{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T11:15:29Z","timestamp":1789211729528,"version":"build-2803163510"},"reference-count":37,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2015,7,21]],"date-time":"2015-07-21T00:00:00Z","timestamp":1437436800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>We examined the combined effect of having multiple key risk factors and the interactions between the key risk factors of multiple sclerosis (MS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed an incident case-control study including cases with a first clinical diagnosis of central nervous system demyelination (FCD) and population-based controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Compared to those without any risk factors, those with one, two, three, and four or five risk factors had increased odds of being an FCD case of 2.12 (95% confidence interval (CI), 1.11\u20134.03), 4.31 (95% CI, 2.24\u20138.31), 7.96 (95% CI, 3.84\u201316.49), and 21.24 (95% CI, 5.48\u201382.40), respectively. Only HLA-DR15 and history of infectious mononucleosis interacted significantly on the additive scale (Synergy index, 3.78; p = 0.03). The five key risk factors jointly accounted for 63.8% (95% CI, 43.9\u201391.4) of FCD onset. High anti-EBNA IgG was another important contributor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A high proportion of FCD onset can be explained by the currently known risk factors, with HLA-DR15, ever smoking and low cumulative sun exposure explaining most. We identified a significant interaction between HLA-DR15 and history of IM in predicting an FCD of CNS demyelination, which together with previous observations suggests that this is a true interaction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1352458515594040","type":"journal-article","created":{"date-parts":[[2015,7,21]],"date-time":"2015-07-21T21:31:00Z","timestamp":1437514260000},"page":"461-469","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":65,"title":["Population attributable fractions and joint effects of key risk factors for multiple sclerosis"],"prefix":"10.1177","volume":"22","author":[{"given":"IAF","family":"van der Mei","sequence":"first","affiliation":[{"name":"Menzies Research Institute, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RM","family":"Lucas","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population 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