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Open Access Highly Accessed Research article

Incidence and prevalence of multiple sclerosis in Europe: a systematic review

Elaine Kingwell1, James J Marriott2*, Nathalie Jetté345, Tamara Pringsheim456, Naila Makhani7, Sarah A Morrow8, John D Fisk39, Charity Evans10, Sarah Gabrielle Béland11, Sophie Kulaga11, Jonathan Dykeman3, Christina Wolfson12, Marcus W Koch45 and Ruth Ann Marrie2

Author Affiliations

1 Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada

2 Department of Internal Medicine, University of Manitoba, Winnipeg, Canada

3 Department of Community Health Sciences, University of Calgary, Calgary, Canada

4 Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada

5 Institute for Public Health, University of Calgary, Calgary, Canada

6 Department of Pediatrics, University of Calgary, Calgary, Canada

7 Division of Neurology and Department of Pediatrics, University of Toronto, Toronto, Canada

8 Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada

9 Departments of Psychiatry and Medicine, Dalhousie University, Halifax, Canada

10 College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada

11 Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada

12 Department of Epidemiology & Biostatistics and Occupational Health, McGill University, Montreal, Canada

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BMC Neurology 2013, 13:128  doi:10.1186/1471-2377-13-128

Published: 26 September 2013

Abstract

Background

Multiple sclerosis (MS) is the most common cause of neurological disability in young adults worldwide and approximately half of those affected are in Europe. The assessment of differential incidence and prevalence across populations can reveal spatial, temporal and demographic patterns which are important for identifying genetic and environmental factors contributing to MS. However, study methodologies vary and the quality of the methods can influence the estimates. This study aimed to systematically review European studies of incidence and prevalence of MS and to provide a quantitative assessment of their methodological quality.

Methods

A comprehensive literature search was performed to obtain all original population-based studies of MS incidence and prevalence in European populations conducted and published between January 1985 and January 2011. Only peer-reviewed full-text articles published in English or French were included. All abstracts were screened for eligibility and two trained reviewers abstracted the data and graded the quality of each study using a tool specifically designed for this study.

Results

There were 123 studies that met the inclusion criteria. The study estimates were highly heterogeneous, even within regions or countries. Quality was generally higher in the more recent studies, which also tended to use current diagnostic criteria. Prevalence and incidence estimates tended to be higher in the more recent studies and were higher in the Nordic countries and in northern regions of the British Isles. With rare exceptions, prevalence and incidence estimates were higher in women with ratios as high as 3:1. Few studies examined ethnicity. Epidemiological data at the national level was uncommon and there were marked geographical disparities in available data, with large areas of Europe unrepresented and other regions well-represented in the literature. Only 37% of the studies provided standardized estimates.

Conclusions

Despite the breadth of the literature on the epidemiology of MS in Europe, inter-study comparisons are hampered by the lack of standardization. Further research should focus on regions not yet studied and the evaluation of ethnic differences in MS prevalence and incidence. National-level studies using current diagnostic criteria, validated case definitions and similar age- and sex-standardization would allow better geographical comparisons.

Keywords:
Multiple sclerosis; Epidemiology; Europe; Incidence; Prevalence