Original article| Volume 44, 102240, September 2020

Mortality trend for multiple sclerosis in Italy during the period 1980–2015


      • An increase in mortality for MS was observed especially for females.
      • Differences in mortality were observed between Italian geographical areas.
      • Mortality reflects prevalence and incidence trend.



      The epidemiology of Multiple Sclerosis (MS) is relevant for health-services planning. Most of MS prevalence and incidence studies in Italy referred to specific geographical areas and periods, whereas mortality data are routinely collected at the national level. The aim was to assess MS mortality trend and geographical differences in Italy from 1980 to 2015.


      Mortality data were provided by the Italian Institute of Statistics. Due to a low number of annual deaths, mortality data were analysed for both the entire period under study and for sub-periods. Temporal trends were first evaluated using age-adjusted mortality rates (AMRs) comparing each sub-period with the initial one. Then, the annual percent change in mortality was estimated through the joinpoint regression model. Spatial differences between 5 main geographical areas were evaluated using standardized mortality ratios (SMRs).


      During the study period, 4,959 deaths for males and 7,434 for females were observed. The higher overall AMR was observed for females (F:0.71 vs. M: 0.56 per 100,000 persons per year). Analysing mortality by gender and geographical area, SMRs 〈 100 were observed in South Italy for both sexes, and in Central Italy for males only, whereas SMRs 〉 100 for Islands for both sexes, and in North-East and North-West for females only. The analysis of the mortality trend through AMRs calculated for sub-periods revealed no difference between the first and the last period for males, whereas a significant increase in mortality was observed for females. The joinpoint regression analysis showed a significant decrease in mortality up to 1995 for males (APC -3.23%) and up to 1999 for females, (APC -1.01%), followed by a significant increase for both sexes, but more marked for females (APC +1.9% M, +2.34% F).


      The increasing trend of mortality for MS, especially for females, may reflect the increase in the prevalence of MS and the improvement in the quality of diagnosis or coding of the cause of death.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Atlas of MS 2013: mapping multiple sclerosis around the world. London: 2013.

      2. Barometro della sclerosi multipla2019. Genoa: italian Multiple Sclerosis Association (AISM).

        • Battaglia M.A.
        • Bezzini D.
        Estimated prevalence of multiple sclerosis in Italy.
        Neurol. Sci. 2015; 38 (2017): 473-479
        • Bezzini D.
        • Battaglia M.A.
        Multiple sclerosis epidemiology in Europe.
        Adv. Exp. Med. Biol. 2017; 958: 141-159
        • Bezzini D.
        • Ulivelli M.
        • Gualdani E.
        • Razzanelli M.
        • Ferretti F.
        • Meucci G.
        • Francesconi P.
        • Battaglia M.A
        Increasing prevalence of Multiple Sclerosis in Tuscany (Italy).
        Neurol. Sci. 2019 Nov 6;
        • Ekestern E.
        • Lebhart G.
        Mortality from multiple sclerosis in Austria 1970-2001: dynamics, trends, and prospects.
        Eur. J. Neurol. 2004; 11: 511-520
        • Lunde H.M.B.
        • Assmus J.
        • Myhr K.M.
        • et al.
        Survival and cause of death in multiple sclerosis: a 60-years longitudinal population study.
        J. Neurol. Neurosurg. Psychiatry. 2007; 88: 621-625
        • Scalfari A.
        • Knappertz V.
        • Cutter G.
        • et al.
        Mortality in patients with multiple sclerosis.
        NeurologyNeurology. 2013; 81: 184-192
      3. [cited 2019 26/07].

        • Tassinari T.
        • Parodi S.
        • Badino R.
        • et al.
        Mortality trend for multiple sclerosis in Italy (1974-1993).
        Eur. J. Epidemiol. 2001; 17: 105-110
        • EUROSTAT
        Revision of the European Standard Population: Report Of The Eurostat's Task Force.
        Luxembourg: EUROPEAN UNION, 2013
        • Hammond S.R.
        • English D.R.
        • de Wytt C.
        • et al.
        The contribution of mortality statistics to the study of multiple sclerosis in Australia.
        J Neurol, Neurosurg Psychiatry. 1989; 52: 1-7
        • Lai S.M.
        • Zhang Z.X.
        • Alter M.
        • et al.
        World-wide trends in multiple sclerosis mortality.
        NeuroepidemiologyNeuroepidemiology. 1989; 8: 56-67
        • Midgard R.
        • Riise T.
        • Kvale G.
        • et al.
        Disability and mortality in multiple sclerosis in western Norway.
        Acta Neurol. Scand. 1996; 93: 307-314
        • Landtblom A.M.
        • Riise T.
        • Boiko A.
        • et al.
        Distribution of multiple sclerosis in Sweden based on mortality and disability compensation statistics.
        NeuroepidemiologyNeuroepidemiology. 2002; 21: 167-179
        • Navarro X.
        Geographical distribution of multiple sclerosis mortality in Spain.
        Acta Neurol. Scand. 1987; 76: 306-309
        • Warren S.A.
        • Janzen W.
        • Warren K.G.
        • et al.
        Multiple Sclerosis Mortality Rates in Canada, 1975-2009.
        Can. J. Neurol. Sci. 2016; 43: 134-141
      4. Barometro della sclerosi multipla2018. Genoa: Italian Multiple Sclerosis Association (AISM), page. 234.

        • Bezzini D.
        • Policardo L.
        • Profili F.
        • et al.
        Multiple sclerosis incidence in Tuscany from administrative data.
        Neurol. Sci. 2018; 39: 1881-1885
        • Trojano M.
        • Lucchese G.
        • Graziano G.
        • et al.
        Geographical variations in sex ratio trends over time in multiple sclerosis.
        PLoS ONE. 2012; 7: e48078
        • Nakken O.
        • LindstrømJC Holmøy T
        Sex ratio in multiple sclerosis mortality over 65 years; an age-period-cohort analysis in Norway.
        J. Neurol. 2018; 265: 1295-1302
        • Cislaghi C.
        • Costa G.
        • Rosano A
        A mass murder or mere statistical data? The 2015 surplus of deaths.
        Epidemiol. Prev. 2016; 40: 9-11
        • Chellini E.
        • Martini A.
        Più Morti in Italia nel 2015!11. Toscana Medica, 2016
        • Ho J.Y.
        • Hendi A.S.
        Recent trends in life expectancy across high income countries: retrospective observational study.
        BMJ. 2018; 362: k2562
        • Goldacre M.J.
        • Duncan M.
        • Griffith M.
        • et al.
        Trends in death certification for multiple sclerosis, motor neuron disease, Parkinson's disease and epilepsy in English populations 1979-2006.
        J. Neurol. 2010; 257: 706-715
      5. ISTAT, guida alla lettura, page 1

      6. World Health Organization. ICD-10. International statistical classification of diseases and related health problems. - 10th revision, Fifth edition, 2016. page. 45.;sequence=1.

        • Black W.C.
        • Haggstrom D.A.
        • Welch H.G
        All-cause mortality in randomized trials of cancer screening.
        J. Natl. Cancer Inst. 2002; 94: 167-173
        • Ponzio M.
        • Gerzeli S.
        • Brichetto G.
        • et al.
        Economic impact of multiple sclerosis in Italy: focus on rehabilitation costs.
        Neurol. Sci. 2015; 36: 227-234