Frequency of MS in the province of Modena, 1970–1990

Before 1975 the multiple sclerosis (MS) prevalence rate in Italy ranged from 4 to 21 cases per 100000 inhabitants. In more recent studies the MS prevalence rate exceeded 30 cases per 100000. We decided to perform an epidemiological survey in the province of Modena, Northern Italy, in order to clarify whether Italy should be considered as an area at high risk for MS like the countries of continental Europe. The mean annual incidence for the disease for the period 1970–1990 was 1.49 per 100000, and the prevalence rate was 38.91 per 100000 on December 31, 1990. These results indicate Modena is a high risk MS area.     

Incidence and prognosis of stroke in the Valle d'Aosta, Italy. First-year results of a community-based study.

BACKGROUND AND PURPOSE: We sought to determine the incidence rate, risk factors, and prognosis of stroke in Valle d'Aosta, Italy, to provide information for planning regional health-care facilities. METHODS: We undertook a prospective study of all new cases of stroke in the geographically defined population of 114,325 residents of Valle d'Aosta in northern Italy. RESULTS: In the first year of the study (January 1-December 31, 1989), 254 cases of first stroke were registered. The crude annual incidence rate was 2.23/1,000, 1.98/1,000 for men and 2.46/1,000 for women. After adjustment to the 1988 Italian population, the incidence rate for first stroke was 2.15/1,000 per year, 2.48/1,000 per year for men and 1.99/1,000 per year for women. The pathological diagnosis was cerebral infarction in 67%, intracranial hemorrhage in 15%, and unknown in 18%. The overall 30-day case-fatality rate was 31%. In survivors, Barthel Index Score recorded at 30 days from stroke onset showed that 100 patients (62%) were dependent in activities of daily living. CONCLUSIONS: Our results do not differ significantly from those reported in Umbria, the only similar study performed in Italy, and support non-Italian data as to risk factors in stroke.     

Prevalence and incidence of multiple sclerosis in Catania, Sicily

OBJECTIVE: An epidemiologic survey was conducted to determine the prevalence and incidence of MS in the city of Catania, Sicily, Italy. Prevalence rate was calculated as point prevalence at January 1,1995, and incidence during 1974 to 1995. METHODS: The authors studied the frequency of MS in the community of Catania in a population of 333,075 inhabitants according to the 1991 census. The primary sources for the case ascertainment were the neurologic and motor rehabilitation departments, the MS Center, the Italian MS Association, private neurologists, and family doctors. All patients who satisfied the Poser criteria for clinically definite MS, laboratory-supported definite MS, clinically probable MS, and laboratory-supported probable MS were considered prevalent and incident cases. RESULTS: One hundred ninety-five patients with MS who had had the onset of disease on prevalence day in a population of 333,075 inhabitants were detected. The prevalence rate was 58.5 per 100,000 (95% CI 50.7 to 67.5). Prevalence was higher in women (62.0/100,000) than in men (54.8/100,000). The age-specific prevalence showed a peak in the group aged 35 to 44 (145.1/100,000). From 1975 to 1994, 170 subjects with MS had the clinical onset of the disease. The mean annual incidence was 2.3 per 100,000 (95% CI 2.0 to 2.6). Age-specific incidence showed a peak in the group aged 25 to 34 (6.32/100,000). Incidence for 5-year intervals increased from 1.3 during 1975 to 1979 to 3.9 during 1990 to 1994. CONCLUSIONS: These prevalence and incidence rates are close to those reported in other similar surveys carried out in Italy and southern Europe.     

Epidemiology of multiple sclerosis in northern Greece

A total of 638 new cases of multiple sclerosis (MS) (365 females, 273 males) were found from 1970-1984 in northern Greece (Macedonia and Thrace); the average annual incidence rate was 1.79 per 100,000 inhabitants with increasing incidence from 1980-1984. A total of 729 people living in northern Greece suffered from MS on December 31, 1984 (prevalence rate 29.5 per 100,000 inhabitants). No difference was found between urban and rural areas. No difference from the international standards was found for sex incidence. The study confirms the quite high prevalence of MS despite the fact that northern Greece is in the intermediate risk zone.     

