Prevalence of MS More Than Doubled in England Alongside Increase in Survival Rate

A new study published in JAMA Neurology found that the incidence of multiple sclerosis (MS) in England had more than doubled in the 20 years between 2000 and 2020, with smoking prevalence, obesity, and socioeconomic deprivation having a significant effect on mortality.¹ Despite an increase in incidence, survival rates in those with MS improved in the same 20-year span.

Expanded access to care and improved means of diagnosis have led to an increased number of diagnoses of MS around the world, including in the US and England.² How survival in MS is associated with weight, tobacco use, and socioeconomic deprivation has not previously been determined. This study aimed to use primary care data to identify trends in the prevalence of MS, smoking, and body mass index (BMI) and their associations with all-cause mortality.¹

The Clinical Practice Research Datalink Aurum was used for this study, as it holds approximately 24% of the English population’s anonymized records. All patients with MS who were registered in England between 1990 and 2023 were included with an index date of the first recorded diagnosis of MS. Age, sex, region, BMI, race and ethnicity, smoking status, and index of multiple deprivation acted as variables in the study. Census denominators were used to estimate prevalence based on age, sex, and region.

The cases of MS increased from 21,997 cases in 2000 to 37,669 cases in 2020, which was equivalent to 107.1 cases per 100,000 in 2000 to 231.8 cases per 100,000 in 2020. Approximately 131,000 people were living with MS as of 2020. There was a 6% annual increase in adjusted prevalence per year (prevalence ratio, 1.06; 95% CI, 1.06-1.06), which was higher in the least vs most deprived areas (prevalence ratio, 2.40; 95% CI, 2.24-2.57).

Higher odds of obesity were found each year (OR, 1.045; 95% CI, 1.042-1.048) vs normal weight; odds of being underweight also increased each year (OR, 1.028; 95% CI, 1.023-1.033) vs normal weight. Being underweight (OR, 1.31; 95% CI, 1.12-1.53) or obese (OR, 1.83; 95% CI, 1.69-1.99) was most common in residents of more deprived areas.

Being a former smoker was more likely than being a current smoker over time (OR, 1.026; 95% CI, 1.024-1.029). People living in the most deprived areas were less likely to be ex-smokers (OR, 0.59; 95% CI, 0.55-0.63) and less likely to be nonsmokers (OR, 0.61; 95% CI, 0.57-0.65).

Mortality rates were lower as time went on, with each later year of diagnosis associated with decreasing mortality rates (HR per year, 0.88; 95% CI, 0.88-0.89). Former smokers had lower mortality rates compared with current smokers (HR, 0.56; 95% CI, 0.52-0.61). People in the most deprived areas had higher mortality rates (HR, 1.22; 95% CI, 1.12-1.32) compared with those in the least deprived areas. Mortality rates were increased for those who were underweight (HR, 1.18; 95% CI, 1.03-1.36) and obese (HR, 1.63; 95% CI, 1.37-1.93).

There were some limitations to the study, including a reliance on data collected routinely, residual confounding, and potential misclassification.

The researchers highlighted that the prevalence of MS increased in England over 20 years while survival rates also increased. Tobacco cessation, they wrote, should be a high-impact target for care in those with MS.

“Integrating effective treatments with targeted smoking cessation and weight-management strategies, and prioritizing socioeconomically disadvantaged populations, represents a pragmatic route to reducing mortality rates and narrowing persistent inequalities in MS outcomes,” the authors concluded.

References

1. Palladino R, Thomspon A, Ciccarelli O. Thirty-year trends in multiple sclerosis prevalence, lifestyle factors, and mortality in England. JAMA Neurol. Published online March 23, 2026. doi:10.1001/jamaneurol.2026.0352
2. MS prevalence. National Multiple Sclerosis Society. Accessed March 23, 2026. https://www.nationalmssociety.org/about-the-society/who-we-are/research-we-fund/ms-prevalence