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, Irene Schiavetti, Roberto Bergamaschi, Enrico Pisoni, Andrea Bellavia, Giulia Mallucci, Luca Carmisciano, Matilde Inglese, Cinzia Cordioli, Girolama Alessandra Marfia, Eleonora Cocco, Paolo Immovilli, Ilaria Pesci, Cinzia Scandellari, Paola Cavalla, Marta Radaelli, Marika Vianello, Francesca Vitetta, Sara Montepietra, Maria Pia Amato, Cristina Fioretti, Massimo Filippi, Arianna Sartori, Francesca Caleri, Marinella Clerico, Antonio Gallo, Antonella Conte, Raffaella Clerici, Giovanna De Luca, Filippo Martinelli Boneschi, Roberto Cantello, Massimiliano Calabrese, Carla Tortorella, Marco Rovaris, Elena Pinuccia Verrengia, Francesco Patti, Vincenzo Brescia Morra, Marco Salvetti, Maria Pia Sormani, Abbadessa Gianmarco, Aguglia Umberto, Allegorico Lia, Allegri Rossi Beatrice Maria, A Semenova Anastasia, Amato Maria Pia, Annovazzi Pietro, Antozzi Carlo, A Ferreira Ana Lucia, Arena Sebastiano, Viola Baione, Balgera Roberto, Barcella Valeria, Baroncini Damiano, Barrilà Caterina, Battaglia Mario A, Bellacosa Alessandra, Bellucci Gianmarco, Roberto Bergamaschi, Bergamaschi Valeria, Bezzini Daiana, Biolzi Beatrice, Alvino Bisecco, Simona Bonavita, Giovanna Borriello, Bosa Chiara, Bosco Antonio, Bovis Francesca, Marco Bozzali, Laura Brambilla, B Vincenzo, Brichetto Giampaolo, Buccafusca Maria, Bucciantini Elisabetta, Bucello Sebastiano, Buscarinu Maria Chiara, Cabboi Maria Paola, Calabrese Massimiliano, Calabria Francesca, Caleri Francesca, Camilli Federico, Caniatti Luisa Maria, Cantello Roberto, Capobianco Marco, Ruggero Capra, Rocco Capuano, Carmisciano Luca, Carta Patrizia, Paola Cavalla, Celani Maria Grazia, Cellerino Maria, Raffaella Cerqua, Chisari Clara, C. Raffaella, Marinella Clerico, Cocco Eleonora, Cola Gaia, Comi Giancarlo, C Paolo, Antonella Conte, Conti Marta Zaffira
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.