Parental ethnicity associated with risk for multiple sclerosis: A population-based incident case–control study in Iran

Published:January 16, 2018DOI:


      • There is no evidence regarding the potential link between heterogeneity in parental ethnicity and MS development.
      • We investigated the heterogeneity in parental ethnicity and MS risk in the setting of a population-based case-control study.
      • Heterogeneity in parental ethnicity of common ethnic groups was significantly associated with increased risk of MS.
      • MS was unequally distributed in the ethnicities with overrepresentation of one specific background, Lor of Caucasian origin.



      The epidemiology of multiple sclerosis (MS) includes a consideration of geography and population ethnicity. To determine whether there is any association between ethnicity and risk of MS in a multiethnic, population-based case–control study.


      We conducted a population-based case–control of 547 incident MS cases and 1057 healthy controls between August 2013 and February 2015, Tehran, a multi-ethnic city. The patients were identified and enrolled through the Iranian MS Society. Case status was confirmed by a panel of MS specialists beside of 2010 McDonald criteria. Controls were selected through random digit dialing. A logistic regression model was applied to estimate the odds ratios (95%CI) adjusted for age, sex, tobacco smoking and socioeconomic status.


      The risk of MS for Kurd, Turk and Fars ethnicities was apparently smaller compared to one specific ethnic background (Lor); OR 0.36 (0.15–0.86) for Kurd, OR 0.42 (0.24–0.74) for Turk and OR 0.53 (0.31–0.89) for Fars. Heterogeneity in parental ethnicity of common ethnic groups was significantly associated with increased risk of MS OR 1.61 (1.13–2.29). All associations remained after adjustment for relevant confounders.


      MS was unequally distributed in the ethnic groups. Moreover, heterogeneity in parental ethnicity seems to be a risk factor for MS.


      IMSS (Iranian multiple sclerosis society), RDD (random digit dialing)


