title: Onset-adjusted incidence of multiple sclerosis in the Girona province (Spain): Evidence of increasing risk in the south of Europe.
abstract: BACKGROUND
  Recent studies show an increasing incidence of multiple sclerosis (MS) in southern Europe. Although by its geographical location and genetic characteristics Spain is expected to be similar to other southern European regions, data on incidence are scarce. The aim of this study was to determine the onset-adjusted incidence of MS in the Girona province in Catalonia (Spain).
  
  
  METHODS
  A prospective incidence study pooling data from the population-based Catalonia MS Registry was performed. Incident cases were defined as patients who had the onset of symptoms compatible with a clinically isolated syndrome (CIS) suggestive of MS in 2009 and fulfilled McDonald-2005 criteria during follow-up. Age- and sex-specific incidence rates were obtained.
  
  
  RESULTS
  The Registry included 182 patients residing in Girona that presented a CIS from January 2009 to December 2013. Fifty one patients had the onset of symptoms in 2009, of whom 27 patients fulfilled the diagnostic criteria, giving an incidence of 3.6 per 100,000 (CI 95% 2.4-5.3) inhabitants; 4.3 (CI 95% 2.5-7.1) for women and 2.9 (CI 95% 1.4-5.2) for men. The age-adjusted incidence rate for the European population was 3.29 (CI 95% 3.2-3.3).
  
  
  CONCLUSIONS
  The incidence estimation derived in this study is consistent with recent epidemiological data of MS in southern Europe suggesting an increase in incidence in this region.
authors.affiliation: Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain; Preventive Medicine and Epidemiology Department, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: sotero@cem-cat.org.
authors.forename: S
authors.initials: S
authors.lastname: Otero-Romero
authors.affiliation: Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital, Neurodegeneration and Neuroinflammation Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain.
authors.forename: Ll
authors.initials: L
authors.lastname: Ramió-Torrentà
authors.affiliation: Hospital Santa Caterina, Girona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Pericot
authors.affiliation: Hospital de Figueres, Girona, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Carmona
authors.affiliation: Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital, Neurodegeneration and Neuroinflammation Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain.
authors.forename: H
authors.initials: H
authors.lastname: Perkal
authors.affiliation: Center of Neuroimmunology, Neurology Service, Hospital Clinic, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Saiz
authors.affiliation: Neurology Department, Hospital General de Vic, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Bufill
authors.affiliation: Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital, Neurodegeneration and Neuroinflammation Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Robles
authors.affiliation: Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Simón
authors.affiliation: Center of Neuroimmunology, Neurology Service, Hospital Clinic, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Llufriu
authors.affiliation: Preventive Medicine and Epidemiology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Vaqué-Rafart
authors.affiliation: Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sastre-Garriga
authors.affiliation: Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Montalban
mesh_terms: D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D015331:Cohort Studies; D018672:Community Health Planning; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology*; D009460:Neurologic Examination; D012042:Registries / Q000706:statistics & numerical data; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
keywords: Clinically isolated syndrome; Cohort study; Epidemiology; Incidence; Multiple sclerosis; Population-based registry