title: Multiple sclerosis in the province of Ferrara : evidence for an increasing trend.
abstract: BACKGROUND
  Epidemiological studies on the distribution of multiple sclerosis (MS) conducted in the Mediterranean area in the last two decades have disclosed a significant increase in frequency of the disease, indicating caution when a latitude-related model of MS is accepted. Previous descriptive surveys in the province of Ferrara, northern Italy, carried out by our own epidemiological research group, have established that this area is at high risk for MS.
  
  
  OBJECTIVE
  To confirm the above assumption and to update MS frequency estimates in this area.
  
  
  METHODS
  We conducted a community-based intensive prevalence and incidence study, by adopting a complete enumeration approach.
  
  
  RESULTS
  On December 31, 2004, 423 patients (300 women and 123 men) suffering from definite or probable MS (Poser's criteria) living in the province of Ferrara, yielded a crude prevalence rate of 120.93 (95 % CI, 110.05-134.23) per 100,000, 164.26 for women and 73.59 for men. The average incidence from 1990 to 2003 was 4.35 per 100,000 (95 % CI, 3.77-4.99), 5.91 for women and 2.63 for men. The incidence rate,which was relatively stable during the previous 25 years (1965-1989) with a mean rate of 2.3 per 100,000, increased to a value of 3.39 per 100,000 in the period 1990-1994, 4.09 per 100,000 in the period 1995-1999 and 3.84 per 100,000 in the period 2000-2003.
  
  
  CONCLUSIONS
  These results confirm that in Ferrara MS occurs more frequently than suggested by the geographic- related distribution model and, based on other recent national surveys, support the view that northern Italy is a high-risk area for the disease. The marked increase in MS prevalence rate, in comparison with previous investigations, is in part due to the increasing survival of patients as a result of improved supportive care and the accumulation of new incidence cases owing to the reduction in diagnostic latency for better quality of neurological diagnostic procedures. The incidence in the province of Ferrara was found to slowly change with an incremental trend,which cannot only be attributed to improvements in diagnostic ability. Environmental risk factors in genetically predisposed people over time could be considered.
authors.affiliation: Dipartimento di Discipline Medico-Chirurgiche della Comunicazione e delComportamento,University of Ferrara, Ferrara, Italy. enrico.granieri@unife.it
authors.forename: E
authors.initials: E
authors.lastname: Granieri
authors.forename: N-T
authors.initials: NT
authors.lastname: Economou
authors.forename: R
authors.initials: R
authors.lastname: De Gennaro
authors.forename: M R
authors.initials: MR
authors.lastname: Tola
authors.forename: L
authors.initials: L
authors.lastname: Caniatti
authors.forename: V
authors.initials: V
authors.lastname: Govoni
authors.forename: E
authors.initials: E
authors.lastname: Fainardi
authors.forename: I
authors.initials: I
authors.lastname: Casetta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies