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The phrase "main underlying cause" is grammatically correct and commonly used in written English.
It is typically used to refer to the primary reason or root cause of a problem or situation. Example: The main underlying cause of poverty in this country is lack of access to education.
Exact(29)
The report notes that poverty, rather than food shortages, is the main underlying cause of hunger.
This blood vessel disease is the main underlying cause of heart attacks and strokes.
But the main underlying cause is the deregulation of the power industry in New York and many other states in the last few years.
For these reasons, we could not consider low blood concentrations of an AED to be the main underlying cause of SE in any of the study patients.
Reports cite the main underlying cause for these issues as poor education.
Invariably, as I've explored with one or both partners, I've discovered that the main underlying cause of many of these scenarios has to do with WHY one of the partners wants to have sex.
Similar(31)
It is a fact that part of the downward trend in consumer credit is due to charge-offs, but it doesn't give you a clear answer as to what are the main underlying causes of that.
Even so, there are three main underlying causes for the widening fragmentation in our programming environments.
He concludes that the proximity to the flood- prone area (57 %) and residing in flood prone area and poverty (18 %) were the main underlying causes of vulnerability by the Sikaunzwe community.
It is the first book to relate the overfishing of juvenile fishes in certain areas to the decline of large spawners in other very distant areas, revealing one of the main underlying causes of this decline, which has remained a mystery to the fishing sector and scientists alike for over 50 years.
"One of the main underlying causes of the closing of the polls in Scotland has been the switch of Labour voters to supporting Yes driven, at least in part, by the fear that the NHS is under threat from policies being pursued in England".
More suggestions(14)
main underlying factor
principal underlying cause
main underlying advantage
main underlying risk
main underlying thread
main underlying browser
main underlying idea
main underlying aetiology
main underlying mechanism
main underlying thrust
main underlying disease
main underlying principle
main underlying pathway
main underlying assumption
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Since I tried Ludwig back in 2017, I have been constantly using it in both editing and translation. Ever since, I suggest it to my translators at ProSciEditing.

Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com