Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 3:13:840158.
doi: 10.3389/fimmu.2022.840158. eCollection 2022.

Smoking Attributable Risk in Multiple Sclerosis

Ali Manouchehrinia  1 , Jesse Huang  1 , Jan Hillert  1 , Lars Alfredsson  1 , Tomas Olsson  1 , Ingrid Kockum  1 , Cris S Constantinescu  2   3
Affiliations

Smoking Attributable Risk in Multiple Sclerosis

Ali Manouchehrinia et al. Front Immunol. .

Abstract

Tobacco smoke is an important modifiable environmental risk factor for multiple sclerosis (MS) risk. The population attributable fraction (AF) of MS due to smoking can be used to assess the contribution of smoking to the risk of MS development. We conducted a matched case-control study, including individuals with MS and population-based controls. Overall, sex- and genetic risk score-stratified AF due to smoking were calculated by fitting logistic regression models. We included 9,419 individuals with MS and 9,419 population-based matched controls. At the time of MS onset 44.1% of persons with MS and 35.9% of controls ever regularly smoked of which 38.1% and 29.2% were still smoking. The overall AF was 13.1% (95%CI: 10.7 to 15.4). The AF was 10.6% (95%CI: 7.4 to 13.7) in females and 19.1% (95%CI: 13.1 to 25.1) in males. The AF was 0.6% (95%CI: 0.0 to 2) in ex-smokers. In those having human leucocyte antigen (HLA) and non-HLA risk scores above the median levels of controls, the AF was 11.4% (95%CI: 6.8 to 15.9) and 12% (95%CI: 7.7 to 16.3), respectively. The AF was 17.6% (95%CI: 10.2 to 24.9) and 18.6% (95%CI: 5.5 to 31.6) in those with HLA and non-HLA risk scores below the median levels in controls, respectively. We noticed a decline in AF in recent birth cohorts. This study indicates that at least 13% of cases of MS could be prevented through the avoidance of tobacco smoking. Considering the prevalence of MS, this represents a very large group of people in absolute number.

Keywords: attributable fraction; multiple sclerosis; risk factor; smoking; tobacco.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Proportion of persons with MS who have ever regularly smoked and the corresponding smoking attributable fraction (AF) over calendar year of birth by five-year birth-cohort.
Figure 2
Figure 2
The overall and stratified smoking attributable fraction (95% confidence intervals) for risk of MS. HLA and non-HLA risk scores are categorized to below and above the median score in the population-based controls. HLA, human leucocyte antigen.
See this image and copyright information in PMC

References

    1. Manouchehrinia A, Tench C, Maxted J. Tobacco Smoking and Disability Progression in Multiple Sclerosis: United Kingdom Cohort Study. Brain (2013) 136:2298–304. doi: 10.1093/brain/awt139 - DOI - PMC - PubMed
    1. Ramanujam R, Hedström A-K, Manouchehrinia A, Alfredsson L, Olsson T, Bottai M, et al. Effect of Smoking Cessation on Multiple Sclerosis Prognosis. JAMA Neurol (2015) 72:1117–23. doi: 10.1001/jamaneurol.2015.1788 - DOI - PubMed
    1. Olsson T, Barcellos LF, Alfredsson L. Interactions Between Genetic, Lifestyle and Environmental Risk Factors for Multiple Sclerosis. Nat Rev Neurol (2017) 13:25–36. doi: 10.1038/nrneurol.2016.187 - DOI - PubMed
    1. Alrouji M, Manouchehrinia A, Gran B, Constantinescu CS. Effects of Cigarette Smoke on Immunity, Neuroinflammation and Multiple Sclerosis. J Neuroimmunol (2019) 329:24–34. doi: 10.1016/j.jneuroim.2018.10.004 - DOI - PubMed
    1. Poorolajal J, Bahrami M, Karami M, Hooshmand E. Effect of Smoking on Multiple Sclerosis: A Meta-Analysis. J Public Health (Bangkok) (2017) 39:312–20. doi: 10.1093/PUBMED/FDW030 - DOI - PubMed

Publication types