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Association of Latitude and Exposure to Ultraviolet B Radiation With Severity of Multiple Sclerosis: An International Registry Study Publisher Pubmed



Vitkova M1, 2 ; Diouf I1 ; Malpas C1 ; Horakova D4 ; Kubala Havrdova E4 ; Patti F5, 6 ; Ozakbas S7 ; Izquierdo G8 ; Eichau S8 ; Shaygannejad V9 ; Onofrj M10 ; Lugaresi A11, 12 ; Alroughani R13 ; Prat A14 Show All Authors
Authors
  1. Vitkova M1, 2
  2. Diouf I1
  3. Malpas C1
  4. Horakova D4
  5. Kubala Havrdova E4
  6. Patti F5, 6
  7. Ozakbas S7
  8. Izquierdo G8
  9. Eichau S8
  10. Shaygannejad V9
  11. Onofrj M10
  12. Lugaresi A11, 12
  13. Alroughani R13
  14. Prat A14
  15. Larochelle C14
  16. Girard M14
  17. Duquette P14
  18. Terzi M15
  19. Boz C16
  20. Grandmaison F17
  21. Sola P18
  22. Ferraro D19
  23. Grammond P20
  24. Butzkueven H21, 22
  25. Buzzard K23, 24
  26. Skibina O22, 23, 24
  27. Yamout BI25
  28. Karabudak R26
  29. Gerlach O27
  30. Lechnerscott J28, 29
  31. Maimone D30
  32. Bergamaschi R31
  33. Van Pesch V32, 33
  34. Iuliano G34
  35. Cartechini E35
  36. Jose Sa M36
  37. Ampapa R37
  38. Barnett M38
  39. Hughes SE39
  40. Ramotello CM40
  41. Hodgkinson S41, 42
  42. Spitaleri DLA43
  43. Petersen T44
  44. Butler EG45
  45. Slee M46
  46. Mcguigan C47
  47. Mccombe PA48, 49
  48. Granella F50, 51
  49. Cristiano E52
  50. Prevost J53
  51. Taylor BV54
  52. Sanchezmenoyo JL55
  53. Laureys G56
  54. Van Hijfte L57
  55. Vucic S58
  56. Macdonell RA59
  57. Gray O60
  58. Olascoaga J61
  59. Deri N62
  60. Fragoso YD63
  61. Shaw C64
  62. Kalincik T1, 3
Show Affiliations
Authors Affiliations
  1. 1. CORe, Department Of Medicine, University Of Melbourne, Australia
  2. 2. Melbourne Ms Centre, Department Of Neurology, Faculty Of Medicine, P.J. Safarik University, Kosice, Slovakia
  3. 3. Melbourne Ms Centre, Department Of Neurology, Royal Melbourne Hospital, Australia
  4. 4. Department Of Neurology, Center Of Clinical Neuroscience, First Faculty Of Medicine, Charles University In Prague And General University Hospital, Czech Republic
  5. 5. Department Of Medical And Surgical Sciences And Advanced Technologies, Gf Ingrassia, Italy
  6. 6. Multiple Sclerosis Center, University Of Catania, Italy
  7. 7. Dokuz Eylul University, Izmir, Turkey
  8. 8. Hospital Universitario Virgen Macarena, Sevilla, Spain
  9. 9. Isfahan Neurosciences Research Center (INRC), Isfahan University Of Medical Sciences (IUMS), Iran
  10. 10. Department Of Neuroscience, Imaging, And Clinical Sciences, University G. d'Annunzio, Chieti, Italy
  11. 11. Irccs Istituto Delle Scienze Neurologiche Di Bologna, Universita Di Bologna, Italy
  12. 12. Dipartimento Di Scienze Biomediche E Neuromotorie, Universita Di Bologna, Italy
  13. 13. Division Of Neurology, Department Of Medicine, Amiri Hospital, Sharq, Kuwait
  14. 14. Chum Ms Center, Universite De Montreal, Quebec, Canada
  15. 15. Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
  16. 16. Ktu Medical Faculty Farabi Hospital, Trabzon, Turkey
  17. 17. Neuro Rive-Sud, Longueuil, QC, Canada
  18. 18. Azienda Ospedaliera Universitaria Di Modena, University Of Modena And Reggio Emilia, Italy
  19. 19. Department Of Biomedical, Metabolic And Neurosciences, University Of Modena And Reggio Emilia, Italy
  20. 20. Cisss Chaudire-Appalache, Levis, QC, Canada
  21. 21. Central Clinical School, Monash University, Australia
  22. 22. Department Of Neurology, The Alfred Hospital, Australia
  23. 23. Department Of Neurology, Box Hill Hospital, Eastern Health, Australia
  24. 24. Monash University, Melbourne, Australia
  25. 25. Nehme And Therese Tohme Multiple Sclerosis Center, American University Of Beirut Medical Center, Lebanon, Lebanon
  26. 26. Hacettepe University, Ankara, Turkey
  27. 27. Zuyderland Medical Centre, Department Of Neurologie, Dr. H. Van Der Hoffplein 1, Sittard-Geleen, Netherlands
  28. 28. School Of Medicine And Public Health, University Newcastle, Newcastle, Australia
  29. 29. Department Of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
  30. 30. Ms Center, Neurology Unit, Garibaldi Hospital, Catania, Italy
  31. 31. Irccs Mondino Foundation, Pavia, Italy
  32. 32. Cliniques Universitaires Saint-Luc, Brussels, Belgium
  33. 33. Universite Catholique De Louvain, Belgium
  34. 34. Ospedali Riuniti Di Salerno, Azienda Sanitaria Unica Regionale Marche-AV3, Macerata, Italy
  35. 35. Uoc Neurologia, Azienda Sanitaria Unica Regionale Marche-AV3, Macerata, Italy
  36. 36. Hospital De Sao Joao, Universidade Fernando Pessoa, Porto, Portugal
  37. 37. Nemocnice Jihlava, Jihlava, Czech Republic
  38. 38. Brain And Mind Centre, Sydney, Australia
  39. 39. Royal Victoria Hospital, Belfast, United Kingdom
  40. 40. Hospital Germans Trias I Pujol, Badalona, Spain
  41. 41. Liverpool Hospital, Sydney, Australia
  42. 42. Liverpool Hospital And Ingham Institute, Australia
  43. 43. Azienda Ospedaliera Di Rilievo Nazionale San Giuseppe Moscati Avellino, Italy
  44. 44. Kommunehospitalet, Aarhus, Denmark
  45. 45. Monash Medical Centre, Melbourne, Australia
  46. 46. Flinders University, Adelaide, Australia
  47. 47. University College Dublin, St. Vincent's University Hospital, Ireland
  48. 48. University Of Queensland, Australia
  49. 49. Royal Brisbane And Women's Hospital, Australia
  50. 50. Department Of Medicine And Surgery, University Of Parma, Italy
  51. 51. Department Of Emergency And General Medicine, Parma University Hospital, Italy
  52. 52. Hospital Italiano, Buenos Aires, Argentina
  53. 53. Csss Saint-Jerome, Saint-Jerome, QC, Canada
  54. 54. Royal Hobart Hospital, Australia
  55. 55. Hospital De Galdakao-Usansolo, Galdakao, Spain
  56. 56. Department Of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, Belgium
  57. 57. University Hospital Ghent, Ghent, Belgium
  58. 58. Westmead Hospital, Sydney, Australia
  59. 59. Austin Health, Melbourne, Australia
  60. 60. South East Trust, Belfast, United Kingdom
  61. 61. Instituto De Investigacion Sanitaria Biodonostia, Hospital Universitario Donostia, San Sebastian, Spain
  62. 62. Hospital Fernandez, Capital Federal, Argentina
  63. 63. Universidade Metropolitana De Santos, Santos, Brazil
  64. 64. Geelong Hospital, Geelong, Australia

