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

Marianna Vitkova; Ibrahima Diouf; Charles Malpas; Dana Horakova; Eva Kubala Havrdova; Francesco Patti; Serkan Ozakbas; Guillermo Izquierdo; Sara Eichau; Vahid Shaygannejad; Marco Onofrj; Alessandra Lugaresi; Raed Alroughani; Alexandre Prat; Catherine Larochelle; Marc Girard; Pierre Duquette; Murat Terzi; Cavit Boz; Francois Grand'maison; Patrizia Sola; Diana Ferraro; Pierre Grammond; Helmut Butzkueven; Katherine Buzzard; Olga Skibina; Bassem I. Yamout; Rana Karabudak; Oliver Gerlach; Jeannette Lechner-Scott; Davide Maimone; Roberto Bergamaschi; Vincent Van Pesch; Gerardo Iuliano; Elisabetta Cartechini; Maria José Sà; Radek Ampapa; Michael Barnett; Stella E. Hughes; Cristina M. Ramo-Tello; Suzanne Hodgkinson; Daniele L.A. Spitaleri; Thor Petersen; Ernest Gerard Butler; Mark Slee; Chris McGuigan; Pamela Ann McCombe; Franco Granella; Edgardo Cristiano; Julie Prevost; Bruce V. Taylor; Josã Luis Sãnchez-Menoyo; Guy Laureys; Liesbeth Van Hijfte; Steve Vucic; Richard A. MacDonell; Orla Gray; Javier Olascoaga; Norma Deri; Yara Dadalti Fragoso; Cameron Shaw; Tomas Kalincik; MSBase Study Group

doi:10.1212/WNL.0000000000200545

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

Marianna Vitkova, Ibrahima Diouf, Charles Malpas, Dana Horakova, Eva Kubala Havrdova, Francesco Patti, Serkan Ozakbas, Guillermo Izquierdo, Sara Eichau, Vahid Shaygannejad, Marco Onofrj, Alessandra Lugaresi, Raed Alroughani, Alexandre Prat, Catherine Larochelle, Marc Girard, Pierre Duquette, Murat Terzi, Cavit Boz, Francois Grand'maisonPatrizia Sola, Diana Ferraro, Pierre Grammond, Helmut Butzkueven, Katherine Buzzard, Olga Skibina, Bassem I. Yamout, Rana Karabudak, Oliver Gerlach, Jeannette Lechner-Scott, Davide Maimone, Roberto Bergamaschi, Vincent Van Pesch, Gerardo Iuliano, Elisabetta Cartechini, Maria José Sà, Radek Ampapa, Michael Barnett, Stella E. Hughes, Cristina M. Ramo-Tello, Suzanne Hodgkinson, Daniele L.A. Spitaleri, Thor Petersen, Ernest Gerard Butler, Mark Slee, Chris McGuigan, Pamela Ann McCombe, Franco Granella, Edgardo Cristiano, Julie Prevost, Bruce V. Taylor, Josã Luis Sãnchez-Menoyo, Guy Laureys, Liesbeth Van Hijfte, Steve Vucic, Richard A. MacDonell, Orla Gray, Javier Olascoaga, Norma Deri, Yara Dadalti Fragoso, Cameron Shaw, Tomas Kalincik, MSBase Study Group

College of Medicine and Public Health

Research output: Contribution to journal › Article › peer-review

24 Citations (Scopus)

Abstract

Background and Objectives: The 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.

Methods: This 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.

Results: The 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).

Discussion: In 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.

