title: Month of birth, vitamin D and risk of immune-mediated disease: a case control study.
abstract: BACKGROUND
  A season of birth effect in immune-mediated diseases (ID) such as multiple sclerosis and type 1 diabetes has been consistently reported. We aimed to investigate whether season of birth influences the risk of rheumatoid arthritis, Crohn's disease, ulcerative colitis and systemic lupus erythematosus in addition to multiple sclerosis, and to explore the correlation between the risk of ID and predicted ultraviolet B (UVB) light exposure and vitamin D status during gestation.
  
  
  METHODS
  The monthly distribution of births of patients with ID from the UK (n = 115,172) was compared to that of the general population using the Cosinor test. Predicted UVB radiation and vitamin D status in different time windows during pregnancy were calculated for each month of birth and correlated with risk of ID using the Spearman's correlation coefficient.
  
  
  RESULTS
  The distributions of ID births significantly differed from that of the general population (P = 5e-12) with a peak in April (odds ratio = 1.045, 95% confidence interval = 1.024, 1.067, P < 0.0001) and a trough in October (odds ratio = 0.945, 95% confidence interval = 0.925, 0.966, P < 0.0001). Stratification by disease subtype showed seasonality in all ID but Crohn's disease. The risk of ID was inversely correlated with predicted second trimester UVB exposure (Spearman's rho = -0.49, P = 0.00005) and third trimester vitamin D status (Spearman's rho = -0.44, P = 0.0003).
  
  
  CONCLUSIONS
  The risk of different ID in the UK is significantly influenced by the season of birth, suggesting the presence of a shared seasonal risk factor or factors predisposing to ID. Gestational UVB and vitamin D exposure may be implicated in the aetiology of ID.
authors: Giulio
authors: G
authors: Disanto
authors: George
authors: G
authors: Chaplin
authors: Julia M
authors: JM
authors: Morahan
authors: Gavin
authors: G
authors: Giovannoni
authors: Elina
authors: E
authors: Hyppönen
authors: George C
authors: GC
authors: Ebers
authors: Sreeram V
authors: SV
authors: Ramagopalan
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000097:blood / Q000453:epidemiology*; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000097:blood / Q000453:epidemiology; D003424:Crohn Disease / Q000097:blood / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000097:blood / Q000453:epidemiology; D016017:Odds Ratio; D012307:Risk Factors; D012621:Seasons; D013472:Sunlight; D014466:Ultraviolet Rays; D014807:Vitamin D / Q000097:blood*
chemical_list: D014807:Vitamin D