Level of education and multiple sclerosis risk after adjustment for known risk factors: The EnvIMS study

Mult Scler. 2016 Jan;22(1):104-11. doi: 10.1177/1352458515579444. Epub 2015 May 26.


Background: Several recent studies have found a higher risk of multiple sclerosis (MS) among people with a low level of education. This has been suggested to reflect an effect of smoking and lower vitamin D status in the social class associated with lower levels of education.

Objective: The objective of this paper is to investigate the association between level of education and MS risk adjusting for the known risk factors smoking, infectious mononucleosis, indicators of vitamin D levels and body size.

Methods: Within the case-control study on Environmental Factors In MS (EnvIMS), 953 MS patients and 1717 healthy controls from Norway reported educational level and history of exposure to putative environmental risk factors.

Results: Higher level of education were associated with decreased MS risk (p trend = 0.001) with an OR of 0.53 (95% CI 0.41-0.68) when comparing those with the highest and lowest level of education. This association was only moderately reduced after adjusting for known risk factors (OR 0.61, 95% CI 0.44-0.83). The estimates remained similar when cases with disease onset before age 28 were excluded.

Conclusion: These findings suggest that factors related to lower socioeconomic status other than established risk factors are associated with MS risk.

Keywords: Multiple sclerosis; education; environmental risk factors; socioeconomic status.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Educational Status
  • Female
  • Humans
  • Infectious Mononucleosis / complications
  • Infectious Mononucleosis / epidemiology*
  • Male
  • Middle Aged
  • Multiple Sclerosis / epidemiology*
  • Multiple Sclerosis / etiology
  • Norway / epidemiology
  • Registries*
  • Risk
  • Risk Factors
  • Smoking / adverse effects
  • Smoking / epidemiology*
  • Social Class*
  • Vitamin D* / administration & dosage


  • Vitamin D