Original language	English
Pages (from-to)	E2401-E2412
Number of pages	12
Journal	Neurology
Volume	98
Issue number	24
DOIs	https://doi.org/10.1212/WNL.0000000000200545
Publication status	Published - 14 Jun 2022

Keywords

severity of multiple sclerosis (MS)
latitude of residence
Ultraviolet B radiation (UVB) exposure

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1212/WNL.0000000000200545Licence: In Copyright

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Vitkova, M., Diouf, I., Malpas, C., Horakova, D., Kubala Havrdova, E., Patti, F., Ozakbas, S., Izquierdo, G., Eichau, S., Shaygannejad, V., Onofrj, M., Lugaresi, A., Alroughani, R., Prat, A., Larochelle, C., Girard, M., Duquette, P., Terzi, M., Boz, C., ... MSBase Study Group (2022). Association of Latitude and Exposure to Ultraviolet B Radiation With Severity of Multiple Sclerosis: An International Registry Study. Neurology, 98(24), E2401-E2412. https://doi.org/10.1212/WNL.0000000000200545

@article{e5712f2894b548ffa82f489f9f007805,

title = "Association of Latitude and Exposure to Ultraviolet B Radiation With Severity of Multiple Sclerosis: An International Registry Study",

abstract = "Background and Objectives: The 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.Methods: This 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.Results: The 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).Discussion: In 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.",

keywords = "severity of multiple sclerosis (MS), latitude of residence, Ultraviolet B radiation (UVB) exposure",

author = "Marianna Vitkova and Ibrahima Diouf and Charles Malpas and Dana Horakova and {Kubala Havrdova}, Eva and Francesco Patti and Serkan Ozakbas and Guillermo Izquierdo and Sara Eichau and Vahid Shaygannejad and Marco Onofrj and Alessandra Lugaresi and Raed Alroughani and Alexandre Prat and Catherine Larochelle and Marc Girard and Pierre Duquette and Murat Terzi and Cavit Boz and Francois Grand'maison and Patrizia Sola and Diana Ferraro and Pierre Grammond and Helmut Butzkueven and Katherine Buzzard and Olga Skibina and Yamout, {Bassem I.} and Rana Karabudak and Oliver Gerlach and Jeannette Lechner-Scott and Davide Maimone and Roberto Bergamaschi and {Van Pesch}, Vincent and Gerardo Iuliano and Elisabetta Cartechini and {Jos{\'e} S{\`a}}, Maria and Radek Ampapa and Michael Barnett and Hughes, {Stella E.} and Ramo-Tello, {Cristina M.} and Suzanne Hodgkinson and Spitaleri, {Daniele L.A.} and Thor Petersen and Butler, {Ernest Gerard} and Mark Slee and Chris McGuigan and McCombe, {Pamela Ann} and Franco Granella and Edgardo Cristiano and Julie Prevost and Taylor, {Bruce V.} and S{\~a}nchez-Menoyo, {Jos{\~a} Luis} and Guy Laureys and {Van Hijfte}, Liesbeth and Steve Vucic and MacDonell, {Richard A.} and Orla Gray and Javier Olascoaga and Norma Deri and Fragoso, {Yara Dadalti} and Cameron Shaw and Tomas Kalincik and {MSBase Study Group}",

year = "2022",

month = jun,

day = "14",

doi = "10.1212/WNL.0000000000200545",

language = "English",

volume = "98",

pages = "E2401--E2412",

journal = "Neurology",

issn = "0028-3878",

publisher = "Wolters Kluwer Health",

number = "24",

}

Vitkova, M, Diouf, I, Malpas, C, Horakova, D, Kubala Havrdova, E, Patti, F, Ozakbas, S, Izquierdo, G, Eichau, S, Shaygannejad, V, Onofrj, M, Lugaresi, A, Alroughani, R, Prat, A, Larochelle, C, Girard, M, Duquette, P, Terzi, M, Boz, C, Grand'maison, F, Sola, P, Ferraro, D, Grammond, P, Butzkueven, H, Buzzard, K, Skibina, O, Yamout, BI, Karabudak, R, Gerlach, O, Lechner-Scott, J, Maimone, D, Bergamaschi, R, Van Pesch, V, Iuliano, G, Cartechini, E, José Sà, M, Ampapa, R, Barnett, M, Hughes, SE, Ramo-Tello, CM, Hodgkinson, S, Spitaleri, DLA, Petersen, T, Butler, EG, Slee, M, McGuigan, C, McCombe, PA, Granella, F, Cristiano, E, Prevost, J, Taylor, BV, Sãnchez-Menoyo, JL, Laureys, G, Van Hijfte, L, Vucic, S, MacDonell, RA, Gray, O, Olascoaga, J, Deri, N, Fragoso, YD, Shaw, C, Kalincik, T & MSBase Study Group 2022, 'Association of Latitude and Exposure to Ultraviolet B Radiation With Severity of Multiple Sclerosis: An International Registry Study', Neurology, vol. 98, no. 24, pp. E2401-E2412. https://doi.org/10.1212/WNL.0000000000200545

