A divergence in earlier multiple sclerosis (MS) mortality rates observed within Europe, prompted us to determine the MS mortality rate in Austria and several European countries. Our aim was to examine the temporal and geographical variations within Austria and to determine future MS mortality rates based on a projection model. MS mortality data set, differentiated by age groups, sex, and region at death for the period 1970-2001 were obtained. Prognostic MS mortality trends for the period 2002-2020 were estimated using the simultaneous multiple cause-delay (SIMCAD) method. Our findings indicate a decline (47%) in the MS mortality rate from 1.41 (1970-79) to 0.96 (1980-89) and 0.70 (1990-2001) per 100 000 in Austria during the 32-year period observed. Conversely, the scenarios of our projection for the period 2002-2020, reveal an increasing MS mortality rate. The median age at death because of MS increased with 0.7 years for men and 2.9 years for women during the observed period (1970-2001). Austria, like many other European countries, has experienced a decreasing MS mortality rate over the last three decades. An increased MS mortality rate is however expected over the next decades in Austria. This increase will be most prominent in the elderly population cohorts because of demographic shifts.