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        • Abdollahpour I.
        • Nedjat S.
        • Sahraian M.A.
        • Mansournia M.A.
        • Otahal P.
        • van der Mei I.
        Waterpipe smoking associated with multiple sclerosis: A population-based incident case–control study.
        Mult. Scler. J. 2017; 2310: 1328-1335
        • Adler N.E.
        • Epel E.S.
        • Castellazzo G.
        • Ickovics J.R.
        Relationship of subjective and objective social status with psychological and physiological functioning: preliminary data in healthy, White women.
        Health Psychol. 2000; 19: 586
        • Albor C.
        • du Sautoy T.
        • Kali Vanan N.
        • Turner B.P.
        • Boomla K.
        • Schmierer K.
        Ethnicity and prevalence of multiple sclerosis in east London.
        Mult. Scler. J. 2017; 23: 36-42
        • Alter M.
        • Kahana E.
        • Loewenson R.
        Migration and risk of multiple sclerosis.
        Neurology. 1978; 28 (1089-1089)
        • Ascherio A.
        • Munger K.L.
        Environmental risk factors for multiple sclerosis. Part I: the role of infection.
        Ann. Neurol. 2007; 61: 288-299
        • Binson D.
        • Canchola J.A.
        • Catania J.A.
        Random selection in a national telephone survey: a comparison of the Kish, next-birthday, and last-birthday methods.
        J. Off. Stat. Stockh. 2000; 16: 53-60
        • Boulware L.E.
        • Cooper L.A.
        • Ratner L.E.
        • LaVeist T.A.
        • Powe N.R.
        Race and trust in the health care system.
        Public Health Rep. 2003; 118: 358
        • Browne P.
        • Chandraratna D.
        • Angood C.
        • Tremlett H.
        • Baker C.
        • Taylor B.V.
        • Thompson A.J.
        Atlas of multiple Sclerosis2013: a growing global problem with widespread inequity.
        Neurology. 2014; 83: 1022-1024
        • Clagett B.
        • Nathanson K.L.
        • Ciosek S.L.
        • McDermoth M.
        • Vaughn D.J.
        • Mitra N.
        • Weiss A.
        • Martonik R.
        • Kanetsky P.A.
        Comparison of Address-based sampling and random-digit dialing methods for recruiting young men as controls in a case-control study of testicular cancer susceptibility.
        Am. J. Epidemiol. 2013; 178: 1638-1647
        • Cree B.
        • Khan O.
        • Bourdette D.
        • Goodin D.
        • Cohen J.
        • Marrie R.
        • Glidden D.
        • Weinstock-Guttman B.
        • Reich D.
        • Patterson N.
        Clinical characteristics of African Americans vs Caucasian Americans with multiple sclerosis.
        Neurology. 2004; 63: 2039-2045
        • Ebers G.C.
        • Sadovnick A.D.
        The geographic distribution of multiple sclerosis: a review.
        Neuroepidemiology. 1993; 12: 1-5
        • Elhami S.-R.
        • Mohammad K.
        • Sahraian M.A.
        • Eftekhar H.
        A 20-year incidence trend (1989–2008) and point prevalence (March 20, 2009) of multiple sclerosis in Tehran, Iran: a population-based study.
        Neuroepidemiology. 2011; 36: 141-147
        • Eriksson I.
        • Undén A.-L.
        • Elofsson S.
        Self-rated health. comparisons between three different measures. results from a population study.
        Int. J. Epidemiol. 2001; 30: 326-333
        • Etemadifar M.
        • Maghzi A.-H.
        Sharp increase in the incidence and prevalence of multiple sclerosis in Isfahan, Iran.
        Mult. Scler. J. 2011; 17: 1022-1027
        • Etemadifar M.
        • Sajjadi S.
        • Nasr Z.
        • Firoozeei T.S.
        • Abtahi S.-H.
        • Akbari M.
        • Fereidan-Esfahani M.
        Epidemiology of multiple sclerosis in Iran: a systematic review.
        Eur. Neurol. 2013; 70: 356-363
        • Gale C.R.
        • Martyn C.N.
        Migrant studies in multiple sclerosis.
        Prog. Neurobiol. 1995; 47: 425-448
        • Gold E.B.
        • Colvin A.
        • Avis N.
        • Bromberger J.
        • Greendale G.A.
        • Powell L.
        • Sternfeld B.
        • Matthews K.A.
        Longitudinal Analysis of the Association between Vasomotor Symptoms and Race/ethnicity Across the Menopausal Transition: Study of Women's Health Across the Nation.
        Am. j. publ. health. 2006; 96: 1226-1235
        • Grugni V.
        • Battaglia V.
        • Kashani B.H.
        • Parolo S.
        • Al-Zahery N.
        • Achilli A.
        • Olivieri A.
        • Gandini F.
        • Houshmand M.
        • Sanati M.H.
        Ancient migratory events in the middle East: new clues from the Y-chromosome variation of modern Iranians.
        PLoS One. 2012; 7: e41252
        • Gundersen D.A.
        • ZuWallack R.S.
        • Dayton J.
        • Echeverría S.E.
        • Delnevo C.D.
        Assessing the feasibility and sample quality of a national random-digit dialing cellular phone survey of young adults.
        Am. J. Epidemiol. 2013; kwt226
        • Hartge P.
        • Brinton L.A.
        • Rosenthal J.F.
        • Cahill J.I.
        • Hoover R.N.
        • Waksberg J.
        Random digit dialing in selecting a population-based control group.
        Am. J. Epidemiol. 1984; 120: 825-833
        • Helgadottir A.
        • Manolescu A.
        • Helgason A.
        • Thorleifsson G.
        • Thorsteinsdottir U.
        • Gudbjartsson D.F.
        • Gretarsdottir S.
        • Magnusson K.P.
        • Gudmundsson G.
        • Hicks A.
        A variant of the gene encoding leukotriene A4 hydrolase confers ethnicity-specific risk of myocardial infarction.
        Nat. Genet. 2006; 38: 68-74
        • Heydarpour P.
        • Mohammad K.
        • Yekaninejad M.S.
        • Elhami S.-R.
        • Khoshkish S.
        • Sahraian M.A.
        Multiple sclerosis in Tehran, Iran: a joinpoint trend analysis.
        Mult. Scler. J. 2014; 20 (512-512)
        • Jewell N.P.
        Statistics for Epidemiology.
        CRC Press, 2003
        • Jo H.
        • Schieve L.A.
        • Rice C.E.
        • Yeargin-Allsopp M.
        • Tian L.H.
        • Blumberg S.J.
        • Kogan M.D.
        • Boyle C.A.
        Age at autism spectrum disorder (ASD) diagnosis by race, ethnicity, and primary household language among children with special health care needs, United States, 2009–2010.
        Matern. Child Health J. 2015; 19: 1687-1697
        • Kish L.
        A procedure for objective respondent selection within the household.
        J. Am. Stat. Assoc. 1949; 44: 380-387
        • Lutton J.
        • Winston R.
        • Rodman T.
        Multiple sclerosis: etiological mechanisms and future directions.
        Exp. Biol. Med. 2004; 229: 12-20
        • Miilunpalo S.
        • Vuori I.
        • Oja P.
        • Pasanen M.
        • Urponen H.
        Self-rated health status as a health measure: the predictive value of self-reported health status on the use of physician services and on mortality in the working-age population.
        J. Clin. Epidemiol. 1997; 50: 517-528
        • Milo R.
        • Kahana E.
        Multiple sclerosis: geoepidemiology, genetics and the environment.
        Autoimmun. Rev. 2010; 9: A387-A394
      1. Organization, W.H., 1996. WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996.

