Migration status, country of origin and long-term outcomes in multiple sclerosis: a Swedish nationwide study
Year: 2026
Type: article
Abstract: BACKGROUND: Multiple 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. METHODS: We 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). RESULTS: Compared 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. CONCLUSIONS: Within 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.
Institutions: Karolinska Institutet, Region Stockholm
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Awards: G1710743662, The significance of environmental and lifestyle factors for the onset and course of multiple sclerosis., The significance of environmental and life-style factors for the onset and course of multiple sclerosis., Autonomous Robots in Medical Practice: An Ethnography of Human-Technology Collaboration on Expertise, The significance of different types of air pollution, diet and viral infections on the risk of developing multiple sclerosis, The influence of modifiable lifestyle factors on multiple sclerosis disease progression, G912596468
OpenAlex ID: W7140106992