{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:23:51Z","timestamp":1790371431080,"version":"4.1.0"},"reference-count":56,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T00:00:00Z","timestamp":1694044800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T00:00:00Z","timestamp":1694044800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Multiple sclerosis is a leading cause of non-traumatic neurological disability among young adults worldwide. Prior studies have identified modifiable risk factors for multiple sclerosis in cohorts of White ethnicity, such as infectious mononucleosis, smoking, and obesity during adolescence\/early adulthood. It is unknown whether modifiable exposures for multiple sclerosis have a consistent impact on risk across ethnic groups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Aim<\/jats:title>\n                <jats:p>To determine whether modifiable risk factors for multiple sclerosis have similar effects across diverse ethnic backgrounds.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted a nested case\u2013control study using data from the UK Clinical Practice Research Datalink. Multiple sclerosis cases diagnosed from 2001 until 2022 were identified from electronic healthcare records and matched to unaffected controls based on year of birth. We used stratified logistic regression models and formal statistical interaction tests to determine whether the effect of modifiable risk factors for multiple sclerosis differed by ethnicity.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We included 9662 multiple sclerosis cases and 118,914 age-matched controls. The cohort was ethnically diverse (MS: 277 South Asian [2.9%], 251 Black [2.6%]; Controls: 5043 South Asian [5.7%], 4019 Black [4.5%]). The age at MS diagnosis was earlier in the Black (40.5 [SD 10.9]) and Asian (37.2 [SD 10.0]) groups compared with White cohort (46.1 [SD 12.2]). There was a female predominance in all ethnic groups; however, the relative proportion of males was higher in the South Asian population (proportion of women 60.3% vs 71% [White] and 75.7% [Black]). Established modifiable risk factors for multiple sclerosis\u2014smoking, obesity, infectious mononucleosis, low vitamin D, and head injury\u2014were consistently associated with multiple sclerosis in the Black and South Asian cohorts. The magnitude and direction of these effects were broadly similar across all ethnic groups examined. There was no evidence of statistical interaction between ethnicity and any tested exposure, and no evidence to suggest that differences in area-level deprivation modifies these risk factor-disease associations. These findings were robust to a range of sensitivity analyses.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions and relevance<\/jats:title>\n                <jats:p>Established modifiable risk factors for multiple sclerosis are applicable across diverse ethnic backgrounds. Efforts to reduce the population incidence of multiple sclerosis by tackling these risk factors need to be inclusive of people from diverse ethnicities.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00415-023-11971-0","type":"journal-article","created":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T10:03:32Z","timestamp":1694081012000},"page":"241-253","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Modifiable risk factors for multiple sclerosis have consistent directions of effect across diverse ethnic backgrounds: a nested case\u2013control study in an English population-based cohort"],"prefix":"10.1007","volume":"271","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6023-6010","authenticated-orcid":false,"given":"Benjamin M.","family":"Jacobs","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Tank","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan P.","family":"Bestwick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair J.","family":"Noyce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles R.","family":"Marshall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohini","family":"Mathur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Giovannoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Dobson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,9,7]]},"reference":[{"key":"11971_CR1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/S1474-4422(18)30443-5","volume":"18","author":"MT Wallin","year":"2019","unstructured":"Wallin MT et al (2019) Global, regional, and national burden of multiple sclerosis 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016. 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RM has received consulting fees from AMGEN. PT has no interests to declare. RD has received speaker honoraria from Biogen Idec, Teva, Merck, Janssen, Roche and Sanofi-Genzyme; sat on advisory boards for Roche, Merck, Novartis, Janssen and Biogen and received research support from Biogen, Merck and Celgene. GG has received speaker honoraria from AbbVie, Actelion, Biogen, Celgene, Sanofi-Genzyme, Genentech, Merck Serono, Novartis, Roche and Teva; sat on advisory boards for AbbVie, Actelion, Biogen, Celgene, Sanofi-Genzyme, Genentech, GlaxoSmithKline, Merck Serono, Novartis, Roche and Teva; and received research support from Sanofi-Genzyme, Takeda, and Merck SJ has received support for conferences, speaker, advisory boards, trials, Data and Safety Monitoring Boards and projects with CSL Behring, Takeda, Swedish Orphan Biovitrum, Biotest, Binding Site, Grifols, BPL, Octapharma, LFB, Pharming, GSK, Weatherden, Zarodex, Sanofi, and UCB Pharma. None of these conflicts relate to the current work. AN reports consultancy and personal fees from AstraZeneca, AbbVie, Profile, Roche, Biogen, UCB, Bial, Charco Neurotech, uMedeor, Alchemab, and Britannia, outside the submitted work. None of these conflicts relate to the current work.\u00a0CM reports personal fees from Biogen and GE Healthcare, outside the submitted work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"This study made use of Hospital Episode Statistics which are under copyright \u00a9 (2023), re-used with the permission of The Health & Social Care Information Centre. All rights reserved. The study was approved by the CPRD Independent Scientific Advisory Committee (application number 21_000677). ONS data were provided by the ONS.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This research was conducted and reported in accordance with the STROBE guidelines on observational studies.\u00a0","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Reporting guidelines"}}]}}