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Alonso-Magdalena L, Carmona I Codina O, Zia E, Sundström P, Pessah-Rasmussen H. Prevalence and disease disability in immigrants with multiple sclerosis in Malmö, southern Sweden. Clin Neurol Neurosurg 2024; 240:108255. [PMID: 38552363 DOI: 10.1016/j.clineuro.2024.108255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common chronic demyelinating disease of the central nervous system and the major non-traumatic cause of permanent disability in young adults. Several migration studies have been performed over the years suggesting a pattern of higher disease disability in certain ethnic groups. To our knowledge, differences in disease progression in immigrants have not been studied in Sweden before. Thus, the aims of our study were to estimate the prevalence of multiple sclerosis among first-generation immigrants in the City of Malmö and to compare differences in disease severity with the native population. METHODS All persons with multiple sclerosis living in Malmö on prevalence day 31 Dec 2010 were included. Cases were classified according to the country of birth into Scandinavians, Western and non-Western. RESULTS The crude prevalence was 100/100,000 (95% CI, 80-124) among first-generation immigrants, 154/100,000 (95% CI, 137-173) among individuals with Scandinavian background, 123/100,000 (95% CI, 94-162) in the Western group and 76/100,000 (95% CI, 53-108) in the non-Western group. The mean Multiple Sclerosis Severity Score (MSSS) value among Scandinavians was 4.2 (SD 3.5), whereas the figures in the immigrant group were 4.6 (SD 3.3) and 5.2 (SD 3.7) among Westerns respectively non-Westerns, which differences were not statistically significant. When adjusting for gender, age at onset and initial disease course, the mean MSSS difference between the non-Western and the Scandinavian individuals was 1.7 (95% CI 0.18-3.3, p = 0.030). There were no differences on time to diagnosis or the time from diagnosis to treatment initiation between the three groups. CONCLUSIONS We found a lower prevalence among Western and non-Western first-generation immigrants compared to the Scandinavian population and a more severe disease in non-Western immigrants than in Scandinavians.
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Affiliation(s)
- Lucía Alonso-Magdalena
- Department of Neurology, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Olga Carmona I Codina
- Department of Neurology, Fundacio Salut Emporda, Figueres and Department of Clinical Sciences, Faculty of Medicine, Girona University, Spain
| | - Elisabet Zia
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Peter Sundström
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Hélène Pessah-Rasmussen
- Department of Rehabilitation medicine, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden
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Vyas MV, Kapral MK, Alonzo R, Fang J, Rotstein DL. Proportion of Life Spent in Canada and the Incidence of Multiple Sclerosis in Permanent Immigrants. Neurology 2024; 102:e209350. [PMID: 38657190 DOI: 10.1212/wnl.0000000000209350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES While immigrants to high-income countries have a lower risk of multiple sclerosis (MS) compared with host populations, it is unknown whether this lower risk among immigrants increases over time. Our objective was to evaluate the association between proportion of life spent in Canada and the hazard of incident MS in Canadian immigrants. METHODS We conducted a population-based retrospective cohort study in Ontario, using linked health administrative databases. We followed immigrants, who arrived in Ontario between 1985 and 2003, from January 1, 2003, to December 31, 2016, to record incident MS using a validated algorithm based on hospital admission or outpatient visits. We derived proportion of life spent in Canada based on age at arrival and time since immigration obtained from linked immigration records. We used multivariable proportional hazard models, adjusting for demographics and comorbidities, to evaluate the association between proportion of life in Canada and the incidence of MS, where proportion of life was modelled using restricted cubic spline terms. We further evaluated the role of age at migration (15 or younger vs older than 15 years), sex, and immigration class in sensitivity analyses. RESULTS We included 1.5 million immigrants (49.9% female, mean age 35.9 [SD 14.2] years) who had spent a median of 20% (Q1-Q3 10%-30%) of their life in Canada. During a mean follow-up of 13.9 years (SD 1.0), 934 (0.44/100,000 person-years) were diagnosed with MS. Compared with the median, a higher risk of MS was observed at higher values of proportion of life spent (e.g., hazard ratio [70% vs 20% proportion of life] 1.38; 1.07-1.78). This association did not vary by sex (p(sex × proportion of life) = 0.70) or immigration class (p(immigration class × proportion of life) = 0.13). The results did not vary by age at migration but were statistically significant only at higher values of proportion of life for immigrants aged 15 years or younger at arrival. DISCUSSION The risk of incident MS in immigrants varied with the proportion of life spent in Canada, suggesting an acculturation effect on MS risk. Further work is required to understand environmental and sociocultural factors driving the observed association.
