PM 2.5 exposure as a risk factor for multiple sclerosis. An ecological study with a Bayesian mapping approach
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RESEARCH ARTICLE
PM2.5 exposure as a risk factor for multiple sclerosis. An ecological study with a Bayesian mapping approach Roberto Bergamaschi 1 & Maria Cristina Monti 2 & Leonardo Trivelli 2 & Giulia Mallucci 1,3 Enrico Pisoni 4 & Cristina Montomoli 2
&
Leonardo Gerosa 1 &
Received: 28 April 2020 / Accepted: 23 August 2020 # The Author(s) 2020
Abstract Some environmental factors are associated with an increased risk of multiple sclerosis (MS). Air pollution could be a main one. This study was conducted to investigate the association of particulate matter 2.5 (PM2.5) concentrations with MS prevalence in the province of Pavia, Italy. The overall MS prevalence in the province of Pavia is 169.4 per 100,000 inhabitants. Spatial groundlevel PM2.5 gridded data were analysed, by municipality, for the period 2010–2016. Municipalities were grouped by tertiles according to PM2.5 concentration. Ecological regression and Bayesian statistics were used to analyse the association between PM2.5 concentrations, degree of urbanization, deprivation index and MS risk. MS risk was higher among persons living in areas with an average winter PM2.5 concentration above the European annual limit value (25 μg/m3). The Bayesian map revealed sizeable MS high-risk clusters. The study found a relationship between low MS risk and lower PM2.5 levels, strengthening the suggestion that air pollution may be one of the environmental risk factors for MS. Keywords Multiple sclerosis . Epidemiology . PM2.5 . Air pollution . Bayesian mapping . Ecological study
Introduction Multiple sclerosis (MS) is a complex disorder, likely arising from interactions between numerous genetic factors and several still incompletely clarified environmental factors (Thompson et al. 2018). These environmental factors include diet and vitamin D levels (Ascherio and Munger 2007), both of which have been widely studied. However, air pollution, too, might influence Maria Cristina Monti and Leonardo Trivelli contributed equally to this work. Responsible Editor: Lotfi Aleya * Giulia Mallucci [email protected] 1
European Commission, Joint Research Centre (JRC), Ispra, Italy
2
Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
3
Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
4
European Commission, Joint Research Centre (JRC), Ispra, Italy
the pathogenesis of immune and inflammatory processes in MS through various mechanisms, such as the development of oxidative stress and proinflammatory milieu (Veldhoen et al. 2008) (Odoardi et al. 2012), blood-brain barrier breakdown (Minagar and Alexander 2003; Kooij et al. 2010; Oppenheim et al. 2013), microglia activation (Calderón-Garcidueñas et al. 2002; Li et al. 2005) and vitamin D hypovitaminosis (Hosseinpanah et al. 2010). Air quality is a major concern in northern Italy, especially in the Po Valley (Pianura Padana), a flat area particularly prone to high levels of particulate matter (PM). There are several reasons for this: high anth
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