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However, it is unclear whether the difference in sex ratio is observed similarly in sporadic compared to familial ALS. Here, we conducted a systematic review to investigate the differences in sex ratio between familial and sporadic ALS. Following the meta-analysis of observational studies in epidemiology (MOOSE) guidelines, this study searched Ovid MEDLINE, Embase, Emcare, SCOPUS and Cochrane databases. We used a random-effects meta-analysis to estimate sex ratios in a total of 9269 ALS patients (4135 female, 5134 male) across 20 included studies. We confirmed that ALS is more prevalent in males than in females (sex ratio: 1.25 (95%CI 1.14\u20131.37). However, when we stratified the analyses, the sex ratio was only different in sporadic ALS. Male-to-female ratios were 1.29 (95% CI 1.16\u20131.42) for sporadic ALS and 1.05 (95% CI 0.93\u20131.18) for familial ALS. A further analysis showed a pooled risk ratio of 1.07 (95% CI 1.00\u20131.15), indicating a 7% higher likelihood of males being diagnosed with sporadic rather than familial ALS. These findings highlight the importance of considering sex-specific factors in ALS research and clinical practice.<\/jats:p>","DOI":"10.1007\/s00415-026-13627-1","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T15:47:03Z","timestamp":1769010423000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The differences in sex ratio between sporadic and familial amyotrophic lateral sclerosis: a systematic review"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4420-5986","authenticated-orcid":false,"given":"Aafke","family":"Boomsma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0471-3294","authenticated-orcid":false,"given":"Caitlin","family":"Doyle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9482-6115","authenticated-orcid":false,"given":"Na","family":"Sai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3482-8741","authenticated-orcid":false,"given":"Mary-Louise","family":"Rogers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9701-2718","authenticated-orcid":false,"given":"Sang Hong","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5608-2293","authenticated-orcid":false,"given":"Beben","family":"Benyamin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"issue":"5 Peripheral Ne","key":"13627_CR1","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1212\/01.CON.0000455886.14298.a4","volume":"20","author":"E Tiryaki","year":"2014","unstructured":"Tiryaki E, Horak HA (2014) ALS and other motor neuron diseases. 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