Epidemiologic survey of multiple sclerosis in the Bucharest city and suburban area

Epidemiologic survey over a restricted area of Romanian territory, i.e. the city of Bucharest with a population of 1,934,052 and a surface of 605 km², established the following values for the MS parameters studied.
On January 5, 1977 the prevalence rate for "probable" and "possible" cases was 46.4 per 100,000 inhabitants and for "probable" cases alone (with certain clinical diagnosis) 41.3 per 100,000.
The specific 20- to 60-year age adjusted prevalence rate was 79.4 per 100,000. The incidence rate over the 1969–1976 period was 1.78 per 100,000.
The prevalence and incidence rates in this survey are similar to those reported for two other large urban centers of Romania (population over 100,000 each), Romania being therefore situated in a geographical area of "high risk" for MS.
The 0.61 per 100,000 nationwide and the 0.65 per 100,000 Bucharest mortality rates are lower than those reported in other geographical areas of "high risk" for MS.     

Estimating the prevalence and incidence of multiple sclerosis in the Lorraine region, France, by the capture-recapture method

OBJECTIVE: The objective of this study was to assess the prevalence and incidence of multiple sclerosis (MS) in the Lorraine region, in France. METHODS: Data from three sources - Regional Health Insurance System, medical records departments and the Lorraine registry of MS - and a capture-recapture method with log-linear models were used to estimate the prevalence and incidence of MS. RESULTS: We identified 7193 records of reported MS corresponding to 4299 unique suspected cases of MS existing on 31 December 2008, in Lorraine. On the basis of the 4001 validated cases, the observed crude prevalence of MS was 170.9 cases per 100,000 inhabitants (95% confidence interval [CI]: 165.7; 176.3), and the observed annual crude incidence of MS was 4.4 cases per 100,000 inhabitants (95% CI: 3.6; 5.4). With the capture-recapture method, the estimated prevalence of MS was 4405.7 (95% CI: 4261.5; 4629.7), so an estimated 405 cases were not identified by the three sources. The estimated prevalence was 188.2 cases per 100,000 inhabitants (95% CI: 182.7; 193.8), and the estimated annual incidence was 8.5 cases per 100,000 inhabitants (95% CI: 7.3; 9.7). CONCLUSIONS: The capture-recapture method allowed us to estimate an additional 10.1% of unobserved prevalent cases and to anticipate 47.5% of unobserved incident cases.     

Epidemiology of primary intracranial tumours in NW Italy,a population based study: stable incidence in the last two decades

Data about the epidemiology of primary intracranial tumours (PIT) are still heterogeneous depending on different methodological approach in collecting data. In Valle d'Aosta, north west side of Italy, we have carried out a prospective consecutive population based study to calculate the incidence of PIT in the last decade (1992–1999) and to compare these rates with the previous period (1986–1991), data reported in a previous paper. The mean annual PIT incidence rate (ri) per 100,000 inhabitants was 25.48. The mean annual incidence rates in the two period of comparison were adjusted to the 1991 Italian population by the direct method. The standardised ratio was 26.43 in the previous period and 23.24 in the second decade. There is no statistically significant difference. The mean annual PIT incidence rates by tumour types were meningiomas 13.27/100,000 (men 9.77; women 16.7), neuroepithelial group 9,3 (men 10.62; women 8,1), adenomas 1.26, neurinomas 0,7. Mean annual incidence rates by tumour class were also stable. The stable incidence rate in the two periods and the similar incidence in England (21.04 /100,000 person year), strengthen the evidence for a stable incidence rate of PIT in the last decade. These three papers used similar methodology. The homogeneous methodology allows comparison and further evaluation. Received: 23 March 2001, Received in revised form: 2 July 2001, Accepted: 10 July 2001     

