Physical and social environment and the risk of multiple sclerosis

• The distribution of the educational level was the same in cases and controls before clinical onset for both sexes.
• The “hygiene hypothesis” could not be confirmed by our study.
• Working in agriculture may show association with a higher MS risk in women.
• MS was not associated with a greater exposure to infective agents due to cohabitation with children.

BackgroundThe incidence of multiple sclerosis (MS) in Denmark has doubled in women since 1970, whereas it has been almost unchanged in men. The rapid epidemiological changes suggest that environmental factors may modify the risk of MS.ObjectivesTo investigate whether occupational, physical, or social environmental influence the risk of MS differently in women than in men.MethodsThe cohort consists of all 1403 patients (939 women, 464 men) identified through Danish Multiple Sclerosis Registry aged 1–55 of years at clinical onset between 2000 and 2004, and up to 25 control persons for each case, matched by sex, year of birth and residential municipality. The same cohort was previously used to investigate the influence of the reproductive factors on the risk of MS.ResultsBy linkage to Danish population registers we found a slight albeit statistically significant excess for 6 female MS patients who had been employed in agriculture: OR 3.52; 95% CI 1.38–9.00, p=0.008 (0.046 when corrected for multiple significance) and a trend for exposure to outdoor work in 12 : OR 1.94, 95% CI 1.06–3.55, p=0.03 (0.09 when corrected for multiple significance), but the numbers of cases were small, and the effects were not found in men. Educational level, housing conditions in youth, or the presence of children unrelated by blood in the household did not influence the risk of MS.ConclusionsOur study did not reveal any additional factors beyond the previously published childbirths which could explain the extent of the MS incidence increase in women.