Climate Change Associated with Declining Clinical Outcomes in Myasthenia Gravis for US States with the Greatest Temperature Increase
Kazim Jaffry1, Scott Karpenos1, James Lin1, Justin Matos1, Narjis Jaffry1, Suhayb Islam1, Kranthi Mandava1, Nizar Souayah1
1Rutgers New Jersey Medical School
Objective:
To investigate the effect of climate change and global warming on myasthenia gravis (MG) mortality and exacerbation in US states with the greatest and least increase in temperature.
Background:
The effect of temperature changes on neuromuscular junction transmission in MG is well known. The effect of global warming inducing ambient temperature increase over time is less understood.
Design/Methods:
A retrospective analysis was conducted from EPIC Electronic Medical Record System data. 5,538 MG patients were identified from 2007-2009 (P1 period) and 85,008 MG patients from 2020-2022 (P2 period). The 5 states (SHT: Alaska, Florida, West Virginia, Ohio, Pennsylvania) with the greatest temperature increase and 5 states (SLT: Oklahoma, North Dakota, Missouri, Kansas, Arkansas) with the lowest temperature increase between P1 and P2 were identified from the National Centers for Environmental Information database.
Results:
P2 patients had a higher mortality rate (P2/P1: 6.5%±0.16% vs 1.7%±0.33%; p<0.05), rate of MG exacerbation (P2/P1: 16.9%±0.25% vs 12.2%±0.86%; p<0.05) and were younger (P2/P1: 67±0.12 years vs 71±0.48 years; p<0.05) than P1 patients. There was no significant difference in average length of hospitalization between P1 and P2 (P2/P1:6.7±0.18 days vs 6±0.87 days). The average increase in temperature from P1 to P2 was 0.28°C. In SLT, from P1 to P2, there was no significant increase in MG exacerbation rate (P2/P1:18.0%±1.2% vs 16.5%±4.7%). In SHT, from P1 to P2, there was a significant increase in the rate of MG exacerbation (P2/P1:18.5%±0.52 vs 15.9%±1.9%; p<0.05). The mean temperature increases were SHT: 0.86°C±0.13°C and SLT: 0.14°C±0.07°C.
Conclusions:
Despite progress in MG management with the availability of more disease modifiers, there was a significant increase in MG mortality and in MG exacerbation rate in P2 compared to P1. Notably, this was greater in SHT than SLT. Work is in progress to adjust to socioeconomic and demographic factors, comorbid conditions, other climate factors, and MG disease modifiers.