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The aim was to study the impact of sun exposure habits on MS disease progression and health\u2010related quality of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients from a population\u2010based case\u2013control study were categorized based on sun exposure habits at diagnosis and were followed up to 15\u2009years post\u2010diagnosis through the Swedish MS registry (<jats:italic>n<\/jats:italic>\u2009=\u20093314) with regard to changes in Expanded Disability Status Scale (EDSS). Linear mixed models were used to analyse long\u2010term changes, while Cox regression models, with 95% confidence intervals, were used to investigate outcomes, including 24\u2010week confirmed diasability worsening, EDSS3, EDSS4, and physical worsening as measured by the physical component of the Multiple Sclerosis Impact Scale 29.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to average sun exposure (median value), low exposure to sunlight was associated with faster EDSS progression, increased risk of confirmed disability worsening (hazard ratio [HR] 1.48, 95% CI 1.21\u20131.81), increased risk of reaching EDSS 3 (HR 1.35, 95% CI 1.02\u20131.79), EDSS 4 (HR 1.47, 95% CI 1.01\u20132.20) and self\u2010reported physical worsening (HR 1.27, 95% CI 1.00\u20131.62). Significant trends revealed a lower risk of unfavourable outcomes with increasing sun exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Very low levels of sun exposure are associated with worse disease progression and health\u2010related quality of life in patients with MS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.16269","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T09:58:54Z","timestamp":1709632734000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Association between sun exposure habits and disease progression in multiple sclerosis"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6033-3734","authenticated-orcid":false,"given":"Jing","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Neurobiology, Care Sciences and Society, Aging Research Center Karolinska Institutet and Stockholm University  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Olsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Alfredsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience Karolinska Institutet  Stockholm Sweden"},{"name":"Institute of Environmental Medicine, Karolinska Institutet  Stockholm Sweden"},{"name":"Centre for Occupational and Environmental Medicine, Region Stockholm  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6612-4749","authenticated-orcid":false,"given":"Anna Karin","family":"Hedstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2018-320189"},{"key":"e_1_2_9_3_1","first-page":"596","article-title":"Multiple sclerosis risk factors and pathogenesis","volume":"25","author":"Nourbakhsh B","year":"2019","journal-title":"Continuum"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09677-3"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000200545"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2018457118"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31825fdec7"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22043"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458508094399"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31825fded9"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2010.227942"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008445"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000597"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu15081945"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.2217\/nmt.15.33"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1039\/c6pp00308g"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/135245850607192"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458511423778"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1159\/000329258"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.20703"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22366"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-013-9853-4"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458514530489"},{"key":"e_1_2_9_24_1","unstructured":"Internet\u2010based information:http:\/\/www.scb.se\/en. 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