        • Page W.
        • Mack T.
        • Kurtzke J.
        • Murphy F.
        • Norman Jr, J.
        Epidemiology of multiple sclerosis in US veterans. 6. population ancestry and surname ethnicity as risk factors for multiple sclerosis.
        Neuroepidemiology. 1994; 14: 286-296
        • Polman C.H.
        • Reingold S.C.
        • Banwell B.
        • Clanet M.
        • Cohen J.A.
        • Filippi M.
        • Fujihara K.
        • Havrdova E.
        • Hutchinson M.
        • Kappos L.
        Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.
        Ann. Neurol. 2011; 69: 292-302
        • Rosati G.
        The prevalence of multiple sclerosis in the world: an update.
        Neurol. Sci. 2001; 22: 117-139
        • Rothman K.J.
        • Greenland S.
        • Lash T.L.
        Modern Epidemiology.
        Lippincott Williams & Wilkins, 2008
        • Smestad C.
        • Sandvik L.
        • Holmoy T.
        • Harbo H.F.
        • Celius E.G.
        Marked differences in prevalence of multiple sclerosis between ethnic groups in Oslo, Norway.
        J. Neurol. 2008; 255: 49-55
        • Sobocki P.
        • Pugliatti M.
        • Lauer L.
        • Kobelt G.
        Estimation of the cost of MS in Europe: extrapolations from a multinational cost study.
        Mult. Scler. 2007;
        • van der Mei I.
        • Lucas R.
        • Taylor B.
        • Valery P.
        • Dwyer T.
        • Kilpatrick T.
        • Pender M.
        • Williams D.
        • Chapman C.
        • Otahal P.
        Population attributable fractions and joint effects of key risk factors for multiple sclerosis.
        Mult. Scler. J. 2015; (1352458515594040)
        • Wacholder S.
        • Silverman D.T.
        • McLaughlin J.K.
        • Mandel J.S.
        Selection of controls in case-control studies: II. Types of controls.
        Am. J. Epidemiol. 1992; 135: 1029-1041
        • Warren S.
        • Svenson L.
        • Woodhead S.
        • Warren K.
        Parental ancestry and risk of multiple sclerosis in Alberta, Canada.
        Neuroepidemiology. 1996; 15: 1-9
        • West B.
        • Luke A.
        • Durazo-Arvizu R.A.
        • Cao G.
        • Shoham D.
        • Kramer H.
        Metabolic syndrome and self-reported history of kidney stones: the National health and Nutrition Examination survey (NHANESIII) 1988–1994.
        Am. J. Kidney Dis. 2008; 51: 741-747