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You just made me think of an excellent cross examination question! Thank you

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That paper dates from 2016. Thank you for finding it, StillTish.

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A question which does not get as much attention as I think it should is that in the early 1900s men who got MS slightly were slightly more than half of the MS population, depending on country. It's gradually increased to significantly more women than men. This ratio is even worse for black women compared to white women. What could be causing this change?

"...birth cohort effects accounted for the change in the sex ratios during the 20th century. The balanced sex ratio at the beginning of the 20th century has been superseded by a ratio with a preponderance of women...." Ajdacic-Gross V, Schmid M, Mutsch M, Steinemann N, von Wyl V, Bopp M. The change in the sex ratio in multiple sclerosis is driven by birth cohort effects. Eur J Neurol. 2017 Jan;24(1):98-104. doi: 10.1111/ene.13160. Epub 2016 Sep 25. PMID: 27666339.

"...women-to-men ratio increased from 1.70 for patients born in the 1930s to 2.67 for patients born in the 1980s...." Boström I, Landtblom AM. Does the changing sex ratio of multiple sclerosis give opportunities for intervention? Acta Neurol Scand. 2015;132(199):42-5. doi: 10.1111/ane.12430. PMID: 26046558.

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