Multiple Sclerosis in Italy: A 40-Year Follow-Up of the Prevalence in Ferrara

Abstract

Background: To assess a longitudinal follow-up of the prevalence of multiple sclerosis (MS) through 4 decades in the province of Ferrara, northern Italy, and reappraise the current rates on December 31, 2016. Methods: We conducted a community-based intensive prevalence study, by adopting a complete enumeration approach. MS cases were identified from administrative health data and medical records from the Units of Neurology and Motor Rehabilitation, Ferrara University Hospital, from other provincial neurological structures and from archives of the National Pension Institute and National Health Insurance scheme of the study area. Case ascertainment method and case definition are analogous to those adopted in previous surveys in the same area of study. Results: On December 31, 2016, 685 patients (478 women and 207 men) affected by definite or probable MS (Poser’s criteria) were living in the province of Ferrara (population 386,896), yielding a crude prevalence ratio of 194.91 (95% CI 180.4–209.6) per 100,000, 260.8 (95% CI 238.10–285.82) for women and 123.1 (95% CI 106.98–141.21) for men The prevalence ratio was 26.9 per 100,000 in 1978, increased to a value of 46.1 per 100,000 in 1981, 69.4 per 100,000 in 1993, 120.9 per 100,000 in 2004. Female to male ratio was 2.31 (1.2 on December 31, 1978). The mean duration of the disease at prevalence day was 17.5 ± 11.9 years (13.9 ± 10.8 years in 1978). The mean age at prevalence day was 52.04 ± 10.8 years (13.8 ± 10.8 years in 1978). Conclusion: Our study has confirmed the province of Ferrara is an area at high risk for MS, in line with epidemiological data from the regions of continental and insular Italy. The sharp increase in MS prevalence over time in this population can be imputed in part to a greater exposition to risk factors in genetically susceptible subjects but also to an increased survival and improved ascertainment. So, the results suggest that both methodologic and environmental factors are essential in determining the real distribution of MS. The need to get reliable estimates of MS prevalence must be highlighted as a public health and research priority, essential to support planning and prioritization of care services and to reduce the overall burden of chronic disease.

An Overground Robotic Gait Training Program for People With Multiple Sclerosis: A Protocol for a Randomized Clinical Trial

“…This occurred with minimal changes in the incidence, possibly indicating that patients with MS were living longer. The same trend was also observed in other epidemiological studies conducted in Europe (11)(12)(13). As they age, people with MS are at increased risk for developing comorbidities (14)(15)(16), at a time when they are often experiencing a progression in their disability (17).…”

Multiple sclerosis epidemiological trends in Italy highlight the environmental risk factors

“…The prevalence of MS in Ferrara, a City located in the South-east part of the Plain (Fig. 2), progressively increased from 26.9/100,000 in 1978 to 46.1/100,000 in 1981, 69.4/100,000 in 1993, 120.9/100,000 in 2004 and 194.9/100,000 in December 31, 2016 [12,13]. This trend was strikingly superimposable to that observed in the Province of Padua, located about 70 km North from Ferrara, where MS prevalence progressively increased from 16/100,000 in 1974 to 45.7/100,000 in 1990, 80.5/100,000 in 1999, 139.5/100,000 in 2009, 180/100,000 in 2015 and 220/100,000 in 2020, with a peak of 245/100,000 in urban area of Padua [10,[14][15][16][17].…”

Long-term effectiveness in patients previously treated with cladribine tablets: a real-world analysis of the Italian multiple sclerosis registry (CLARINET-MS)

“…An approach to addressing such uncertainty is the collection of real-world data (RWD) from large patient registries, which allow for the investigation of long-term safety and efficacy of treatment in chronic diseases like MS. 9,10 Analysis of RWD alongside clinical data would therefore provide evidence for the sustained effectiveness of cladribine tablets; indeed, long-term safety data have already been described from the observational PREMIERE registry. 11 Italy is considered a high-risk area for MS with an incidence of approximately 3000 new cases in 2018 and an estimated prevalence of 193 cases per 100,000 (360 cases per 100,000 in Sardinia), 12,13 and was also one of the largest recruiters of patients into the cladribine tablets clinical development programme. In 2014, the Italian MS Association (AISM) and its research foundation (FISM) promoted and supported, through a FISM-Bari University Research Agreement, the creation of the Italian MS Registry.…”

“…Italy is considered a high-risk area for MS with an incidence of approximately 3000 new cases in 2018 and an estimated prevalence of 193 cases per 100,000 (360 cases per 100,000 in Sardinia), 12,13 and was also one of the largest recruiters of patients into the cladribine tablets clinical development programme. In 2014, the Italian MS Association (AISM) and its research foundation (FISM) promoted and supported, through a FISM-Bari University Research Agreement, the creation of the Italian MS Registry.…”