MS risk in immigrants in the McDonald era: A population-based study in Ontario, Canada
OBJECTIVETo determine risk factors for multiple sclerosis (MS) in immigrants and to compare MS risk in immigrants and long-term residents in Ontario, Canada. METHODSWe applied a validated algorithm to linked, population-based immigration and health claims data to identify incident cases of MS in imm...
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| Veröffentlicht in: | Neurology 2019-12, Vol.93 (24), p.e2203-e2215 |
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| container_title | Neurology |
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| creator | Rotstein, Dalia L Marrie, Ruth Ann Maxwell, Colleen Gandhi, Sima Schultz, Susan E Fung, Kinwah Tu, Karen |
| description | OBJECTIVETo determine risk factors for multiple sclerosis (MS) in immigrants and to compare MS risk in immigrants and long-term residents in Ontario, Canada.
METHODSWe applied a validated algorithm to linked, population-based immigration and health claims data to identify incident cases of MS in immigrants and long-term residents between 1994 and 2016. We conducted 2 multivariable Cox proportional hazards regression analyses1 analysis limited to the immigrant cohort assessing potential risk factors for developing MS, and 1 analysis comparing MS risk between immigrants and matched long-term residents (1:3 match).
RESULTSWe identified 2,304,302 immigrants for the immigrant-only analysis, of whom 1,526 (0.066%) developed MS. Risk was greatest in those |
| doi_str_mv | 10.1212/WNL.0000000000008611 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6937488</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>31690681</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3601-ad849e69435bab6b107af5291930807620ac4d9ede904ce8e49589ac5ae5c5303</originalsourceid><addsrcrecordid>eNp9kM1OwzAQhC0EoqXwBgj5AUix48SxOSBV5Vdq6YHfm7VJ3MY0TSI7oerbk6pQFQ7sZbWamW-lQeiUkj71qX_x9jjqk50RnNI91KWhzz3O_Pd91CXEFx4TkeigI-c-CGnFSB6iDqNcEi5oF72On7A1bo5Ngc1iYWYWitqtrzrTeJxclwXkKdYWLvEAV2XV5FCbsvBicDrFrm7S1do9KWqwpjzHQygghWN0MIXc6ZPv3UMvtzfPw3tvNLl7GA5GXsI4oR6kIpCay4CFMcQ8piSCaehLKhkRJOI-gSRIpU61JEGihQ5kKCQkIegwCRlhPXS14VZNvNBpoovaQq4qaxZgV6oEo34rhcnUrPxUXLIoEKIFBBtAYkvnrJ5us5Sodc-q7Vn97bmNne3-3YZ-im0NYmNYlnmtrZvnzVJblWnI6-x_9hcSHYo_</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>MS risk in immigrants in the McDonald era: A population-based study in Ontario, Canada</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><source>Journals@Ovid Complete</source><creator>Rotstein, Dalia L ; Marrie, Ruth Ann ; Maxwell, Colleen ; Gandhi, Sima ; Schultz, Susan E ; Fung, Kinwah ; Tu, Karen</creator><creatorcontrib>Rotstein, Dalia L ; Marrie, Ruth Ann ; Maxwell, Colleen ; Gandhi, Sima ; Schultz, Susan E ; Fung, Kinwah ; Tu, Karen</creatorcontrib><description>OBJECTIVETo determine risk factors for multiple sclerosis (MS) in immigrants and to compare MS risk in immigrants and long-term residents in Ontario, Canada.
METHODSWe applied a validated algorithm to linked, population-based immigration and health claims data to identify incident cases of MS in immigrants and long-term residents between 1994 and 2016. We conducted 2 multivariable Cox proportional hazards regression analyses1 analysis limited to the immigrant cohort assessing potential risk factors for developing MS, and 1 analysis comparing MS risk between immigrants and matched long-term residents (1:3 match).
RESULTSWe identified 2,304,302 immigrants for the immigrant-only analysis, of whom 1,526 (0.066%) developed MS. Risk was greatest in those <15 years old at landing (referent <15 years; 16–30 yearshazard ratio [HR] 0.73, 95% confidence interval [CI] 0.63–0.85; 31–45 yearsHR 0.55, 95% CI 0.47–0.64). Immigrants from the Middle East (HR 1.22, 95% CI 1.06–1.40) were at greater MS risk than immigrants from Western nations; all other regions had lower risk (p < 0.0001). The matched analysis included 2,207,751 immigrants and 6,362,169 long-term residents. Immigrants were less likely to develop MS than long-term residents (p < 0.0001), although this lower risk was attenuated with longer residence in Canada.
