title: Sociocultural and Demographic Risk Factors for the Development of Multiple Sclerosis in Kuwait: A Case - Control Study.
abstract: BACKGROUND
  Immunological, genetic and environmental factors are believed to play important roles in the pathogenesis of Multiple Sclerosis (MS). There have been many studies on risk factors for MS but these have been mainly in Caucasian populations; robust studies in Arab populations remain relatively uncommon. This study therefore aimed to identify behavioral, socio-cultural, and demographic factors associated with development of MS in Kuwait, a high income Arab country, currently undergoing a demographic transition.
  
  
  METHODS
  In this case- control study, 195 Kuwaiti MS patients and 146 healthy age and sex-matched controls were recruited. Both groups of subjects were interviewed using a structured questionnaire, in relation to anthropometric, socio-cultural and demographic data, residence during the 1990/91 Gulf War and current and past medical history, including medications. We also clinically evaluated, and retrospectively reviewed medical records of patients to derive appropriate clinical information, including associated chronic medical illness requiring long-term treatment.
  
  
  RESULTS
  On multiple logistic regression analysis after adjustment for potential confounders including age, gender and BMI, in all the subjects, a positive associations prevail with presence of MS and some sociocultural and demographic factors, which included non-Bedouin ethnicity (AOR 2, 95% CI 1.0-3.9, p 0.049), positive family history of MS (AOR 10.6, 95% CI 3.0-36.9), p < 0.001), and low daily sunlight exposure of < 15min/day (AOR 5.3, 95% CI 2.7-10.5 p < 0.001). In addition, while 41.8% of MS patients indicated at least one comorbidity, only 26.8% of the controls reported any associated physical illness, with the suggestion that presence of certain comorbidities might increase MS risk (AOR 2.4, 95% CI 1.3-4.7, p < 0.001). Other risk variables such as smoking status and mode of routine outdoor dressing were not significant in all the MS subjects taken as a whole, but demonstrated variably positive associations in the MS subgroup classified as those with established disease and those who were newly diagnosed and drug naïve.
  
  
  CONCLUSIONS
  This study suggests that a positive family history of MS and presence of certain comorbidities appeared to be associated with an increased risk of developing MS. In contrast, relatively increased amount of daily sunlight exposure and Bedouin ethnicity appear to somewhat be protective. It is speculated that the relationship of sunlight exposure with MS might be due to vitamin D availability, and is deserving of further study.
authors.affiliation: Neurology Unit, Mubarak Al Kabir Hospital, Ministry of Health, Jabriya, Kuwait; Division of Neurology, Department of Medicine, Faculty of Medicine, Jabriya, Kuwait University, Kuwait.
authors.forename: Suhail N
authors.initials: SN
authors.lastname: Al-Shammri
authors.affiliation: Neurology Unit, Mubarak Al Kabir Hospital, Ministry of Health, Jabriya, Kuwait.
authors.forename: Magdy G
authors.initials: MG
authors.lastname: Hanna
authors.affiliation: Division of Neurology, Department of Medicine, Faculty of Medicine, Jabriya, Kuwait University, Kuwait.
authors.forename: Arpita
authors.initials: A
authors.lastname: Chattopadhyay
authors.affiliation: Department of Medical Sciences, Frank H. Netter, MD, School of Medicine, Quinnipiac University, Hamden, Connecticut, United States of America.
authors.forename: Abayomi O
authors.initials: AO
authors.lastname: Akanji
mesh_terms: D000328:Adult; D017677:Age Distribution; D000886:Anthropometry; D016022:Case-Control Studies; D002908:Chronic Disease / Q000453:epidemiology; D003020:Clothing; D015897:Comorbidity; D003241:Consanguinity; D003469:Culture; D004641:Emigration and Immigration; D005006:Ethnicity; D005192:Family Health; D047830:Gulf War; D006801:Humans; D007730:Kuwait / Q000453:epidemiology; D008499:Medical Records; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000453:epidemiology*; D015995:Prevalence; D012036:Refugees / Q000706:statistics & numerical data; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013472:Sunlight; D055815:Young Adult