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Affiliation(s)
- Manav V Vyas
- From the Division of Neurology (M.V.V., D.L.R.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., D.L.R.); ICES (M.V.V., M.K.K., R.A., J.F.); and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Moira K Kapral
- From the Division of Neurology (M.V.V., D.L.R.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., D.L.R.); ICES (M.V.V., M.K.K., R.A., J.F.); and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Rea Alonzo
- From the Division of Neurology (M.V.V., D.L.R.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., D.L.R.); ICES (M.V.V., M.K.K., R.A., J.F.); and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Jiming Fang
- From the Division of Neurology (M.V.V., D.L.R.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., D.L.R.); ICES (M.V.V., M.K.K., R.A., J.F.); and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Dalia L Rotstein
- From the Division of Neurology (M.V.V., D.L.R.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., D.L.R.); ICES (M.V.V., M.K.K., R.A., J.F.); and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
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Sipilä JOT, Viitala M, Hänninen A, Soilu-Hänninen M. Exposure to systemic antibiotics in outpatient care and the risk of multiple sclerosis. Mult Scler 2023; 29:1296-1303. [PMID: 37431169 PMCID: PMC10503255 DOI: 10.1177/13524585231185045] [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] [Received: 04/16/2023] [Revised: 05/29/2023] [Accepted: 06/12/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Infections, early life exposures and the microbiome have been associated with the aetiology of multiple sclerosis (MS). Data on any possible roles of antibiotics is scarce and conflicting. OBJECTIVE The objective of this study was to investigate associations between outpatient systemic antibiotic exposure and the risk of MS in a nationwide case-control setting. METHODS Patients with MS were identified from the nation MS registry and their exposure to antibiotics was compared with that of persons without MS, provided by the national census authority. Antibiotic exposure was investigated using the national prescription database and analyzed by Anatomical Therapeutic Chemical (ATC) category. RESULTS Among the 1830 patients with MS and 12765 control persons, there were no associations between exposure to antibiotics in childhood (5-9 years) or adolescence (10-19 years) and the subsequent risk of MS. There was also no association between antibiotic exposure 1-6 years before disease onset and the risk of MS, save for exposure to fluoroquinolones in women (odds ratio: 1.28; 95% confidence interval: 1.03, 1.60; p = 0.028) which is probably associated with the increased infection burden in the MS prodrome. CONCLUSION Use of systemic prescription antibiotics was not associated with subsequent MS risk.
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Affiliation(s)
- Jussi OT Sipilä
- Department of Neurology, Siun Sote, North Karelia Central Hospital, Joensuu, Finland and Clinical Neurosciences, University of Turku, Turku, Finland
| | | | - Arno Hänninen
- Institute of Biomedicine, University of Turku and Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Merja Soilu-Hänninen
- Clinical Neurosciences, University of Turku and Neurocenter, Turku University Hospital, Turku, Finland
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Boorgu DSSK, Venkatesh S, Lakhani CM, Walker E, Aguerre IM, Riley C, Patel CJ, De Jager PL, Xia Z. The impact of socioeconomic status on subsequent neurological outcomes in multiple sclerosis. Mult Scler Relat Disord 2022; 65:103994. [DOI: 10.1016/j.msard.2022.103994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/04/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
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Amiri M, Peinkhofer C, Othman MH, De Vecchi T, Nersesjan V, Kondziella D. Global warming and neurological practice: systematic review. PeerJ 2021; 9:e11941. [PMID: 34430087 PMCID: PMC8349167 DOI: 10.7717/peerj.11941] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background Climate change, including global warming, will cause poorer global health and rising numbers of environmental refugees. As neurological disorders account for a major share of morbidity and mortality worldwide, global warming is also destined to alter neurological practice; however, to what extent and by which mechanisms is unknown. We aimed to collect information about the effects of ambient temperatures and human migration on the epidemiology and clinical manifestations of neurological disorders. Methods We searched PubMed and Scopus from 01/2000 to 12/2020 for human studies addressing the influence of ambient temperatures and human migration on Alzheimer’s and non-Alzheimer’s dementia, epilepsy, headache/migraine, multiple sclerosis, Parkinson’s disease, stroke, and tick-borne encephalitis (a model disease for neuroinfections). The protocol was pre-registered with PROSPERO (2020 CRD42020147543). Results Ninety-three studies met inclusion criteria, 84 of which reported on ambient temperatures and nine on migration. Overall, most temperature studies suggested a relationship between increasing temperatures and higher mortality and/or morbidity, whereas results were more ambiguous for migration studies. However, we were unable to identify a single adequately designed study addressing how global warming and human migration will change neurological practice. Still, extracted data indicated multiple ways by which these aspects might alter neurological morbidity and mortality soon. Conclusion Significant heterogeneity exists across studies with respect to methodology, outcome measures, confounders and study design, including lack of data from low-income countries, but the evidence so far suggests that climate change will affect the practice of all major neurological disorders in the near future. Adequately designed studies to address this issue are urgently needed, requiring concerted efforts from the entire neurological community.
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Affiliation(s)
- Moshgan Amiri
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Costanza Peinkhofer
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Medical Faculty, University of Trieste, Trieste, Italy
| | - Marwan H Othman
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Teodoro De Vecchi
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Medical Faculty, University of Trieste, Trieste, Italy
| | - Vardan Nersesjan
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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