CONCLUSIONSMS incidence in immigrants to Ontario, Canada, varied widely by region of origin, with greatest risk seen in those from the Middle East. Longer residence in Canada was associated with increased risk, even with migration in adulthood, suggesting that environmental exposures into adulthood contribute to MS risk.</description><identifier>ISSN: 0028-3878</identifier><identifier>EISSN: 1526-632X</identifier><identifier>DOI: 10.1212/WNL.0000000000008611</identifier><identifier>PMID: 31690681</identifier><language>eng</language><publisher>United States: American Academy of Neurology</publisher><subject>Adolescent ; Adult ; Cohort Studies ; Emigrants and Immigrants ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Multiple Sclerosis - epidemiology ; Multiple Sclerosis - etiology ; Ontario - epidemiology ; Retrospective Studies ; Risk Factors ; Young Adult</subject><ispartof>Neurology, 2019-12, Vol.93 (24), p.e2203-e2215</ispartof><rights>2019 American Academy of Neurology</rights><rights>2019 American Academy of Neurology.</rights><rights>2019 American Academy of Neurology 2019 American Academy of Neurology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3601-ad849e69435bab6b107af5291930807620ac4d9ede904ce8e49589ac5ae5c5303</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31690681$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rotstein, Dalia L</creatorcontrib><creatorcontrib>Marrie, Ruth Ann</creatorcontrib><creatorcontrib>Maxwell, Colleen</creatorcontrib><creatorcontrib>Gandhi, Sima</creatorcontrib><creatorcontrib>Schultz, Susan E</creatorcontrib><creatorcontrib>Fung, Kinwah</creatorcontrib><creatorcontrib>Tu, Karen</creatorcontrib><title>MS risk in immigrants in the McDonald era: A population-based study in Ontario, Canada</title><title>Neurology</title><addtitle>Neurology</addtitle><description>OBJECTIVETo determine risk factors for multiple sclerosis (MS) in immigrants and to compare MS risk in immigrants and long-term residents in Ontario, Canada.
METHODSWe applied a validated algorithm to linked, population-based immigration and health claims data to identify incident cases of MS in immigrants and long-term residents between 1994 and 2016. We conducted 2 multivariable Cox proportional hazards regression analyses1 analysis limited to the immigrant cohort assessing potential risk factors for developing MS, and 1 analysis comparing MS risk between immigrants and matched long-term residents (1:3 match).
RESULTSWe identified 2,304,302 immigrants for the immigrant-only analysis, of whom 1,526 (0.066%) developed MS. Risk was greatest in those <15 years old at landing (referent <15 years; 16–30 yearshazard ratio [HR] 0.73, 95% confidence interval [CI] 0.63–0.85; 31–45 yearsHR 0.55, 95% CI 0.47–0.64). Immigrants from the Middle East (HR 1.22, 95% CI 1.06–1.40) were at greater MS risk than immigrants from Western nations; all other regions had lower risk (p < 0.0001). The matched analysis included 2,207,751 immigrants and 6,362,169 long-term residents. Immigrants were less likely to develop MS than long-term residents (p < 0.0001), although this lower risk was attenuated with longer residence in Canada.
