Highlights
- •This study utilizes a comprehensive measure of environmental quality to determine the contribution of environmental factors to the odds for having multiple sclerosis during childhood.
- •Our study found that of several environmental components, poor air quality was associated with increased odds for pediatric MS.
- •Future studies will examine specific air constituents and other location-based air exposures to better understand the relationship between air quality and pediatric MS.
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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References
- Effects of particulate matter exposure on multiple sclerosis hospital admission in Lombardy region, Italy.Environ. Res. 2016; 145: 68-73
- Activation of the inducible form of nitric oxide synthase in the brains of patients with multiple sclerosis.Proc. Natl. Acad. Sci. USA. 1995; 92: 12041-12045
- Air pollution: mechanisms of neuroinflammation & CNS disease.Trends Neurosci. 2010; 32: 506-516
- Disruption of thiol homeostasis and nitrosative stress in the cerebrospinal fluid of patients with active multiple sclerosis: evidence for a protective role of acetylcarnitine.Neurochem. Res. 2003; 28: 1321-1328
- Long-term air pollution exposure is associated with neuroinflammation, an altered innate immune response, disruption of the blood-brain barrier, ultrafine particulate deposition, and accumulation of amyloid beta-42 and alpha-synuclein in children and youn.Toxicol. Pathol. 2008; 36: 289-310
- The US network of pediatric multiple sclerosis centers: development, progress, and next steps.J. Child Neurol. 2014;
- Air pollution and cardiovascular disease.Curr. Probl. Cardiol. 2015; 40: 207-238
- Exposure to air pollution and development of asthma and rhinoconjunctivitis throughout childhood and adolescence: a population-based birth cohort study.Lancet Respir. Med. 2015; 3: 933-942
- Multiple Sclerosis disease distribution and potential impact of environmental air pollutants in Georgia.Sci. Total Environ. 2008; 396: 42-51
- Prenatal exposure to residential air pollution and infant mental development: modulation by antioxidants and detoxification factors.Environ. Health Perspect. 2012; 120: 144-149
- Potential impact of air pollution on multiple sclerosis in Tehran, Iran.Neuroepidemiology. 2014; 43: 233-238
- Oxidative stress in serum and peripheral blood leukocytes in patients with different disease courses of multiple sclerosis.J. Neurol. 2006; 253: 483-487
- Urban air pollution, poverty, violence and health – neurological and immunological aspects as mediating factors.Environ. Res. 2015; 140: 511-513
Lobdell D.T., 2016. U.S. Environmental Protection Agency [Internet]. Developer Central Data. Available from: 〈https://developer.epa.gov/usepa-environmental-quality-index-eqi-and-associated-domain-indices-by-county-for-the-united-states/〉.
- Air pollution and stroke – an overview of the evidence base.Spat. Spatiotemporal Epidemiol. 2016; 18: 74-81
- Construction of an environmental quality index for public health research.Environ. Health. 2014; 13: 39
- A multicentre study of air pollution exposure and childhood asthma prevalence: the ESCAPE project.Eur. Respir. J. 2015; 45: 610-624
- Passage of intratracheally instilled ultrafine particles from the lung into the systemic circulation in hamster.Am. J. Respir. Crit. Care Med. 2001; 164: 1665-1668
- Ambient air quality and occurrence of multiple sclerosis relapse.Neuroepidemiology. 2016; 22: 95-99
- Oxidative stress in multiple sclerosis patients in clinical remission: association with the expanded disability status scale.J. Neurol. Sci. 2012; 321: 49-53
- The multiple sclerosis functional composite: a clinically meaningful measure of disability.Neurology. 2010; 74: S8-S15
Short term exposure to air pollution and stroke: systematic review and meta-analysis. BMJ, 2016, p. i4851.
U.S. Census Bureau [Internet], 2016. TIGER Products. Available from: 〈https://www.census.gov/geo/maps-data/data/tiger.html〉.
- Cardiovascular emergency hospital visits and hourly changes in air pollution.Stroke. 2014; 45: 1264-1268
- Long-term exposure to ambient air pollution and mortality due to cardiovascular disease and cerebrovascular disease in Shenyang, China.PLoS One. 2011; 6 (Federici M., editor): e20827
Article info
Publication history
Published online: September 07, 2017
Accepted:
September 5,
2017
Received:
August 3,
2017
Identification
Copyright
© 2017 Published by Elsevier B.V.
