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. 2022 Dec:68:104243.
doi: 10.1016/j.msard.2022.104243. Epub 2022 Oct 20.

The impact of PM2.5, PM10 and NO2 on Covid-19 severity in a sample of patients with multiple sclerosis: A case-control study

Marta Ponzano  1 , Irene Schiavetti  2 , Roberto Bergamaschi  3 , Enrico Pisoni  4 , Andrea Bellavia  5 , Giulia Mallucci  3 , Luca Carmisciano  2 , Matilde Inglese  6 , Cinzia Cordioli  7 , Girolama Alessandra Marfia  8 , Eleonora Cocco  9 , Paolo Immovilli  10 , Ilaria Pesci  11 , Cinzia Scandellari  12 , Paola Cavalla  13 , Marta Radaelli  14 , Marika Vianello  15 , Francesca Vitetta  16 , Sara Montepietra  17 , Maria Pia Amato  18 , Cristina Fioretti  19 , Massimo Filippi  20 , Arianna Sartori  21 , Francesca Caleri  22 , Marinella Clerico  23 , Antonio Gallo  24 , Antonella Conte  25 , Raffaella Clerici  26 , Giovanna De Luca  27 , Filippo Martinelli Boneschi  28 , Roberto Cantello  29 , Massimiliano Calabrese  30 , Carla Tortorella  31 , Marco Rovaris  32 , Elena Pinuccia Verrengia  33 , Francesco Patti  34 , Vincenzo Brescia Morra  35 , Marco Salvetti  36 , Maria Pia Sormani  37 ; MuSC-19 Study Group
Affiliations

The impact of PM2.5, PM10 and NO2 on Covid-19 severity in a sample of patients with multiple sclerosis: A case-control study

Marta Ponzano et al. Mult Scler Relat Disord. 2022 Dec.

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.

Keywords: Air pollution; Covid-19 severity; Environmental mixture; Multiple sclerosis.

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Conflict of interest statement

Declaration of Competing Interest Sormani MP received consulting fees from Roche, Biogen, Merck, Novartis, Sanofi, Celgene, Immunic, Geneuro, GSK, Medday; received payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Roche, Biogen Merck, Novartis, Sanofi, Celgene; participated on a Data Safety Monitoring Board or Advisory Board for Roche, Sanofi, Novartis, Merck. Caleri F received honoraria for lectures or presentation from Biogen, Merck, Teva, Novartis, Sanofi-Genzyme, Roche; received support for attending meeting and travel grant from Biogen, Merck, Teva, Novartis, Sanofi-Genzyme, Roche; received honoraria for participation on Advisory Boards from Biogen, Merck, Teva, Novartis, Sanofi-Genzyme, Roche. Cordioli C received grants or contracts from Roche, Novartis, Merck Serono, Biogen, Celgene; received consulting fees from Biogen. Inglese M received grants or contracts from FISM, INAIL, European Union. Salvetti M received grants or contracts from Biogen, Merck, Novartis; received payments or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Biogen, Merck, Novartis, Roche, Sanofi. R. Bergamaschi has served on scientific advisory boards for Biogen, Merck‐Serono, Novartis, Sanofi‐Genzyme; received research support from Almirall, Bayer, Biogen, Merck‐Serono, Novartis, Sanofi‐Genzyme; received support for travel and congress from Biogen, Roche, Merck‐Serono, Sanofi‐Genzyme, Teva; received honoraria for speaking engagements from Biogen, Merck‐Serono, Novartis, Sanofi‐Genzyme. M. Filippi is Editor‐in‐Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Associate Editor of Radiology and Associate Editor of Neurological Sciences; received compensation for consulting services and/or speaking activities from Alexion, Almirall, Bayer, Biogen, Celgene, Eli Lilly, Genzyme, Merck‐Serono, Novartis, Roche, Sanofi, Takeda and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck‐Serono, Novartis, Roche, Teva Pharmaceutical Industries, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla and ARiSLA (Fondazione Italiana di Ricerca per la SLA). He received speaker honoraria from the following companies: Biogen, Merck, Novartis, Roche, Sanofi‐Genzyme and TEVA. M. Radaelli received speaker honoraria from Biogen Idec, Sanofi‐Genzyme, Novartis and Merck Serono and funding for travel to scientific meetings from Biogen Idec, Sanofi‐Genzyme, Novartis, Merck Serono, Teva and Roche. P. Immovilli reports personal fees from Roche, personal fees from Biogen, personal fees from Merck, outside the submitted work. V. Brescia Morra has received funding for travel, speaker honoraria, advisory board and research support from Merck Serono, Novartis, Biogen Idec, TEVA, Genzyme, Roche, Bayer, Almirall. G. Comi reports personal fees from Novartis, Teva Pharmaceutical Industries Ltd, Teva Italia Srl, Sanofi Genzyme, Genzyme Corporation, Genzyme Europe, Merck KGaA, Merck Serono SpA, Celgene Group, Biogen Idec, Biogen Italia Srl, F. Hoffman‐La Roche, Roche SpA, Almirall SpA, Forward Pharma, Medday, Excemed, outside the submitted work. F. Patti reports grants from Biogen, grants from Merck, grants from FISM, grants from Onlus association, grants from University of Catania, personal fees from Almirall, personal fees from Bayer, personal fees from Biogen, personal fees from Merck, personal fees from Roche, personal fees from Sanofi, personal fees from TEVA, outside the submitted work.

Figures

Fig 1
Fig. 1
Flowchart describing the patients included in the principal analysis and in the sensitivity analysis.
Fig 2
Fig. 2
Average observed annual concentrations of PM2.5 (Panel A), PM10 (Panel B), NO2 (Panel C) and proportion of cases of Covid-19 pneumonia occurred (Panel D). Observed averages and proportions refer to the 491 patients included in the principal analysis and areas where no patients were included are in gray.
Fig 3
Fig. 3
Pearson correlation coefficients between the components of the mixture.
Fig 4
Fig. 4
WQS logistic covariates-adjusted models: WQS index weights for positive direction. The dashed line indicates the selection threshold.
See this image and copyright information in PMC

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