Source: Neurology Published:2022


Abstract

Background and ObjectivesThe severity of multiple sclerosis (MS) varies widely among individuals. Understanding the determinants of this heterogeneity will help clinicians optimize the management of MS. The aim of this study was to investigate the association between latitude of residence, UV B radiation (UVB) exposure, and the severity of MS.MethodsThis observational study used the MSBase registry data. The included patients met the 2005 or 2010 McDonald diagnostic criteria for MS and had a minimum dataset recorded in the registry (date of birth, sex, clinic location, date of MS symptom onset, disease phenotype at baseline and censoring, and ≥1 Expanded Disability Status Scale score recorded). The latitude of each study center and cumulative annualized UVB dose at study center (calculated from National Aeronautics and Space Administration's Total Ozone Mapping Spectrometer) at ages 6 and 18 years and the year of disability assessment were calculated. Disease severity was quantified with Multiple Sclerosis Severity Score (MSSS). Quadratic regression was used to model the associations between latitude, UVB, and MSSS.ResultsThe 46,128 patients who contributed 453,208 visits and a cumulative follow-up of 351,196 patient-years (70% women, mean age 39.2 ± 12 years, resident between latitudes 19°35′ and 56°16′) were included in this study. Latitude showed a nonlinear association with MS severity. In latitudes <40°, more severe disease was associated with higher latitudes (β = 0.08, 95% CI 0.04-0.12). For example, this translates into a mean difference of 1.3 points of MSSS between patients living in Madrid and Copenhagen. No such association was observed in latitudes <40° (β =-0.02, 95% CI-0.06 to 0.03). The overall disability accrual was faster in those with a lower level of estimated UVB exposure before the age of 6 years (β =-0.5, 95% CI-0.6 to 0.4) and 18 years (β =-0.6, 95% CI-0.7 to 0.4), as well as with lower lifetime UVB exposure at the time of disability assessment (β =-1.0, 95% CI-1.1 to 0.9).DiscussionIn temperate zones, MS severity is associated with latitude. This association is mainly, but not exclusively, driven by UVB exposure contributing to both MS susceptibility and severity. © 2022 American Academy of Neurology.
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