Evidence map›Paper›PMID 31690681›Full record

ArticleNeurology2019

MS risk in immigrants in the McDonald era: A population-based study in Ontario, Canada.

Dalia L Rotstein, Ruth Ann Marrie, Colleen Maxwell, Sima Gandhi, Susan E Schultz, Kinwah Fung, Karen Tu

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed.

  1. Article
  2. Toward a global research agenda for preventing multiple sclerosis.Multiple sclerosis (Houndmills, Basingstoke, England) · 2026
    Article
  3. Article
  4. Review
  5. Review
  6. Article
  7. Article
  8. Exposure to systemic antibiotics in outpatient care and the risk of multiple sclerosis.Multiple sclerosis (Houndmills, Basingstoke, England) · 2023
    Article
  9. Article
  10. Review
  11. High prevalence of comorbidities at diagnosis in immigrants with multiple sclerosis.Multiple sclerosis (Houndmills, Basingstoke, England) · 2021
    Article
  12. Article
  13. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Dalia L RotsteinFrom the Department of Medicine (D.L.R.) and Departments of Family and Community Medicine and Institute for Health Policy, Management and Evaluation (K.T.), University of Toronto; St. Michael's Hospital (D.L.R.), Toronto, Ontario; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Schools of Pharmacy and Public Health and Health Systems (C.M.), University of Waterloo; Institute for Clinical Evaluative Sciences (C.M., S.G., S.E.S., K.F.); and Toronto Western Hospital University Health Network (K.T.), Ontario, Canada. dalia.rotstein@unityhealth.to.
Ruth Ann MarrieFrom the Department of Medicine (D.L.R.) and Departments of Family and Community Medicine and Institute for Health Policy, Management and Evaluation (K.T.), University of Toronto; St. Michael's Hospital (D.L.R.), Toronto, Ontario; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Schools of Pharmacy and Public Health and Health Systems (C.M.), University of Waterloo; Institute for Clinical Evaluative Sciences (C.M., S.G., S.E.S., K.F.); and Toronto Western Hospital University Health Network (K.T.), Ontario, Canada.
Colleen MaxwellFrom the Department of Medicine (D.L.R.) and Departments of Family and Community Medicine and Institute for Health Policy, Management and Evaluation (K.T.), University of Toronto; St. Michael's Hospital (D.L.R.), Toronto, Ontario; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Schools of Pharmacy and Public Health and Health Systems (C.M.), University of Waterloo; Institute for Clinical Evaluative Sciences (C.M., S.G., S.E.S., K.F.); and Toronto Western Hospital University Health Network (K.T.), Ontario, Canada.
Sima GandhiFrom the Department of Medicine (D.L.R.) and Departments of Family and Community Medicine and Institute for Health Policy, Management and Evaluation (K.T.), University of Toronto; St. Michael's Hospital (D.L.R.), Toronto, Ontario; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Schools of Pharmacy and Public Health and Health Systems (C.M.), University of Waterloo; Institute for Clinical Evaluative Sciences (C.M., S.G., S.E.S., K.F.); and Toronto Western Hospital University Health Network (K.T.), Ontario, Canada.
Susan E SchultzFrom the Department of Medicine (D.L.R.) and Departments of Family and Community Medicine and Institute for Health Policy, Management and Evaluation (K.T.), University of Toronto; St. Michael's Hospital (D.L.R.), Toronto, Ontario; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Schools of Pharmacy and Public Health and Health Systems (C.M.), University of Waterloo; Institute for Clinical Evaluative Sciences (C.M., S.G., S.E.S., K.F.); and Toronto Western Hospital University Health Network (K.T.), Ontario, Canada.
Kinwah FungFrom the Department of Medicine (D.L.R.) and Departments of Family and Community Medicine and Institute for Health Policy, Management and Evaluation (K.T.), University of Toronto; St. Michael's Hospital (D.L.R.), Toronto, Ontario; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Schools of Pharmacy and Public Health and Health Systems (C.M.), University of Waterloo; Institute for Clinical Evaluative Sciences (C.M., S.G., S.E.S., K.F.); and Toronto Western Hospital University Health Network (K.T.), Ontario, Canada.
Karen TuFrom the Department of Medicine (D.L.R.) and Departments of Family and Community Medicine and Institute for Health Policy, Management and Evaluation (K.T.), University of Toronto; St. Michael's Hospital (D.L.R.), Toronto, Ontario; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Schools of Pharmacy and Public Health and Health Systems (C.M.), University of Waterloo; Institute for Clinical Evaluative Sciences (C.M., S.G., S.E.S., K.F.); and Toronto Western Hospital University Health Network (K.T.), Ontario, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

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 analyses: 1 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 years: hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.63-0.85; 31-45 years: HR 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 (

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.

Indexed as

Emigrants and ImmigrantsAdolescentAdultCohort StudiesFemaleHumansIncidenceMaleMiddle AgedMultiple SclerosisOntarioRetrospective StudiesRisk FactorsYoung Adult

Identifiers

PMID31690681
PMCPMC6937488

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.