Prevalence of Multiple Sclerosis (MS) in Zanjan Province of Iran

Mahsa Ghajarzadeh, Abbas R. Foroushani, Parviz Ghezelbash, Abdoreza Ghoreishi, Mehdi Maghbooli, Mehran Yousefi, Babak K. Rahgoshai, Farhad G. Maemodan, Mehdi Mohammadifar, Mohammad A. Sahraian


Background: The prevalence of multiple sclerosis (MS) varies in different geographical regions and has dramatically increased in Iran. Revealing the high prevalence rate draws the attention of policymakers and helps them allocate necessary resources. The aim of this study is to determine
the prevalence of MS in Zanjan province of Iran.

Methods: We included all registered residents of Zanjan province with MS on the prevalence day (July 31, 2019). All cases met the McDonald criteria.
All registered cases in Zanjan MS society were identified as index cases. Data regarding patient’s national code, gender, age, age at the first symptom onset, city of residence, marital status, education level, occupation, ethnicity, family history of MS and the time span between symptom’s onset and disease diagnosis were recorded.

Results: We identified 758 patients, 551 of whom (72.7%) were female. The mean age at the first symptom onset was 28.9 ±8.7 years old. The crude prevalence was 71.6 per 100,000 population (95% CI 66.6–76.9). The disease was most prevalent in Zanjan city (100.5 per 100,000). The gender‑specific prevalence per 100,000 population was 105.4 for women (95% CI: 96.8–114.6) and 38.7 for men (95% CI: 33.6–44.1), with female to male ratio of 2.6. The standardized mortality ratio (SMR) was calculated as expected/observed for both men and women as 2.3 (207/88.2) (551/234.1).

Conclusions: Our data confirm that the MS prevalence rate is high in Zanjan province of Iran.


Epidemiology; Iran; multiple sclerosis; prevalence

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Etemadifar M, Maghzi A‑H. Sharp increase in the incidence and

prevalence of multiple sclerosis in Isfahan, Iran. Mult Scler J


Ghajarzadeh M, Azizi S, Moghadasi AN, Sahraian MA, Azimi A,

Mohammadifar M, et al. Validity and reliability of the Persian

version of the perception de la Scle’rose En Plaques et de ses

Pousse’es questionnaire evaluating multiple sclerosis‑related

quality of life. Int J Prev Med 2016;7:25.

Kurtzke JF. Epidemiologic contributions to multiple sclerosis:

An overview. Neurology 1980;30:61‑79.

Ahlgren C, Odén A, Lycke J. High nationwide prevalence of

multiple sclerosis in Sweden. Mult Scler J 2011;17:901‑8.

Berg‑Hansen P, Moen S, Harbo H, Celius E. High prevalence

and no latitude gradient of multiple sclerosis in Norway. Mult

Scler J 2014;20:1780‑2.

Bentzen J, Meulengracht Flachs E, Stenager E,

Brønnum‑Hansen H, Koch‑Henriksen N. Prevalence of multiple

sclerosis in Denmark 1950—2005. Mult Scler J 2010;16:520‑5.

Warren S, Svenson L, Warren K. Contribution of incidence to

increasing prevalence of multiple sclerosis in Alberta, Canada.

Mult Scler J 2008;14:872‑9.

Cheng Q, Miao L, Zhang J, Ding SJ, Liu ZG, Wang X, et al.

A population‑based survey of multiple sclerosis in Shanghai,

China. Neurology 2007;68:1495‑500.

Bhigjee A, Moodley K, Ramkissoon K. Multiple sclerosis in

KwaZulu Natal, South Africa: An epidemiological and clinical

study. Mult Scler J 2007;13:1095‑9.

Etemadifar M, Janghorbani M, Shaygannejad V, Ashtari F.

Prevalence of multiple sclerosis in Isfahan, Iran.

Neuroepidemiology 2006;27:39‑44.

Rosati G. The prevalence of multiple sclerosis in the world: An

update. Neurol Sci 2001;22:117‑39.

Etemadifar M, Izadi S, Nikseresht A, Sharifian M, Sahraian MA,

Nasr Z. Estimated prevalence and incidence of multiple sclerosis

in Iran. Eur Neurol 2014;72:370‑4.

Available from:

Available from:‑zanjan.


Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA,

Filippi M, et al. Diagnostic criteria for multiple sclerosis:

revisions to the McDonald criteria. Ann Neurol


Azami M, YektaKooshali MH, Shohani M, Khorshidi A,

Mahmudi L. Epidemiology of multiple sclerosis in

Iran: A systematic review and meta‑analysis. PloS One


Eskandarieh S, Heydarpour P, Elhami S‑R, Sahraian MA.

Prevalence and incidence of multiple sclerosis in Tehran, Iran.

Iran J Public Health 2017;46:699.

Moghaddam VK, Sarmadi M, Tatari M, Najafi F, Esmaeili A,

Hadei M. Epidemiology of multiple sclerosis in Torbat‑e

Heydarieh (Northeast of Iran) during 1982‑2016. Mult Scler

Relat Disord 2018;24:184‑9.

Izadi S, Nikseresht AR, Poursadeghfard M, Borhanihaghighi A,

Heydari ST. Prevalence and incidence of multiple sclerosis in

Fars province, Southern Iran. Iran J Med Sci 2015;40:390.

Sarasoja T, Wikström J, Paltamaa J, Hakama M, Sumelahti ML.

Occurrence of multiple sclerosis in central Finland: A regional

and temporal comparison during 30 years. Acta Neurol Scand


Eskandari G, Ghajarzadeh M, Yekaninejad MS, Sahraian MA,

Gorji R, Rajaei F, et al. Comparison of serum vitamin D level

in multiple sclerosis patients, their siblings, and healthy controls.

Iran J Neurol 2015;14:81‑5.

Khosravi‑Boroujeni H, Sarrafzadegan N, Sadeghi M, Roohafza H,

Ng SK, Pourmogaddas A, et al. Prevalence and trends of vitamin

D deficiency among Iranian adults: A longitudinal study from

‑2013. J Nutr Sci Vitaminol 2017;63:284‑90.

Oksenberg JR, Baranzini SE, Sawcer S, Hauser SL. The genetics

of multiple sclerosis: SNPs to pathways to pathogenesis. Nat

Rev Genet 2008;9:516‑26.

Abdollahzadeh R, Fard MS, Rahmani F, Moloudi K,

Azarnezhad A. Predisposing role of vitamin D receptor (VDR)

polymorphisms in the development of multiple sclerosis:

A case‑control study. J Neurol Sci 2016;367:148‑51