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Ponzano M, Schiavetti I, Bergamaschi R, Pisoni E, Bellavia A, Mallucci G, Carmisciano L, Inglese M, Cordioli C, Marfia GA, Cocco E, Immovilli P, Pesci I, Scandellari C, Cavalla P, Radaelli M, Vianello M, Vitetta F, Montepietra S, Amato MP, Fioretti C, Filippi M, Sartori A, Caleri F, Clerico M, Gallo A, Conte A, Clerici R, De Luca G, Boneschi FM, Cantello R, Calabrese M, Tortorella C, Rovaris M, Verrengia EP, Patti F, Morra VB, Salvetti M, Sormani MP. The impact of PM2.5, PM10 and NO2 on Covid-19 severity in a sample of patients with multiple sclerosis: A case-control study. Mult Scler Relat Disord 2022; 68:104243. [PMID: 36288659 PMCID: PMC9581645 DOI: 10.1016/j.msard.2022.104243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/19/2022] [Accepted: 10/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Many studies investigated the association between air pollution and Covid-19 severity but the only study focusing on patients with Multiple Sclerosis (MS) exclusively evaluated exposure to PM2.5. We aim to study, in a sample of MS patients, the impact of long-term exposure to PM2.5, PM10 and NO2 on Covid-19 severity, described as occurrence of pneumonia. METHODS A 1:2 ratio case-control study was designed, differentiating cases and controls based on Covid-19 pneumonia. Associations between pollutants and outcome were studied using logistic regression. Weighted quantile sum (WQS) logistic regression was used to identify the individual contribution of each pollutant within the mixture; Least Absolute Shrinkage and Selection Operator (LASSO) penalized regression was performed to confirm the variable selection from WQS. All the analyses were adjusted for confounders selected a priori. RESULTS Of the 615 eligible patients, 491 patients provided detailed place of exposure and were included in the principal analysis. Higher concentrations of air pollutants were associated with increased odds of developing Covid-19 pneumonia (PM2.5: 3rd vs 1st tercile OR(95% CI)=2.26(1.29;3.96); PM10: 3rd vs 1st tercile OR(95% CI)=2.12(1.22;3.68); NO2: 3rd vs 1st tercile OR(95% CI)=2.12(1.21;3.69)). Pollutants were highly correlated with each other; WQS index was associated to an increased risk of pneumonia (β=0.44; p-value=0.004) and the main contributors to this association were NO2 (41%) and PM2.5 (34%). Consistently, Lasso method selected PM2.5 and NO2. CONCLUSIONS Higher long-term exposure to PM2.5, PM10 and NO2 increased the odds of Covid-19 pneumonia among MS patients and the most dangerous pollutants were NO2 and PM2.5.
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Affiliation(s)
- Marta Ponzano
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy.
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy
| | | | - Enrico Pisoni
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Andrea Bellavia
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Giulia Mallucci
- Multiple Sclerosis Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Luca Carmisciano
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Montichiari, Italy
| | - Girolama Alessandra Marfia
- Department of Systems Medicine, Multiple Sclerosis Clinical and Research Unit, Tor Vergata University, Rome, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Ospedale Binaghi, Cagliari, Italy
| | - Paolo Immovilli
- Multiple Sclerosis Center, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, UO Neurology, Fidenza, Fidenza, Italy
| | - Cinzia Scandellari
- IRCCS Institute of Neurological Sciences, UOSI Multiple Sclerosis Rehabilitation, Bologna, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Marika Vianello
- Unit of Neurology, Ca' Fancello Hospital, AULSS2, Treviso, Italy
| | - Francesca Vitetta
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Sara Montepietra
- Neurology Unit, Neuromotor and Rehabilitation Department, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, ASUGI, University of Trieste, Trieste, Italy
| | - Francesca Caleri
- Department of Neurology, MS Center, F. Tappeiner Hospital, Merano, Italy
| | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Turin, Turin, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, (NA), Italy
| | - Antonella Conte
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | | | - Giovanna De Luca
- Institute for Advanced Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | | | - Roberto Cantello
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Massimiliano Calabrese
- Department of Neuroscience, Biomedicine and Movement, The Multiple Sclerosis Center of the University Hospital of Verona, Verona, Italy
| | - Carla Tortorella
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | | | | | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Federico II University, Naples, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy; Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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