TY - JOUR

T1 - Association of Latitude and Exposure to Ultraviolet B Radiation With Severity of Multiple Sclerosis

T2 - An International Registry Study

AU - Vitkova, Marianna

AU - Diouf, Ibrahima

AU - Malpas, Charles

AU - Horakova, Dana

AU - Kubala Havrdova, Eva

AU - Patti, Francesco

AU - Ozakbas, Serkan

AU - Izquierdo, Guillermo

AU - Eichau, Sara

AU - Shaygannejad, Vahid

AU - Onofrj, Marco

AU - Lugaresi, Alessandra

AU - Alroughani, Raed

AU - Prat, Alexandre

AU - Larochelle, Catherine

AU - Girard, Marc

AU - Duquette, Pierre

AU - Terzi, Murat

AU - Boz, Cavit

AU - Grand'maison, Francois

AU - Sola, Patrizia

AU - Ferraro, Diana

AU - Grammond, Pierre

AU - Butzkueven, Helmut

AU - Buzzard, Katherine

AU - Skibina, Olga

AU - Yamout, Bassem I.

AU - Karabudak, Rana

AU - Gerlach, Oliver

AU - Lechner-Scott, Jeannette

AU - Maimone, Davide

AU - Bergamaschi, Roberto

AU - Van Pesch, Vincent

AU - Iuliano, Gerardo

AU - Cartechini, Elisabetta

AU - José Sà, Maria

AU - Ampapa, Radek

AU - Barnett, Michael

AU - Hughes, Stella E.

AU - Ramo-Tello, Cristina M.

AU - Hodgkinson, Suzanne

AU - Spitaleri, Daniele L.A.

AU - Petersen, Thor

AU - Butler, Ernest Gerard

AU - Slee, Mark

AU - McGuigan, Chris

AU - McCombe, Pamela Ann

AU - Granella, Franco

AU - Cristiano, Edgardo

AU - Prevost, Julie

AU - Taylor, Bruce V.

AU - Sãnchez-Menoyo, Josã Luis

AU - Laureys, Guy

AU - Van Hijfte, Liesbeth

AU - Vucic, Steve

AU - MacDonell, Richard A.

AU - Gray, Orla

AU - Olascoaga, Javier

AU - Deri, Norma

AU - Fragoso, Yara Dadalti

AU - Shaw, Cameron

AU - Kalincik, Tomas

AU - MSBase Study Group

PY - 2022/6/14

Y1 - 2022/6/14

N2 - Background and Objectives: The 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.Methods: This 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.Results: The 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).Discussion: In 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.

AB - Background and Objectives: The 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.Methods: This 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.Results: The 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).Discussion: In 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.

KW - severity of multiple sclerosis (MS)

KW - latitude of residence

KW - Ultraviolet B radiation (UVB) exposure

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UR - http://purl.org/au-research/grants/NHMRC/1140766

UR - http://purl.org/au-research/grants/NHMRC/1129189

UR - http://purl.org/au-research/grants/NHMRC/1157717

U2 - 10.1212/WNL.0000000000200545

DO - 10.1212/WNL.0000000000200545

M3 - Article

C2 - 35410900

AN - SCOPUS:85131902572

SN - 0028-3878

VL - 98

SP - E2401-E2412

JO - Neurology

JF - Neurology

IS - 24

ER -

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

Abstract

Keywords

UN SDGs

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