High nationwide incidence of multiple sclerosis in Sweden.

Cecilia Ahlgren,Anders Odén,Jan Lycke,Jerson Laks

doi:10.1371/journal.pone.0108599

Cecilia Ahlgren, Anders Odén + Show 2 more

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https://doi.org/10.1371/journal.pone.0108599

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Abstract

Over recent years increased MS incidence, primarily in women, has been reported. We recently reported an unexpectedly high MS prevalence of 189/100,000 in Sweden. In the present study we estimated the nationwide age- and gender-specific MS incidence and the sex ratio in Sweden between 2001 and 2008. MS patients were identified by linking two nationwide health data registers, and the Swedish population register. The earliest registered date of MS diagnosis was determined. By logistic regression, the probability of the date of MS diagnosis being within the incidence period, depending on age and time was estimated for a subset of patients and applied to other patients. By Poisson regression, the hazard functions for the incidence of MS diagnosis were estimated. The expected number of MS patients was 7,361.4. The incidence in the average population of 9,054,658 was 10.2 per 100,000 person-years, and 6.2 and 14.0 per 100,000 person-years for men and women, respectively. The crude female to male ratio was 2.26. No increase of incidence or change of sex ratio was observed from 2001 to 2008. In conclusion, the average MS incidence in Sweden from 2001 to 2008 was 10.2 per 100.000, which was considerably higher than previous regional Swedish estimates of 4.3–6.4. No increase of female to male ratio of MS during the study period was observed. We provide supplementary data that can be used as tools for examining excess MS risk in different study materials.

Highlights

Several studies [1,2,3,4,5] and systematic reviews [6,7] report increased incidence of MS, primarily in women
MS incidence is not affected by the survival time and better reflect MS risk, the number of cases and the observational time are often limited, making incidence estimates statistically uncertain
The incidence was considerably higher than previous regional Swedish estimates; 4.3 in Gothenburg city (1984–1988) [11], 5.2 in Vasterbotten county (1988– 1997) [10], and 6.4 in Varmland county (1991–2000) [9], we did not observe any change of MS incidence or sex-ratio during the incidence period

Summary

Introduction

Several studies [1,2,3,4,5] and systematic reviews [6,7] report increased incidence of MS, primarily in women. We recently reported the 2008 nationwide gender- and age-specific prevalence of MS in Sweden. It was unexpectedly high (188.9 per 100,000, 113.4 for men and 263.6 for women) [8], and considerably higher than previous regional estimates [9,10,11]. Age- and gender-specific MS incidence in populations larger than one million have been reported from Uusimaa, Finland [12], Olmsted County in the US [13], the UK [14], Taiwan [15], and France [16]. Investigating MS incidence on a large scale, involves other challenging problems which are related to the difficulties in achieving complete ascertainment of patients, obtaining information about age and residency at the time of disease onset or diagnosis, and obtaining age- and gender-specific population data for each calendar year

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