Multiple Sclerosis disease distribution and potential impact of environmental air pollutants in Georgia

Multiple Sclerosis (MS) is one of the most common diseases of the central nervous system. Although the disease has been associated with some genetic and environmental factors, it has neither clear causes nor clear temporality with respect to exposure. The purpose of this study was to explore potential relationships between MS and outdoor air pollutants in GA. This study used cross-sectional data from the memberʹs list of the Multiple Sclerosis Societyʹs GA chapter (MSS-GA), the US Census, and a database of county-level Toxic Release Inventory data (emissions across identified, reporting sources to outdoor air, as a surrogate indicator of potential exposure to a criteria pollutant subject to regulation or to chemical toxicants). The final study population was 9,072,576 people, including 6247 self-reported MS cases from MSS-GA. Cases were stratified by gender and transformed into county-level, selfreported prevalence rates using 2005 US Census estimates. County-level prevalence was displayed using a Geographic Information System. Linear regression was conducted to investigate potential relationships between self-reported MS prevalence rates, census data, and environmental outdoor air pollutant indicators. MS prevalence tended to be clustered within the largest metropolitan statistical area (MSA) in Georgia, around Atlanta (Fulton County). The best predictive models for the MS prevalence in GA included both per capita income and PM-10 for females, but only per capita income only for males. The clustering of prevalence of MS in the largest MSA of Georgia, after controlling for population distribution, suggested that urban attributes may be associated with MS. The results of this study further suggested a potential role of PM-10 in the etiology of MS in females, perhaps due to the influence of PM-10 on systemic immune response and inflammation. Based on this initial exploratory study, we recommend more basic and clinical exposure research to understand environmental influences on MS. In particular, outdoor air pollutants like particles, and attached chemicals and metals, which have other known adverse cardiopulmonary health outcomes and are subject to federal and state regulations, could be examined using routinely collected outdoor air monitoring station data and/ or modeling.