Examining the contributions of environmental quality to pediatric multiple sclerosis

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


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.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Air Pollution
  • Case-Control Studies
  • Environmental Exposure*
  • Female
  • Gene-Environment Interaction
  • Geography, Medical
  • Humans
  • Male
  • Multiple Sclerosis / diagnosis
  • Multiple Sclerosis / epidemiology*
  • Multiple Sclerosis / genetics
  • Odds Ratio
  • Referral and Consultation
  • Regression Analysis
  • United States
  • Water Quality