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Rotstein DL, Wolfson C, Carruthers R, Freedman MS, Morrow SA, Lee L, Burton JM, Nisenbaum R, Konig A, Magalhaes S, Marrie RA. A national case-control study investigating demographic and environmental factors associated with NMOSD. Mult Scler 2023; 29:521-529. [PMID: 36803237 PMCID: PMC10152218 DOI: 10.1177/13524585231151953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Risk factors for aquaporin-4 (AQP4+) antibody neuromyelitis optica spectrum disorder (NMOSD) are not well-established. OBJECTIVE To investigate demographic and environmental factors associated with NMOSD using a validated questionnaire and case-control design. METHODS We enrolled patients with AQP4 + NMOSD through six Canadian Multiple Sclerosis Clinics. Participants completed the validated Environmental Risk Factors in Multiple Sclerosis Study (EnvIMS) questionnaire. Their responses were compared to those of 956 unaffected controls from the Canadian arm of EnvIMS. We calculated odds ratios (ORs) for the association between each variable and NMOSD using logistic regression and Firth's procedure for rare events. RESULTS In 122 participants (87.7% female) with NMOSD, odds of NMOSD in East Asian and Black participants were ⩾8 times that observed in White participants. Birthplace outside Canada was associated with an increased risk of NMOSD (OR = 5.5, 95% confidence interval (CI) = 3.6-8.3) as were concomitant autoimmune diseases (OR = 2.7, 95% CI = 1.4-5.0). No association was observed with reproductive history or age at menarche. CONCLUSION In this case-control study, risk of NMOSD in East Asian and Black versus White individuals was greater than that observed in many previous studies. Despite the preponderance of affected women, we did not observe any association with hormonal factors such as reproductive history or age at menarche.
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Affiliation(s)
- Dalia L Rotstein
- DL Rotstein MS Clinic, St. Michael’s
Hospital, 30 Bond St., Toronto, ON M5B 1W8, Canada.
| | - Christina Wolfson
- Departments of Epidemiology, Biostatistics and
Occupational Health and Medicine, Faculty of Medicine and Health Sciences,
McGill University, Montreal, QC, Canada/Research Institute of the McGill
University Health Centre, Montreal, QC, Canada
| | - Robert Carruthers
- Division of Neurology, Faculty of Medicine,
University of British Columbia, Vancouver, BC, Canada
| | - Mark S Freedman
- Department of Medicine, University of Ottawa,
Ottawa, ON, Canada/Ottawa Hospital Research Institute, Ottawa, ON,
Canada
| | - Sarah A Morrow
- Western University, London, ON, Canada/London
Health Sciences Centre, London, ON, Canada
| | - Liesly Lee
- Department of Medicine, University of Toronto,
Toronto, ON, Canada/Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, ON, Canada
| | - Jodie M Burton
- Departments of Clinical Neurosciences and
Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Rosane Nisenbaum
- St. Michael’s Hospital, Toronto, ON,
Canada/Applied Health Research Centre and MAP Centre for Urban Health
Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity
Health Toronto, Toronto, ON, Canada/Division of Biostatistics, Dalla Lana
School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Sandra Magalhaes
- Department of Sociology, University of New
Brunswick, Fredericton, NB, Canada
| | - Ruth Ann Marrie
- Departments of Medicine and Community Health
Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences,
University of Manitoba, Winnipeg, MB, Canada
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