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Mult Scler Relat Disord. 2017 Nov;18:164-169. doi: 10.1016/j.msard.2017.09.004. Epub 2017 Sep 7.

Examining the contributions of environmental quality to pediatric multiple sclerosis.

Author information

1
Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States. Electronic address: laverya@email.chop.edu.
2
Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
3
University of Utah, Salt Lake City, UT, United States.
4
Stony Brook University, Stony Brook, NY, United States.
5
Buffalo General Hospital, State University of New York at Buffalo, Buffalo, NY, United States.
6
Loma Linda University Children's Hospital, Loma Linda, CA, United States.
7
Mayo Clinic, Rochester, MN, United States.
8
University of Alabama, Tuscaloosa, AL, United States.
9
University of California San Francisco, San Francisco, CA, United States.
10
New York University Medical Center, New York, NY, United States.
11
Boston Children's Pediatric MS Center, Boston, MA, United States.
12
Cleveland Clinic, Cleveland, OH, United States.
13
Washington University in St. Louis, St. Louis, MO, United States.
14
Massachusetts General Hospital, Harvard Medical School, Boston, MS, United Staes.
15
Denver Children's Hospital, Denver, CO, United States.
16
Texas Children's Hospital, Houston, TX, United States.
17
University of Texas Southwestern Medical Center, Dallas, TX, United States.
18
Children's National Medical Center, Washington, DC, United States.
19
Lurie Children's Hospital, Chicago, IL, United States.

Abstract

BACKGROUND:

Multiple sclerosis (MS) is a presumed autoimmune disease caused by genetic and environmental factors. It is hypothesized that environmental exposures (such as air and water quality) trigger the innate immune response thereby activating a pro-inflammatory cascade.

OBJECTIVE:

To examine potential environmental factors in pediatric MS using geographic information systems (GIS).

METHODS:

Pediatric MS cases and healthy controls were identified as part of an ongoing multicenter case-control study. Subjects' geographic locations were mapped by county centroid to compare to an Environmental Quality Index (EQI). The EQI examines 5 individual environmental components (air, land, water, social, built factors). A composite EQI score and individual scores were compared between cases and controls, stratified by median proximity to enrollment centers (residence <20 or ≥20 miles from the recruiting center), using logistic regression.

RESULTS:

Of the 287 MS cases and 445 controls, 46% and 49% respectively live in areas where the total EQI is the highest (worst environmental quality). Total EQI was not significantly associated with the odds for MS (p = 0.90 < 20 miles from center; p = 0.43 ≥ 20 miles); however, worsening air quality significantly impacted the odds for MS in those living near a referral center (OR = 2.83; 95%CI 1.5, 5.4) and those who reside ≥ 20 miles from a referral center (OR = 1.61; 95%CI 1.2, 2.3).

CONCLUSION:

Among environmental factors, air quality may contribute to the odds of developing MS in a pediatric population. Future studies will examine specific air constituents and other location-based air exposures and explore potential mechanisms for immune activation by these exposures.

PMID:
29141802
PMCID:
PMC5720353
DOI:
10.1016/j.msard.2017.09.004
[Indexed for MEDLINE]
Free PMC Article

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