Global MS burden in women of childbearing age rises 48% from 1990 to 2021

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Frontiers in Medicine Published May 1, 2026 Medically reviewed May 1, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider that MS incidence and prevalence in women of childbearing age have increased globally, but observational data limit causal inference.

This global cohort analysis used data from 204 countries (1990–2021) to assess multiple sclerosis (MS) burden among women of childbearing age (15–49 years). The study examined age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (ASDR) rates over time, with projections to 2040.

Main results showed a 48% rise in MS incidence and a 66% increase in prevalence among women of childbearing age. Mortality grew 17%, while DALYs decreased 7%. ASMR and ASDR improved, with effect sizes of -0.35 and -0.3, respectively. Birth cohort risk generally declined (relative risk from 1.146 to 0.805), but the 2002–2006 cohort showed elevated risk (RR 1.413).

Regional variations were notable: incidence growth was greatest in Australasia, while East Asia saw a decline. Prevalence increases were led by Central Latin America. High-SDI countries (>0.4) carried a disproportionate burden, with peak incidence at ages 45–49. Low-SDI nations like Cambodia demonstrated optimal disease control compared to high-SDI underperformers like Sweden.

Safety and tolerability data were not reported. Key limitations include that specific disease burden among women of childbearing age remains undercharacterized. These observational findings should be interpreted cautiously and not imply causation.

For practice, these trends advocate for tailored, age-specific management strategies for MS in women of childbearing age, though direct clinical recommendations require further confirmatory studies.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedMay 2026

View Original Abstract ↓

IntroductionMultiple sclerosis (MS) shows marked female predominance, particularly among women of childbearing age (WCBA, 15–49 years), yet their specific disease burden remains under characterized. Using Global Burden of Disease (GBD) 1990–2021 data, we conducted the first comprehensive analysis of MS trends in WCBA globally, with projections to 2040, to guide targeted interventions for this vulnerable population.MethodsWe analyzed age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (ASDR) rates across 204 countries using GBD 2021 data. Our analytical approach incorporated Pearson correlation to examine Socio-demographic Index (SDI) relationships, decomposition analysis to identify burden drivers, and frontier analysis to assess disease control efficiency gaps. We employed Bayesian Age-Period-Cohort modeling alongside ARIMA for 20-year projections, with joinpoint regression analyzing temporal trends through annual percentage changes. Age-period-cohort effects were further disentangled through APC modeling, with stratification by age group, SDI level, and geographic region.ResultsBetween 1990-2021, WCBA experienced a 48% rise in MS incidence and 66% increase in prevalence, with mortality growing by 17% despite a 7% DALYs reduction. Age-standardized rates improved (ASMR:-0.35; ASDR:-0.3), though burden varied regionally: Australasia showed greatest incidence growth versus East Asia’s decline, while Central Latin America led prevalence increases. High-SDI countries (>0.4) carried disproportionate burden, peaking at ages 45-49 (incidence:30–34 years). Projections indicate rising crude rates but falling ASDR. Low-SDI nations (e.g., Cambodia) demonstrated optimal control versus high-SDI underperformers (e.g., Sweden). Birth cohorts revealed generally declining risk (RR1.146→0.805) except 2002-2006(RR1.413), with elevated DALYs(20-25y) and prevalence(30-35y) warranting targeted action.DiscussionThis study reveals key disparities in MS burden among WCBA, with high-SDI countries showing paradoxical high burden yet improvement potential. The 2002–2006 cohort rebound and persistent burdens in 30-49-year-olds highlight critical intervention windows. While low-SDI countries demonstrate unexpected control efficiency, rising crude rates globally underscore the growing women’s health challenge of MS, particularly given projected prevalence increases. These findings advocate for tailored, age-specific management strategies.