Research Article| Volume 18, P164-169, November 2017

Examining the contributions of environmental quality to pediatric multiple sclerosis

Published:September 07, 2017DOI:


      • 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.



      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.


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


      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.


      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).


      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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