Risk Factors for Multiple Sclerosis in Kuwait: A Population-Based Case-Control Study

Abstract

Multiple sclerosis (MS) is a chronic and progressively disabling inflammatory autoimmune disorder of the central nervous system. MS has a multifactorial etiology and is triggered by environmental factors in individuals with complex genetic risk profiles. The epidemiology of MS changes with the spatial and temporal distribution of these genetic and nongenetic risk factors. This population-based matched case-control study aimed to determine the risk factors for MS in Kuwait. From May 2 to 9, 2010, we enrolled 101 confirmed MS cases using the list frame maintained by the Multiple Sclerosis Association of Kuwait. For each case, two population controls individually matched for age (±2 years), gender and nationality were selected. Data on demographic, socioeconomic variables, potential genetic and environmental factors were collected using a structured questionnaire. For a case, the questions were directed to the period that preceded the recognition of the disease, while for each of the two matched controls, a date of ‘pseudodiagnosis’ of MS was established, i.e. the date on which the control subject was of the same age as his/her matched case was at MS diagnosis and accordingly questions were directed to the preceding period. The multivariable conditional logistic regression model showed that compared with controls, the cases were significantly more likely to have a family history of MS [matched odds ratio (OR)_adj = 6.7; 95% confidence interval (95% CI): 2.5–18.0; p < 0.001] or have suffered from a head trauma in the past before MS diagnosis (matched OR_adj = 2.6; 95% CI: 1.2–5.5; p = 0.014). Furthermore, compared with controls, cases were significantly more likely to have stayed in Kuwait during the Iraqi invasion of 1990 (matched OR_adj = 1.8; 95% CI: 1.1–3.5; p = 0.022). This study showed that a family history of MS, a history of head injury, and presence in Kuwait at the time of the Iraqi invasion of 1990 were associated with a significantly increased MS risk. Future retrospective cohort studies by using existing biological and epidemiological databases may provide a clue to MS etiology.

Differential upregulation of the hypothetical transmembrane protein 66 (TMEM66) in multiple sclerosis patients with potential inflammatory response

“…There is a universal increase in the prevalence and incidence of MS over time. In the Middle East, and particularly the Gulf region, an increased prevalence has been recently reported (6)(7)(8) due to genetic and environmental factors, particularly following the most recent wars in the region (9), with a similar increase in Bahrain (Alsharoqi et al, 2014, unpublished data).…”

“…Microarray was used to evaluate the overall gene expression patterns and to understand the composition of the genetic regulatory networks and the mechanisms involved in MS (11,15). In order to examine such gene expression in Bahraini MS patients, that may be associated with the pathogenesis of the disease in response to the emerged environmental factors (9) and via epigenetic mechanisms (2) for the initiation of molecular-targeted approaches to personalized therapy, microarray technology was utilized in the present study to analyze differential gene upregulation in PBMCs isolated from Bahraini MS patients in comparison to healthy subjects. The differential novel gene expression was shown in the Bahraini MS patients, the gene was cloned and protein showed potential immunological activity.…”

Is Alcohol Harmful for Patients with Multiple Sclerosis?

“…It is relevant to observe that papers from the Middle East studying risk factors for MS did not include alcohol as a potential protective or risk-promoting factor [21][22][23]. This highlights the importance of the cultural and religious background involved in studying this particular risk factor.…”

Age-Period-Cohort Modeling of Multiple Sclerosis Incidence Rates in Kuwait: 1980–2014

“…Non-nationals constitute about 68% of the population and resultantly 80% of the labor force comprises migrants. Majority of the migrants are men with a low educational attainment [9-11]. Among nationals, the male and female literacy rates (defined as individuals aged 10 years or more and who can read and write) are 98.5 and 91.2%, respectively, with a gender ratio (male: female) of 1.04 at birth [12].…”