent variable) and the midpoint age of the reported age category (independent variable). Prevalence for the midpoint of each target age category was calculated from the fitted model and the median across studies was set as the final summary estimate.

Results: Significant heterogeneity was noted from study to study (I² >95%). Data suggested that prevalence is lower in Asian countries, thus two sets of prevalence estimates were calculated. Prevalence estimates in countries outside of Asia by target age categories were 0.4%, 0.9%, 1.7%, 2.8%, 3.5%, 4.2%, 7.8%, and 10.6%, respectively, while those in Asian countries were 0%, 0.2%, 0.3%, 0.4%, 0.7%, 1.9%, 2.6%, and 4.2%. The three studies with prevalence estimates across the adult age span were consistent with a monotonic increasing relationship between prevalence and age.

Conclusion: Prevalence may be lower in Asian countries compared to other parts of the world, but more research is necessary to confirm this. While significant heterogeneity is noted from study to study, the data are derived from a variety of populations and offer a set of possible global estimates that continue to place ET among the most common movement disorders [21].

References: 1. Louis ED, Dogu O. Does age of onset in essential tremor have a bimodal distribution? Data from a tertiary referral setting and a population-based study. Neuroepidemiology. 2007;29(3-4):208-12. doi: 10.1159/000111584. Epub 2007 Nov 27. PMID: 18043006; PMCID: PMC2824583.
2. Hopfner F, Ahlf A, Lorenz D, Klebe S, Zeuner KE, Kuhlenbäumer G, Deuschl G. Early- and late-onset essential tremor patients represent clinically distinct subgroups. Mov Disord. 2016 Oct;31(10):1560-1566. doi: 10.1002/mds.26708. PMID: 27384030.
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11. Louis ED, Thawani SP, Andrews HF. Prevalence of essential tremor in a multiethnic, community-based study in northern Manhattan, New York, N.Y. Neuroepidemiology. 2009;32(3):208-14. doi: 10.1159/000195691. Epub 2009 Jan 24. PMID: 19169043; PMCID: PMC2744469.
12. Das SK, Banerjee TK, Roy T, Raut DK, Chaudhuri A, Hazra A. Prevalence of essential tremor in the city of Kolkata, India: a house-to-house survey. Eur J Neurol. 2009 Jul;16(7):801-7. doi: 10.1111/j.1468-1331.2009.02589.x. Epub 2009 Mar 23. PMID: 19473370.
13. Aharon-Peretz J, Badarny S, Ibrahim R, Gershoni-Baruch R, Hassoun G. Essential Tremor Prevalence is Low in the Druze Population in Northern Israel. Tremor Other Hyperkinet Mov (N Y). 2012;2:tre-02-81-390-1. doi: 10.7916/D8GF0S7H. Epub 2012 Mar 22. PMID: 23440912; PMCID: PMC3570042.
14. Okubadejo NU, Bankole IA, Ojo OO, Ojini FI, Danesi MA. Prevalence of essential tremor in urban Lagos, Nigeria: a door-to-door community-based study. BMC Neurol. 2012 Sep 27;12:110. doi: 10.1186/1471-2377-12-110. PMID: 23017021; PMCID: PMC3488469.
15. Barbosa MT, Caramelli P, Cunningham MC, Maia DP, Lima-Costa MF, Cardoso F. Prevalence and clinical classification of tremor in elderly–a community-based survey in Brazil. Mov Disord. 2013 May;28(5):640-6. doi: 10.1002/mds.25355. Epub 2013 Feb 28. PMID: 23450620.
16. Seijo-Martínez M, Del Río MC, Alvarez JR, Prado RS, Salgado ET, Esquete JP, Sobrido-Gómez MJ. Prevalence of Essential Tremor on Arosa Island, Spain: a Community-based, Door-to-Door Survey. Tremor Other Hyperkinet Mov (N Y). 2013 Sep 3;3:tre-03-192-4299-1. doi: 10.7916/D89P30BB. PMID: 24116344; PMCID: PMC3779822.
17. Oh ES, Kim JM, Kim YE, Yun JY, Kim JS, Kim SE, Lee SB, Lee JJ, Park JH, Kim TH, Kim KW, Jeon BS. The prevalence of essential tremor in elderly Koreans. J Korean Med Sci. 2014 Dec;29(12):1694-8. doi: 10.3346/jkms.2014.29.12.1694. Epub 2014 Nov 21. PMID: 25469072; PMCID: PMC4248593.
18. Louis ED, Factor-Litvak P. Screening for and Estimating the Prevalence of Essential Tremor: A Random-Digit Dialing-Based Study in the New York Metropolitan Area. Neuroepidemiology. 2016;46(1):51-6. doi: 10.1159/000442576. Epub 2015 Dec 17. PMID: 26673312; PMCID: PMC5473152.
19. Wu Y, Wang X, Wang C, Sun Q, Song N, Zhou Y, Jiang Q, Qiao Y, Xu J, Liang L, Tang H, Ma J, Gao X, Chen SD. Prevalence and clinical features of non-motor symptoms of essential tremor in Shanghai rural area. Parkinsonism Relat Disord. 2016 Jan;22:15-20. doi: 10.1016/j.parkreldis.2015.10.617. PMID: 26777409.
20. Sun H, Sun F, Zhang XQ, Fang XH, Chan P. The Prevalence and Clinical Characteristics of Essential Tremor in Elderly Chineses: A Population-Based Study. J Nutr Health Aging. 2020;24(10):1061-1065. doi: 10.1007/s12603-020-1472-7. PMID: 33244561.
21. Louis ED, McCreary M. How Common is Essential Tremor? Update on the Worldwide Prevalence of Essential Tremor. Tremor Other Hyperkinet Mov (N Y). 2021 Jul 9;11:28. Doi: 10.5334/tohm.632. PMID: 34277141; PMCID: PMC8269764.

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