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.
KeywordsMultiple sclerosis Epidemiology Incidence Prevalence Republic of San Marino
The authors thank Eva Sjolin for her help in revising the translation of the text.
This work is supported by Ferrara University (Fondo di Ateneo per la Ricerca).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics approval for the study was obtained.
- 10.Trojano M, Lucchese G, Graziano G, Taylor BV, Simpson S, Lepore V, Grand’Maison F, Duquette P, Izquierdo G, Grammond P, Amato MP, Bergamaschi R, Giuliani G, Boz C, Hupperts R, van Pesch V, Lechner-Scott J, Cristiano E, Fiol M, Oreja-Guevara C, Saladino ML, Verheul F, Slee M, Paolicelli D, Tortorella C, D’Onghia M, Iaffaldano P, Direnzo V, Butzkueven H, MSBase Study Group and the New Zealand MS Prevalence Study Group (2012) Geographical variations in sex ratio trends over time in multiple sclerosis. PLoS One 7:e48078CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Grimaldi LM, Palmeri B, Salemi G, Giglia G, D’Amelio M, Grimaldi R, Vitello G, Ragonese P, Savettieri G High prevalence and fast rising incidence of multiple sclerosis in Caltanissetta, Sicily, southern Italy(2007) Neuroepidemiology 28:28–32CrossRefPubMedGoogle Scholar
- 16.Granieri E, Monaldini C, De Gennaro R et al (2007) Multiple sclerosis in the Republic of San Marino: a prevalence and incidence study. Mult Scler 00:1–5Google Scholar
- 17.Statistics Office of the Republic of San Marino (2015) Demographic balance (movement of the resident population), www.statistica.sm/on-line/en/home/statistics/docCat.140008184.108.40.206.html. Accessed 30 Sept 2015
- 20.Italian National Institute of Statistics (2011) Population Census. http://dati-censimentopopolazione.istat.it/Index.aspx?lang=en. 2012, Accessed 30 Sept 2015
- 21.Waterhouse JAH, Muir CS, Correa P et al (eds) (1976) Cancer incidence in five continents, vol 3. IARC, Lyon, p 456Google Scholar
- 25.Ranzato F, Perini P, Tzintzeva E, Tiberio M, Calabrese M, Ermani M, Davetag F, de Zanche L, Garbin E, Verdelli F, Villacara A, Volpe G, Moretto G, Gallo P (2003) Increasing frequency of multiple sclerosis in Padova, Italy: a 30 year epidemiological survey. Mult Scler 9:387–392CrossRefPubMedGoogle Scholar
- 29.Grytten N, Aarseth JH, Lunde HMB et al (2015) A 60-year follow-up of the incidence and prevalence of multiple sclerosis in Hordaland County, Western Norway. J Neurol Neurosurg Psychiatry 0:1–6Google Scholar
- 30.Govoni V, Casetta I, Granieri E, Vernonesi V, Malagù S, Tola MR, Paolino E, Fainardi E, Monetti VC, Aiello I (1993) Mortality study on multiple sclerosis in the province of Ferrara, northern Italy, 1968 through 1989. Acta Neurol 15:161–176Google Scholar
- 34.Casetta I, Granieri E (2000) Clinical infections and multiple sclerosis: contribution from analytical epidemiology. J Neuro-Oncol 6:S147–S151Google Scholar