CONCLUSIONSMS incidence in immigrants to Ontario, Canada, varied widely by region of origin, with greatest risk seen in those from the Middle East. Longer residence in Canada was associated with increased risk, even with migration in adulthood, suggesting that environmental exposures into adulthood contribute to MS risk.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Cohort Studies</subject><subject>Emigrants and Immigrants</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multiple Sclerosis - epidemiology</subject><subject>Multiple Sclerosis - etiology</subject><subject>Ontario - epidemiology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Young Adult</subject><issn>0028-3878</issn><issn>1526-632X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1OwzAQhC0EoqXwBgj5AUix48SxOSBV5Vdq6YHfm7VJ3MY0TSI7oerbk6pQFQ7sZbWamW-lQeiUkj71qX_x9jjqk50RnNI91KWhzz3O_Pd91CXEFx4TkeigI-c-CGnFSB6iDqNcEi5oF72On7A1bo5Ngc1iYWYWitqtrzrTeJxclwXkKdYWLvEAV2XV5FCbsvBicDrFrm7S1do9KWqwpjzHQygghWN0MIXc6ZPv3UMvtzfPw3tvNLl7GA5GXsI4oR6kIpCay4CFMcQ8piSCaehLKhkRJOI-gSRIpU61JEGihQ5kKCQkIegwCRlhPXS14VZNvNBpoovaQq4qaxZgV6oEo34rhcnUrPxUXLIoEKIFBBtAYkvnrJ5us5Sodc-q7Vn97bmNne3-3YZ-im0NYmNYlnmtrZvnzVJblWnI6-x_9hcSHYo_</recordid><startdate>20191210</startdate><enddate>20191210</enddate><creator>Rotstein, Dalia L</creator><creator>Marrie, Ruth Ann</creator><creator>Maxwell, Colleen</creator><creator>Gandhi, Sima</creator><creator>Schultz, Susan E</creator><creator>Fung, Kinwah</creator><creator>Tu, Karen</creator><general>American Academy of Neurology</general><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20191210</creationdate><title>MS risk in immigrants in the McDonald era: A population-based study in Ontario, Canada</title><author>Rotstein, Dalia L ; Marrie, Ruth Ann ; Maxwell, Colleen ; Gandhi, Sima ; Schultz, Susan E ; Fung, Kinwah ; Tu, Karen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3601-ad849e69435bab6b107af5291930807620ac4d9ede904ce8e49589ac5ae5c5303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Cohort Studies</topic><topic>Emigrants and Immigrants</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multiple Sclerosis - epidemiology</topic><topic>Multiple Sclerosis - etiology</topic><topic>Ontario - epidemiology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rotstein, Dalia L</creatorcontrib><creatorcontrib>Marrie, Ruth Ann</creatorcontrib><creatorcontrib>Maxwell, Colleen</creatorcontrib><creatorcontrib>Gandhi, Sima</creatorcontrib><creatorcontrib>Schultz, Susan E</creatorcontrib><creatorcontrib>Fung, Kinwah</creatorcontrib><creatorcontrib>Tu, Karen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rotstein, Dalia L</au><au>Marrie, Ruth Ann</au><au>Maxwell, Colleen</au><au>Gandhi, Sima</au><au>Schultz, Susan E</au><au>Fung, Kinwah</au><au>Tu, Karen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>MS risk in immigrants in the McDonald era: A population-based study in Ontario, Canada</atitle><jtitle>Neurology</jtitle><addtitle>Neurology</addtitle><date>2019-12-10</date><risdate>2019</risdate><volume>93</volume><issue>24</issue><spage>e2203</spage><epage>e2215</epage><pages>e2203-e2215</pages><issn>0028-3878</issn><eissn>1526-632X</eissn><abstract>OBJECTIVETo determine risk factors for multiple sclerosis (MS) in immigrants and to compare MS risk in immigrants and long-term residents in Ontario, Canada.
METHODSWe applied a validated algorithm to linked, population-based immigration and health claims data to identify incident cases of MS in immigrants and long-term residents between 1994 and 2016. We conducted 2 multivariable Cox proportional hazards regression analyses1 analysis limited to the immigrant cohort assessing potential risk factors for developing MS, and 1 analysis comparing MS risk between immigrants and matched long-term residents (1:3 match).
RESULTSWe identified 2,304,302 immigrants for the immigrant-only analysis, of whom 1,526 (0.066%) developed MS. Risk was greatest in those <15 years old at landing (referent <15 years; 16–30 yearshazard ratio [HR] 0.73, 95% confidence interval [CI] 0.63–0.85; 31–45 yearsHR 0.55, 95% CI 0.47–0.64). Immigrants from the Middle East (HR 1.22, 95% CI 1.06–1.40) were at greater MS risk than immigrants from Western nations; all other regions had lower risk (p < 0.0001). The matched analysis included 2,207,751 immigrants and 6,362,169 long-term residents. Immigrants were less likely to develop MS than long-term residents (p < 0.0001), although this lower risk was attenuated with longer residence in Canada.
CONCLUSIONSMS incidence in immigrants to Ontario, Canada, varied widely by region of origin, with greatest risk seen in those from the Middle East. Longer residence in Canada was associated with increased risk, even with migration in adulthood, suggesting that environmental exposures into adulthood contribute to MS risk.</abstract><cop>United States</cop><pub>American Academy of Neurology</pub><pmid>31690681</pmid><doi>10.1212/WNL.0000000000008611</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Adolescent Adult Cohort Studies Emigrants and Immigrants Female Humans Incidence Male Middle Aged Multiple Sclerosis - epidemiology Multiple Sclerosis - etiology Ontario - epidemiology Retrospective Studies Risk Factors Young Adult |
| title | MS risk in immigrants in the McDonald era: A population-based study in Ontario, Canada |
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