Abstract
BackgroundThe incidence of multiple sclerosis (MS) changes from generation to generation in ethnically different immigrants compared with native-born people. We aimed to determine whether there are generational changes in MS phenotypes among North African immigrants in France.MethodsCohort study with data from a population-based MS registry to compare the clinical characteristics of 80 first (NAG1) and 167 second (NAG2) generation North Africans with MS living in France with 5200 native-born Europeans. Adjusted Cox models were used to test the association between scores of 3 and 6 on the expanded disability status scale (EDSS) and the “origin/generation” variable.ResultsCox models for EDSS scores 3 and 6 showed a higher risk of score 3 (hazard ratio = 1.738, 95% confidence interval 1.237 to 2.444; P = .002) and 6 (hazard ratio = 2.372, 95% confidence interval 1.626 to 3.462; P<.0001) for NAG1 than Europeans. Being NAG2 was not significantly associated with higher hazards of scores 3 and 6.ConclusionsWe found two different phenotypes among NAG1 and NAG2 MS patients in France. NAG1, but not NAG2, have a higher risk of disability than Europeans. This raises the question of environmental factors in MS expression, and advocates appropriate patient management according to generation in immigrants.
Highlights
Most epidemiological studies in multiple sclerosis (MS) published to date concern patients of Caucasian origin living in North America or Europe
Cohort study with data from a population-based MS registry to compare the clinical characteristics of 80 first (NAG1) and 167 second (NAG2) generation North Africans with MS living in France with 5200 native-born Europeans
Cox models for expanded disability status scale (EDSS) scores 3 and 6 showed a higher risk of score 3 and 6 for NAG1 than Europeans
Summary
Most epidemiological studies in multiple sclerosis (MS) published to date concern patients of Caucasian origin living in North America or Europe. A study about patients living in Norway found a lower incidence in the first generation of immigrants from Pakistan compared with their descendants born in Norway— the “second generation”–whose incidence rate was very similar to the population of Norwegian origin [13]. This “generational effect” suggests that early exposure to an environment plays a role in the risk of MS.
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