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Higher Latitude Is Significantly Associated With an Earlier Age of Disease Onset in Multiple Sclerosis Publisher Pubmed



Tao C1 ; Van Der Mei I1 ; Blizzard L1 ; Havrdova E2 ; Horakova D2 ; Shaygannejad V4 ; Lugaresi A5, 6 ; Izquierdo G7 ; Trojano M8 ; Duquette P9 ; Girard M9 ; Grandmaison F10 ; Grammond P11 ; Alroughani R12 Show All Authors
Authors
  1. Tao C1
  2. Van Der Mei I1
  3. Blizzard L1
  4. Havrdova E2
  5. Horakova D2
  6. Shaygannejad V4
  7. Lugaresi A5, 6
  8. Izquierdo G7
  9. Trojano M8
  10. Duquette P9
  11. Girard M9
  12. Grandmaison F10
  13. Grammond P11
  14. Alroughani R12
  15. Terzi M13
  16. Orejaguevara C14
  17. Sajedi SA15
  18. Iuliano G16
  19. Sola P17
  20. Lechnerscott J18
  21. Van Pesch V19
  22. Pucci E20
  23. Bergamaschi R21
  24. Barnett M22
  25. Ramo C23
  26. Singhal B24
  27. Spitaleri DLA25
  28. Slee M26
  29. Verheul F27
  30. Fernandez Bolanos R28
  31. Amato MP29
  32. Cristiano E30
  33. Granella F31
  34. Hodgkinson S32
  35. Fiol M33
  36. Gray O34
  37. Mccombe P35
  38. Saladino ML36
  39. Sanchez Menoyo JL37
  40. Shuey N38
  41. Vucic S39
  42. Shaw C40
  43. Deri N41
  44. Arruda WO42
  45. Butzkueven H3, 43
  46. Spelman T43
  47. Taylor BV1
Show Affiliations
Authors Affiliations
  1. 1. Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, 7001, TAS, Australia
  2. 2. Department of Neurology, Faculty of Medicine, Center of Clinical Neuroscience, General University Hospital, Charles University in Prague, Prague, Czech Republic
  3. 3. Department of Neurology, Eastern Health, Monash University, Box Hill, VIC, Australia
  4. 4. Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
  5. 5. Department of Biomedical and NeuroMotor Sciences (DIBINEM), Alma Mater Studiorum - Universita di Bologna, Bologna, Italy
  6. 6. IRCCS Istituto delle Scienze Neurologiche - 'UOSI Riabilitazione Sclerosi Multipla', Bologna, Italy
  7. 7. Hospital Universitario Virgen Macarena, Sevilla, Spain
  8. 8. Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
  9. 9. CHUM - Hopital Notre Dame, Montreal, QC, Canada
  10. 10. Neuro Rive-Sud, Hopital Charles LeMoyne, Quebec, QC, Canada
  11. 11. CISSS Chaudiere-Appalaches, Levis, QC, Canada
  12. 12. Amiri Hospital, Kuwait City, Kuwait
  13. 13. Department of Neurology, Mayis University, Samsun, Turkey
  14. 14. University Hospital San Carlos, IdISSC, Madrid, Spain
  15. 15. Department of Neurology, Golestan University of Medical Sciences, Gorgan, Iran
  16. 16. Ospedali Riuniti di Salerno, Salerno, Italy
  17. 17. Department of Neuroscience, Universitu of Modena e Reggio Emilia, Nuovo Ospedale Civile S. Agostino/Estense, Modena, Italy
  18. 18. John Hunter Hospital, University of Newcastle, Hunter Medical Research Institute, Newcastle, NSW, Australia
  19. 19. Cliniques Universitaires Saint-Luc, Brussels, Belgium
  20. 20. Neurology Unit, ASUR Marche, AV 3, Macerata, Italy
  21. 21. C. Mondino National Neurological Institute, Pavia, Italy
  22. 22. Brain and Mind Research Institute, Sydney, NSW, Australia
  23. 23. Hospital Germans Trias I Pujol, Badalona, Spain
  24. 24. Bombay Hospital Institute of Medical Sciences, Mumbai, India
  25. 25. AORN San Giuseppe Moscati Avellino, Avellino, Italy
  26. 26. Flinders University and Medical Centre, Adelaide, SA, Australia
  27. 27. Groene Hart Ziekenhuis, Gouda, Netherlands
  28. 28. Hospital Universitario Virgen de Valme, Sevilla, Spain
  29. 29. Department of Neurofarba, Section of Neurosciences, University of Florence, Florence, Italy
  30. 30. Hospital Italiano, Buenos Aries, Argentina
  31. 31. Department of Neuroscience, University of Parma, Parma, Italy
  32. 32. Liverpool Hospital, Liverpool, NSW, Australia
  33. 33. FLENI, Buenos Aries, Argentina
  34. 34. Ulster Hospital, Dundonald, United Kingdom
  35. 35. St Andrew's Place, Brisbane, QLD, Australia
  36. 36. INEBA, Buenos Aries, Argentina
  37. 37. Hospital de Galdakao-Usansolo, Galdakao, Spain
  38. 38. St Vincent's Hospital, Melbourne, VIC, Australia
  39. 39. Westmead Hospital, Sydney, NSW, Australia
  40. 40. Geelong Hospital, Geelong, VIC, Australia
  41. 41. Hospital Fernandez, Capital Federal, Argentina
  42. 42. Hospital Ecoville, Curitiba, Brazil
  43. 43. Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia

Source: Journal of Neurology, Neurosurgery and Psychiatry Published:2016


Abstract

Background: Age at onset (AAO) in multiple sclerosis (MS) is an important marker of disease severity and may have prognostic significance. Understanding what factors can influence AAO may shed light on the aetiology of this complex disease, and have applications in the diagnostic process. Methods: The study cohort of 22 162 eligible patients from 21 countries was extracted from the MSBase registry. Only patients with MS aged ≥16 years were included. To reduce heterogeneity, only centres of largely European descent were included for analysis. AAO was defined as the year of the first symptom suggestive of inflammatory central nervous system demyelination. Predictors of AAO were evaluated by linear regression. Results: Compared with those living in lower latitudes (19.0-39.9°), onset of symptoms was 1.9 years earlier for those at higher latitudes (50.0-56.0°) (p=3.83×10-23). A reciprocal relationship was seen for ambient ultraviolet radiation (UVR), with a significantly increasing AAO for patients with MS per each quartile increment of ambient UVR (p=1.56×10-17). We found that the AAO of female patients was ∼5 months earlier than male patients (p=0.002). AAO of progressive-onset patients with MS were ∼9 years later than relapsing-onset patients (p=1.40×10-265). Conclusions: An earlier AAO in higher latitude regions was found in this worldwide European-descent cohort and correlated inversely with variation in latitudinal UVR. These results suggest that environmental factors which act at the population level may significantly influence disease severity characteristics in genetically susceptible populations. © 2016 Published by the BMJ Publishing Group Limited.
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