title: Incidence of multiple sclerosis in Northern Lisbon, Portugal: 1998-2007.
abstract: BACKGROUND
  There are few, recent, well assessed, multiple sclerosis (MS) incidence surveys on European populations. This study sought to measure MS incidence in a Northern Lisbon population and assess it using capture-recapture methods (CRMs).
  
  
  METHODS
  Among the population residing in the Northern Lisbon Health Area, registered MS diagnoses were obtained from general practitioners in three primary-care districts covering a population of 196,300, and a neurology unit at the main referral hospital. Cases with onset during the periods 1978-1997 and 2008-2012 were excluded due to perceived poor access to image-supported neurological diagnosis and administrative changes in patient referral respectively. Age- and sex-specific incidences for the period 1998-2007 were calculated using McDonald diagnostic criteria, and CRMs were used to correct age-specific incidence rates. The corrected figures were also adjusted for age using the European Standard Population as reference.
  
  
  RESULTS
  When applied to 62 MS patients with onset in the period 1998-2007, the rates per 100,000 population were as follows for both sexes: crude, 3.16; age-adjusted, 3.09 (95% CI 2.32 to 3.87); CRM-adjusted, 4.53 (95% CI 3.13 to 5.94); and age- and CRM-adjusted, 4.48 (3.54-5.41). In general, the rates were 3-fold higher among women than among men. Negative source dependency and CRM impact were highest at ages 35-44 years, where a 60% rise led to a peak incidence.
  
  
  CONCLUSIONS
  MS incidence in Northern Lisbon, Portugal, is moderately lower than that yielded by surveys on European populations. CRMs, which in this instance suggest undercounts, are a potentially useful tool for case-finding assessment but their application may introduce bias.
authors.affiliation: Neurology Department, Santa Maria Hospital, Av Prof. Egas Moniz, Lisbon, 1600-001, Portugal. jcorreiasa@gmail.com.
authors.forename: Joao
authors.initials: J
authors.lastname: de Sá
authors.affiliation: National Centre for Epidemiology, Carlos III Institute of Health, Av Monforte de Lemos, 5, 28029, Madrid, Spain. ealcalde@isciii.es.|Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Ministry of Economy and Competitiveness, Madrid, Spain. ealcalde@isciii.es.
authors.forename: Enrique
authors.initials: E
authors.lastname: Alcalde-Cabero
authors.affiliation: National Centre for Epidemiology, Carlos III Institute of Health, Av Monforte de Lemos, 5, 28029, Madrid, Spain. jalmazan@isciii.es.|Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Ministry of Economy and Competitiveness, Madrid, Spain. jalmazan@isciii.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Almazán-Isla
authors.affiliation: National Centre for Epidemiology, Carlos III Institute of Health, Av Monforte de Lemos, 5, 28029, Madrid, Spain. fjgarcial@isciii.es.|Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Ministry of Economy and Competitiveness, Madrid, Spain. fjgarcial@isciii.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: García-López
authors.affiliation: National Centre for Epidemiology, Carlos III Institute of Health, Av Monforte de Lemos, 5, 28029, Madrid, Spain. jpedro@isciii.es.|Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Ministry of Economy and Competitiveness, Madrid, Spain. jpedro@isciii.es.|Department Epidemiología Aplicada - CIBERNED, Centro Nacional de Epidemiología, Pab 12, Instituto Salud Carlos III, Av/ Monforte de Lemos 5, 28029, Madrid, Spain. jpedro@isciii.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: de Pedro-Cuesta
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002947:Cities; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology*; D011174:Portugal / Q000453:epidemiology; D017678:Sex Distribution; D055815:Young Adult