Estimated prevalence of multiple sclerosis in Italy in 2015

Italy is a high risk area for multiple sclerosis (MS) as confirmed by the numerous prevalence and incidence studies conducted in several regions/districts of the country. Nevertheless, there are no recent published epidemiological data, nor studies about the total prevalence of MS in Italy. Our aim was to update as of 2015 the prevalence rates of MS in different geographical areas using already published epidemiological studies, and to estimate the overall prevalence of the disease in Italy. We made a search in MEDLINE database of all published studies on epidemiology of MS in Italy. Then, we applied, to the already published prevalence data, the last published incidence and mortality rates to recalculate, as of 2015, the prevalence of MS. So, we calculated the mean prevalence rate from our extrapolations, and we applied it to the population in 2015 to estimate the number of MS patients in Italy. Our prevalence extrapolations ranged from 122 to 232 cases/100,000 in the mainland and Sicily, with an average of 176/100,000, and from 280 to 317 cases/100,000 in Sardinia with an average of 299/100,000. Applying these media to the Italian population in 2015, we obtained an estimate of more than 109,000 MS patients in Italy. Our estimates were higher than the latest published rates but consistent with the annual increase of prevalence due to incidence that exceeds mortality, with the increase of survival and, maybe, with the probable increase of incidence.     

A prevalence study of multiple sclerosis in L'Aquila, central Italy

We report the results of an epidemiologic study in the Municipality of L'Aquila, Abruzzo, Central Italy, undertaken to estimate the prevalence rate of Multiple Sclerosis (MS). On December 31, 1984, the prevalence was 33.2 per 100,000 (34.2 when age and sex is standardized to the Italian population). In agreement with recent intensive surveys from different regions in the North and South of Italy, our data indicate that the prevalence of MS in Italy is higher than 30 per 100,000, and emphasize the importance of small population studies in the epidemiology of MS. Our findings suggest that in Italy the risk for MS is higher than recorded before.     

The frequency of multiple sclerosis in Mediterranean Europe

Recent investigations on multiple sclerosis (MS) distribution in Italy, based on relatively small population groups, contradict the current thesis, derived from studies undertaken in populations exceeding 300,000, of a lower spreading of the disease in Mediterranean Europe. Intensive surveys on small populations strengthen the suggestion that Italy is a high-risk area, although MS studies based on prevalence rather than incidence could also be biased by geographic variables making prevalence unsuitable for comparing MS prevalence rates found in different years and/or zones. We report a further epidemiologic study in Barbagia, Sardinia, insular Italy, undertaken both to establish the MS incidence in the last 20 years, and to estimate a new prevalence rate. Based on 31 probable incident cases, the mean incidence per year for the years 1961-1980 was 2.9 per 100,000 (3.2 if age- and sex-standardized to the Italian population). On October 24, 1981, the prevalence per 100,000 was 65.3 (77.9 if standardized to the Italian population). These results confirm that in Barbagia, MS occurs more frequently than expected in a Mediterranean area, and give further support to the idea that MS frequency in Italy is similar to that established for most central and northern European countries.     

Prevalence and mortality of patients with multiple sclerosis in France in 2012: a study based on French health insurance data

Data on the prevalence of multiple sclerosis (MS) in France are scarce. National and regional updated estimates are needed to better plan health policies. In this nationwide study, we provided estimates of the prevalence of MS in France in 2012 and mortality rate in 2013. MS cases were identified in the French national health insurance database (SNIIRAM-PMSI) using reimbursement data for disease-modifying treatment, long-term disease status for MS, disability pension for MS, and hospitalisation for MS (MS ICD-10 code: G35). We identified 99,123 MS cases, corresponding to an overall crude prevalence rate of 151.2 per 100,000 inhabitants [95% confidence interval (CI) 150.3–152.2]: 210.0 per 100,000 in women (95% CI 208.4–211.5) and 88.7 per 100,000 in men (95% CI 87.6–89.7). The overall prevalence rate was 155.6 per 100,000 inhabitants (95% CI 154.7–156.6) after standardization on the 2013-European population. We observed a prevalence gradient with a higher prevalence (190–200 per 100,000) in North-Eastern France and a lower prevalence in Southern and Western France (126–140). The crude mortality rate in 2013 was 13.7 per 1,000 MS cases (11.4 in women and 20.3 in men). The standardized mortality ratio was 2.56 (95% CI 2.41–2.72). Our results revise upwards the estimation of MS prevalence in France and confirm the excess mortality of MS patients compared to the general population.     

