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

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.

Informations de copyright

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Déclaration de conflit d'intérêts

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.