TY - JOUR
T1 - Association between Time Spent Outdoors and Risk of Multiple Sclerosis
AU - US Network of Pediatric Multiple Sclerosis Centers
AU - Sebastian, Prince
AU - Cherbuin, Nicolas
AU - Barcellos, Lisa F.
AU - Roalstad, Shelly
AU - Casper, Charles
AU - Hart, Janace
AU - Aaen, Gregory S.
AU - Krupp, Lauren
AU - Benson, Leslie
AU - Gorman, Mark
AU - Candee, Meghan
AU - Chitnis, Tanuja
AU - Goyal, Manu
AU - Greenberg, Benjamin
AU - Mar, Soe
AU - Rodriguez, Moses
AU - Rubin, Jennifer
AU - Schreiner, Teri
AU - Waldman, Amy
AU - Weinstock-Guttman, Bianca
AU - Graves, Jennifer
AU - Waubant, Emmanuelle
AU - Lucas, Robyn
N1 - Funding Information:
P. Sebastian, N. Cherbuin, and L. Barcellos report no disclosures relevant to the manuscript. S. Roalstad and C. Casper report grants from National MS Society, during the conduct of the study. J. Hart reports no disclosures relevant to the manuscript. G. Aaen reports grants from National Pediatric MS Society and grants from NIH, during the conduct of the study. L. Krupp reports grants from National Multiple Sclerosis Society, during the conduct of the study; personal fees from Sanofi-Aventis; grants and personal fees from Biogen; personal fees and nonfinancial support from Novartis; nonfinancial support from Celgene; and personal fees from EMD Serono, Allergan, Tesaro, Eisai, Roche, and Janssen, outside the submitted work. L. Benson reports grants from NIH, during the conduct of the study; other from Alexion Pharmaceuticals; personal fees from Department of Public Health, Massachusetts, and Vaccine Injury Compensation Program; and grants from ROHHAD Fight, Inc and Shore Foundation, outside the submitted work. M. Gorman reports grants from National Multiple Sclerosis Society and National Institute of Neurologic Disorders and Stroke, during the conduct of the study, and grants from Biogen, Novartis, and Roche, outside the submitted work. M. Candee reports no disclosures relevant to the manuscript. T. Chitnis reports consulting fees from Biogen Idec, Novartis, Sanofi, Bayer, Celgene, and Genentech, as well as grants from Novartis, Octave Bioscience, EMD Serono, and Verily Life Sciences, all outside the submitted work. M. Goyal reports no disclosures relevant to the manuscript. B. Greenberg reports grants from NIH, during the conduct of the study’ personal fees from Novartis, EMD Serono, and Alexion; grants from Guthy Jackson Charitable Foundation; grants and other from Siegel Rare Neuroimmune Association; and grants from NMSS and Clene Nanomedicine, outside the submitted work. S. Mar, M. Rodriguez, J. Rubin, T. Schreiner, and A. Waldman report no disclosures relevant to the manuscript. B. Weinstock-Guttman reports grants and personal fees from Biogen, Novartis, Genentech, and Genzyme & Sanofi, as well as personal fees from Abbvie and Bayer, outside the submitted work. J. Graves reports personal fees from Alexion and Celgene and grants from Biogen and Octave, outside the submitted work. E. Waubant reports personal fees from MS@TheLimit, MS curriculum, PRIME, DBV, Emerald, Jazz Pharma, and The Corpus, outside the submitted work. R. Lucas reports no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Funding Information:
This study was funded by the NIH (R01NS071463, E.W.) and the National MS Society (HC0165, C.C.).
Publisher Copyright:
Copyright © 2021 American Academy of Neurology
PY - 2022/1/18
Y1 - 2022/1/18
N2 - Background and Objectives This study aims to determine the contributions of sun exposure and ultraviolet radiation (UVR) exposure to risk of pediatric-onset multiple sclerosis (MS). Methods Children with MS and controls recruited from multiple centers in the United States were matched on sex and age. Multivariable conditional logistic regression was used to investigate the association of time spent outdoors daily in summer, use of sun protection, and ambient summer UVR dose in the year before birth and the year before diagnosis with MS risk, with adjustment for sex, age, race, birth season, child's skin color, mother's education, tobacco smoke exposure, being overweight, and Epstein-Barr virus infection. Results Three hundred thirty-two children with MS (median disease duration 7.3 months) and 534 controls were included after matching on sex and age. In a fully adjusted model, compared to spending <30 minutes outdoors daily during the most recent summer, greater time spent outdoors was associated with a marked reduction in the odds of developing MS, with evidence of dose-response (30 minutes'1 hour: adjusted odds ratio [AOR] 0.48, 95% confidence interval [CI] 0.23'0.99, p = 0.05; 1'2 hours: AOR 0.19, 95% CI 0.09'0.40, p < 0.001). Higher summer ambient UVR dose was also protective for MS (AOR 0.76 per 1 kJ/m2, 95% CI 0.62'0.94, p = 0.01). Discussion If this is a causal association, spending more time in the sun during summer may be strongly protective against developing pediatric MS, as well as residing in a sunnier location.
AB - Background and Objectives This study aims to determine the contributions of sun exposure and ultraviolet radiation (UVR) exposure to risk of pediatric-onset multiple sclerosis (MS). Methods Children with MS and controls recruited from multiple centers in the United States were matched on sex and age. Multivariable conditional logistic regression was used to investigate the association of time spent outdoors daily in summer, use of sun protection, and ambient summer UVR dose in the year before birth and the year before diagnosis with MS risk, with adjustment for sex, age, race, birth season, child's skin color, mother's education, tobacco smoke exposure, being overweight, and Epstein-Barr virus infection. Results Three hundred thirty-two children with MS (median disease duration 7.3 months) and 534 controls were included after matching on sex and age. In a fully adjusted model, compared to spending <30 minutes outdoors daily during the most recent summer, greater time spent outdoors was associated with a marked reduction in the odds of developing MS, with evidence of dose-response (30 minutes'1 hour: adjusted odds ratio [AOR] 0.48, 95% confidence interval [CI] 0.23'0.99, p = 0.05; 1'2 hours: AOR 0.19, 95% CI 0.09'0.40, p < 0.001). Higher summer ambient UVR dose was also protective for MS (AOR 0.76 per 1 kJ/m2, 95% CI 0.62'0.94, p = 0.01). Discussion If this is a causal association, spending more time in the sun during summer may be strongly protective against developing pediatric MS, as well as residing in a sunnier location.
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U2 - 10.1212/WNL.0000000000013045
DO - 10.1212/WNL.0000000000013045
M3 - Article
C2 - 34880094
AN - SCOPUS:85123651371
VL - 98
SP - E267-E278
JO - Neurology
JF - Neurology
SN - 0028-3878
IS - 3
ER -