ArticleJournal of neurology, neurosurgery, and psychiatry2026
Migration status, country of origin and long-term outcomes in multiple sclerosis: a Swedish nationwide study.
Article in Journal of neurology, neurosurgery, and psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMultiple sclerosis (MS) shows marked geographic and ethnic variation, but the contribution of migration status and region of origin to long-term outcomes remains uncertain. We aimed to examine disability, cognitive and patient-reported outcomes across these dimensions.
methodsWe analysed 4008 individuals with incident relapsing-onset MS from two nationwide Swedish case-control studies (2005-2019), with registry-based follow-up through April 2022. Repeated measures of expanded disability status scale (EDSS), symbol digit modalities test (SDMT) and MS impact scale (MSIS-29) were obtained prospectively. Cox regression compared outcomes by migration status (Swedish-born with Swedish parents, first-generation immigrants, Swedish-born with immigrant parent/s) and region of origin (Sweden, Nordic countries, non-Nordic Europe, Middle East and North Africa (MENA) and other).
resultsCompared with Swedish-born individuals with Swedish parents, first-generation immigrants had higher risks of confirmed disease worsening (CDW) (HR 1.36, 95% CI 1.18 to 1.56) and reaching EDSS 3 (HR 1.25, 95% CI 1.03 to 1.52), whereas Swedish-born individuals with immigrant parents did not differ from the reference group. By region of origin, participants of MENA origin had higher risks of CDW (HR 1.45, 95% CI 1.15 to 1.82), EDSS 3 (HR 1.46, 95% CI 1.07 to 2.00), EDSS 4 (HR 1.82, 95% CI 1.19 to 2.80), SDMT worsening (HR 1.79, 95% CI 1.26 to 2.51) and MSIS-29 worsening.
conclusionsWithin a universal-access health system, first-generation immigration into Sweden was associated with faster disability progression, and MENA origin showed consistent excess risks across disability, cognitive and patient-reported outcomes. The overall pattern points to a combination of migration-related and origin-linked influences on MS progression, supporting early risk stratification and culturally adapted care strategies.
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