- Lavery, Amy M;
- Waldman, Amy T;
- Casper, T Charles;
- Roalstad, Shelly;
- Candee, Meghan;
- Rose, John;
- Belman, Anita;
- Weinstock-Guttman, Bianca;
- Aaen, Greg;
- Tillema, Jan-Mendelt;
- Rodriguez, Moses;
- Ness, Jayne;
- Harris, Yolanda;
- Graves, Jennifer;
- Krupp, Lauren;
- Benson, Leslie;
- Gorman, Mark;
- Moodley, Manikum;
- Rensel, Mary;
- Goyal, Manu;
- Mar, Soe;
- Chitnis, Tanuja;
- Schreiner, Teri;
- Lotze, Tim;
- Greenberg, Benjamin;
- Kahn, Ilana;
- Rubin, Jennifer;
- Waubant, Emmanuelle;
- Centers, for the US Network of Pediatric MS
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.