Multiple sclerosis mortality trends in Spain from 1981 to 2020

Objective: Assess time trends in mortality from multiple sclerosis (MS) in the Spanish population (1981-2020), considering the influence of independent effects of gender, age, period, and birth cohort. Methods: MS deaths and populations needed for calculations were obtained from the National Institute of Statistics. Age-standardised mortality rates (ASMR) and trend analysis were performed using joinpoint regression software. Age-period-cohort (APC) analysis was performed using the web-based statistical tool of the US National Cancer Institute to explore the underlying reason for the MS mortality. Results: ASMR increased significantly in both women and men (1.7% and 1.2% respectively). The joinpoint analysis detected no trend change for women, but for men it detects a first period where rates remain stable (1981-2000; annual percentage change: -0.7%, not significant) followed by a period of significant increase (2000-2020; 2.6%, P < .05). For period effects, a steady increase was observed among women since the early 1990s and among men since the late 1990s. A birth cohort-related increase in mortality was detected: women born from 1916 onwards see their risk of MS mortality increase until it peaks in 1956, after which it decreases. A similar pattern is observed in men, albeit with a decade delay (from 1926 to 1966). Conclusion: ASMR shows a steady increase in both sexes over the last decades, although it has been more intense in men. The decreasing birth cohort pattern for MS mortality in men born since the mid-1960s and women born since the mid-1950s is similar to APC analyses in other countries. (c) 2025 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Neurolog<acute accent>& imath;a. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).