Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Neurology, Cooper Neurological Institute, Camden, NJ, United States.
Front Immunol. 2022 Mar 3;13:840158. doi: 10.3389/fimmu.2022.840158. eCollection 2022.
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.
烟草烟雾是多发性硬化症（MS）风险的重要可改变环境风险因素。归因于吸烟的多发性硬化症人群归因分数（AF）可用于评估吸烟对 MS 发病风险的贡献。我们进行了一项匹配病例对照研究，包括 MS 患者和基于人群的对照。总体而言，通过拟合逻辑回归模型计算了基于性别和遗传风险评分分层的吸烟归因 AF。我们纳入了 9419 名 MS 患者和 9419 名基于人群的匹配对照。在 MS 发病时，44.1%的 MS 患者和 35.9%的对照者曾经经常吸烟，其中 38.1%和 29.2%仍在吸烟。总体 AF 为 13.1%（95%CI：10.7-15.4）。女性的 AF 为 10.6%（95%CI：7.4-13.7），男性为 19.1%（95%CI：13.1-25.1）。在曾经吸烟者中，AF 为 0.6%（95%CI：0.0-2）。在 HLA 和非-HLA 风险评分高于对照组中位数水平的人群中，AF 分别为 11.4%（95%CI：6.8-15.9）和 12%（95%CI：7.7-16.3）。在 HLA 和非-HLA 风险评分低于对照组中位数水平的人群中，AF 分别为 17.6%（95%CI：10.2-24.9）和 18.6%（95%CI：5.5-31.6）。我们注意到，最近出生的队列中 AF 有所下降。这项研究表明，通过避免吸烟，至少有 13%的 MS 病例可以预防。考虑到 MS 的流行率，这代表了一个非常大的人群。