An epidemiological study of multiple sclerosis in central Sardinia, Italy

Objectives – To verify morbidity estimates in central Sardinia, Italy. Methods – A prevalence study was performed in the province of Nuoro, Central Sardinia, which has a population of 273,768 inhabitants (135,383 men and 138,385 women). A complete enumeration approach was adopted by using all possible case-collection sources. Results – On prevalence day, December 31, 1993, 394 subjects (124 men and 270 women) living in the study area were known to suffer from definite and probable MS, giving a crude prevalence rate of 143.9 cases per 100,000 people, 91.6 for males and 195.11 for females. The crude prevalence estimated on December 31, 1985, based on 282 MS cases alive in the study area, was 102.94 per 100,000. Conclusion – This study reinforced central Sardinia's position as a high and rising prevalence area for MS.     

The organisation of health care and epidemiology of multiple sclerosis in France

STATE OF THE ART: According to the available previous studies, France is considered a zone of medium to high risk of multiple sclerosis (MS) with an estimated overall prevalence of at least 50/100,000 inhabitants, incidence rates were stable in some areas but increased over time in others and a strong ethnic effect on the incidence, clinical presentation, and course of MS is reported. RESULTS: Based on two health insurance survey the prevalence has been deduced. At January 1, 2003 from the data of agricultural health insurance the prevalence is evaluated at 65.5/100,000 inhabitants (95p.cent CI=62.5-67.5) with a gradient of North East towards South-West. The data from the national health insurance were very near. During the period 2000-2004, recent studies in Auvergne and Brittany demonstrated an annual incidence comprising between 4.2 and 5.1 per 100,000 inhabitants. In Lorraine, in a large population-based study, in December 31, 2004 the prevalence rate was 120/100,000 (95p.cent CI: 119 to 121). During the period 1990-2002, the average age- and sex-adjusted annual incidence rate was 5.5/100,000 (95p.cent CI: 4.4-6.6). In Lorraine, we found that the age-adjusted incidence rate increased during the period 1990-2002. The incidence of MS in women increased, whereas that in men did not change significantly during this period. Similarly, in Norway, North Ireland and Denmark, the incidence among women increased the most. The clinical features of MS were compared in 211 North Africans patients and 2 945 Europeans patients in two French MS centres (Lorraine and Nice) with definite MS according to McDonald's criteria. The course of MS appears more aggressive in North Africans than in Europeans patients. For example, we demonstrated a shorter time to reach the Expanded Disability Status Scale score of 4.0 (p=0.001) or 6.0 (p<0.0001) in North Africans patients. PERSPECTIVES AND CONCLUSIONS: The incidence rates found in these studies were comparable to those reported in several European populations. This undoubtedly places France in the category of regions with a high risk zone of MS. The incidence of MS in women increased; thus, exogenous (or epigenetic) factors vary over time and may affect men and women differently. The course of MS appears more aggressive in North Africans than in Europeans patients.     

Motor neuron disease in the Province of Turin, Italy, 1971-1980

The incidence and prevalence of motor neuron disease (MND) in the Province of Turin, North-West Italy, were investigated for the period 1971-1980. The crude incidence rate of MND was 0.67/100,000/year. The annual incidence rate, age and sex adjusted to the Italian population in 1971 was 0.69 cases per 100,000 inhabitants, 0.94 for men and 0.45 for women, with a male to female incidence ratio of 2.09:1. The prevalence of MND was 2.62/100,000, 3.57 for males and 1.71 for females. The mean age at the time of diagnosis was 55.6 years. Annual incidence rates increased with advancing age. Amyotrophic lateral sclerosis was found to be 4 times more frequent than progressive muscular atrophy (0.53/100,000/year v. 0.14/100,000/year). The distribution of MND was uneven in the Province suggesting a proportional relationship to the distribution of population density. Possible explanations of this finding are discussed.     

