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Background.  Multiple sclerosis (MS) has become a disease that represents a tremendous burden on patients, families, and societies. The exact etiology of MS is still unclear, but it is believed that a combination of genetic and environmental factors contribute to this disease. Although some meta-analyses on the association between smoking and MS have been previously published, a number of new studies with larger population data have published since then. Consequently, these additional critical articles need to be taken into consideration.   Method.  We reviewed articles by searching in PubMed and EMBASE. Both conservative and non-conservative models were used to investigate the association between smoking and the susceptibility to MS. We also explored the effect of smoking on the susceptibility to MS in strata of different genders and smoking habits. The association between passive smoking and MS was also explored.   Results. The results of this study suggest that smoking is a risk factor for MS (conservative model: odds ratio (OR) 1.55, 95% CI [1.48–1.62],  p  < 0.001; non-conservative model: 1.57, 95% CI [1.50–1.64],  p  < 0.001). Smoking appears to increase the risk of MS more in men than in women and in current smokers more than in past smokers. People who exposed to passive smoking have higher risk of MS than those unexposed.   Conclusion. This study demonstrated that exposure to smoking is an important risk factor for MS. People will benefit from smoking cessation, and policymakers should pay attention to the association between smoking and MS.

The risk of smoking on multiple sclerosis: a meta-analysis based on 20,626 cases from case-control and cohort studies