Tobacco smoking and multiple sclerosis: a systematic review of systematic and narrative reviews of observational studies

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The aim of this review was to systematically review systematic and narrative reviews of observational studies published on the relation between tobacco smoking and multiple sclerosis (MS).

Subjects and methods

A systematic search of the literature in PubMed and Scopus was conducted in June 2016. Two authors independently reviewed the search results and extracted key points. Review studies (i.e., review, systematic, narrative, or meta-analysis) that reported on smoking and MS were selected. The methodological quality of included systematic reviews and meta-analyses was assessed using the AMSTAR checklist. The methodological quality of narrative reviews was evaluated using a seven-item measure developed by the authors.


Seventeen reviews met the inclusion criteria and were categorized as either systematic reviews or narrative reviews. Smoking was associated with increased risk of MS for ever- compared with never-smokers and current compared with non-smokers. The summary odds ratio of MS for ever-smokers versus never-smokers varied between 1.40 (95% CI: 1.29–1.52) and 1.46 (95% CI: 1.33–1.59).


This review of reviews identifies smoking as a risk factor for MS susceptibility. However, more research is needed to conclusively establish the mechanisms driving this association.

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Fig. 1


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We thank Tyra Lagerberg for her thoughts and comments and for improving the use of English in the manuscript.

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Corresponding author

Correspondence to Insa Backhaus.

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Ethical standards

This article does not contain any patient data; thus, ethical approval was not required for this study.

Conflict of interest

The authors declare that they have no conflict of interest.


This study did not receive any funding.

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The authors have contributed sufficiently to the scientific work and share collective responsibility and accountability for the results.

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Backhaus, I., Mannocci, A. & La Torre, G. Tobacco smoking and multiple sclerosis: a systematic review of systematic and narrative reviews of observational studies. J Public Health 25, 453–460 (2017).

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  • Tobacco
  • Smoking
  • Multiple sclerosis
  • Systematic review