Multiple sclerosis in Móstoles,central Spain

Objectives– Until relatively recently southern Europe was regarded as having a medium to low multiple sclerosis prevalence, of about 20 or less per 100,000. However, recent studies in Sardinia, Sicily, continental Italy, Cyprus and Spain have yielded higher MS prevalence rates, between 32 and 102.6 per 100,000. We present the results of a prevalence study of MS in the municipality of Móstoles, central Spain. Material and methods– To ascertain the prevalence of multiple sclerosis in Móstoles (195,979 inhabitants), an intensive study was undertaken using several sources of information. We used the Poser criteria in diagnosis. Results– There were 85 patients (53 women and 32 men) classified as definite or probable, prevalence 43.4/100,000 (95% CI, 34.7 to 53.7). The incidence rate was 3.8/100,000/year (95% CI, 2.7 to 5.3) in the last 5 years. Mean age on prevalence day was 38.8±10.9 years. Mean age at onset was 31.7±9.3 years. Mean interval between initial symptoms and diagnosis was 1.7 years. Mean duration of disease was 7.6±6.1 years. Overall, 70.6% had a relapsing–remitting course, 18.8% had a primary progressive and 10.5% had a secondary progressive. Mean EDSS score was 2.7±1.9. Conclusion– The Móstoles study confirms the conclusions of previous smaller population studies that Spain is a moderately high or medium MS risk zone.     

Multiple sclerosis epidemiology in Sardinia: evidence for a true increasing risk

OBJECTIVES: To update prevalence and incidence rates of MS among Sardinians. MATERIALS AND METHODS: The present work is a "spider" kind of population based survey, conducted over the interval 1968-97, on patients with MS (Poser criteria) living in the province of Sassari, Northern Sardinia (454,904 population). RESULTS: A crude total prevalence rate of 144.4 per 100,000, an onset-adjusted prevalence rate of 149.7 per 100,000 and an average annual incidence rate of 8.2 for the period 1993-7 were found. CONCLUSION: Repeated epidemiological assessments of MS in Sardinia over decades have shown that the island is at high risk for MS. The present work highlights that MS incidence in Sardinia has been increasing over time. Although a substantial and widely spread improvement in MS case ascertainment can be postulated as the reason for such observations, a comparison between our data and those recently reported from a more industrialized province in Northern Italy seems to prove an at least partially real increase in MS risk among Sardinians and favours the hypothesis of a MS "Sardinian focus" as related to its latitude.     

Multiple sclerosis in the Republic of San Marino,Italian peninsula: an incidence and prevalence study from a high-risk area

Epidemiological studies on multiple sclerosis (MS) carried out in Southern Europe in the last years have shown a significant increase in the disease frequency. Previous surveys conducted in the Republic of San Marino, Northern Italian peninsula, identified that the population is at high risk for MS, with a prevalence of 51.6 per 100,000 population in 1982 and of 166.7 in 2005 and with a mean annual incidence of 7.9 per 100,000 for the period 1990–2005. The present work is a community-based intensive prevalence and incidence survey, by a complete enumeration approach, to update the prevalence and incidence of MS in the Republic of San Marino. The mean annual incidence for the period 2005–14 was 7.7 (95% CI 4.9–11.4) per 100,000, 3.3 (95% CI 1.1–7.6) for men and 11.9 (95% CI 7.2–18.6) for women. On 31 December 2014, 67 patients (19 men and 48 women), suffering from definite or probable MS and living in the Republic of San Marino, yielded a crude prevalence of 204.3 (95% CI 158.4–259.5) per 100,000, 117.8 (95% CI 70.9–183.7) for men and 288.2 (95% CI 212.4–383.3) for women. Our study has confirmed San Marino is an area at high risk for MS, in line with epidemiological data from continental Italy. The marked increase in MS prevalence over time in this population can be ascribable to increased survival and improved ascertainment, in the presence of a substantially stable, yet high, incidence rate.     

Multiple sclerosis in Spain: an epidemiological study of the Alcoy health region, Valencia

Alcoy is a defined health region in eastern Spain, at 3 degrees E-38 degrees N, with a single neurology department and includes 33 towns with a total population of 133,915 inhabitants. We have evaluated the prevalence and incidence of multiple sclerosis (MS) by analysing this region. Six new cases have been detected (2.24/100,000/year) and the prevalence rate was 17.17/100,000, the highest in Spain at the moment. However, we found an irregular distribution in the different towns in so far that 15 of our 23 patients lived in a particular subregion, which means a prevalence of 44.59/100,000. Our study shows that the area of Alcoy is a medium MS risk region according to the thesis of Kurzke, although high MS areas may be found, thus confirming that MS distribution in southern Europe is not uniform.