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Multicenter Study
. 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

Amy M Lavery  1 , Amy T Waldman  2 , T Charles Casper  3 , Shelly Roalstad  3 , Meghan Candee  3 , John Rose  3 , Anita Belman  4 , Bianca Weinstock-Guttman  5 , Greg Aaen  6 , Jan-Mendelt Tillema  7 , Moses Rodriguez  7 , Jayne Ness  8 , Yolanda Harris  8 , Jennifer Graves  9 , Lauren Krupp  10 , Leslie Benson  11 , Mark Gorman  11 , Manikum Moodley  12 , Mary Rensel  12 , Manu Goyal  13 , Soe Mar  13 , Tanuja Chitnis  14 , Teri Schreiner  15 , Tim Lotze  16 , Benjamin Greenberg  17 , Ilana Kahn  18 , Jennifer Rubin  19 , Emmanuelle Waubant  9 ; U.S. Network of Pediatric MS Centers
Affiliations
Multicenter Study

Examining the contributions of environmental quality to pediatric multiple sclerosis

Amy M Lavery et al. Mult Scler Relat Disord. 2017 Nov.

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.

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Conflict of interest statement

Conflict of interest

The authors have no conflicts of interest relevant to this article to disclose.

Figures

Fig. 1
Fig. 1
Air EQI in relation to pediatric MS and healthy controls, full U.S. (a), west coast (b), and east coast (c).
Fig. 2
Fig. 2
Land (a) and water (b) EQI scores in relation to pediatric MS cases and healthy controls.
See this image and copyright information in PMC

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