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Published on: July 12, 2024
An impact of air pollution on moderate to severe relapses among multiple sclerosis patients
Miri Elgabsi1, Lena Novack2, Shaked Yarza3
1Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Background:
Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system with both a genetic and environmental component.
Objective:
In the current study, we examined an association between incidence of MS moderate to severe relapses and exposure to air pollutants and meteorological exposures.
Methods:
We enrolled MS patients in Southern Israel during 2000-2017. Exposure assessment relied on satellite-based model of exposure to particulate matter of size <2.5 and 10 microns (PM2.5, PM10) and temperature at a spatial resolution of 1 km (Kloog et al., 2015). The information on exposure to nitrogen dioxide (NO2), sulfur dioxide (SO2) and ozone (O3) levels was completed from the database of the monitoring stations. We analyzed the data using a semi-ecological approach. The monthly incidence of MS-related relapses requiring hospitalization as a function of environmental factors was analyzed by time-series technique, adjusting to sex, age and smoking. We also used a case-crossover approach to compare environmental exposure of a patient on the day of the relapse with the exposure on the relapse-free days. All estimates were adjusted to the heat index and were divided by IQR.
Results:
There were 287 MS patients in the study, with an average age of 52.8 ± 16.7 years, 37% of them (107) being under 40. Mostly female (66.2%), and 13.6% of the patients smoking (47% non-smoking and 39.4% unknown). PM2.5 was independently associated with MS relapses within the non-smoking population [Relative Risk (RR)=1.28, 95%CI:1.01-1.62]. O3 was found adversely associated with MS relapses among patients younger than 40 [RR=1.58, 95%CI 1.03-4.43]. Based on the case-crossover approach, relapses were associated with elevated levels of PM10 and NO2 in all subjects [Odds Ratio (OR)=1.05, 95%CI:1.00-1.11; OR=1.85, 95%CI: 1.28-2.68, respectively]. An adverse association with PM2.5 was observed in non-smokers [OR 1.12, 95%CI 1.00-1.25].
Conclusions:
The findings show that MS relapses are adversely associated with an ambient exposure to PM and NO2.
Insights
Exposure to particulate matter (PM) and nitrogen dioxide (NO2) is linked to increased Multiple Sclerosis (MS) relapses. This study highlights environmental factors impacting MS disease activity, particularly in non-smokers and younger individuals.
Area of Science:
- Environmental Health
- Neurology
- Epidemiology
Background:
- Multiple Sclerosis (MS) is a chronic central nervous system inflammatory disease with genetic and environmental influences.
- Understanding environmental triggers for MS relapses is crucial for disease management.
Purpose of the Study:
- To investigate the association between exposure to specific air pollutants and meteorological factors and the incidence of moderate to severe MS relapses.
- To analyze these associations using both semi-ecological and case-crossover epidemiological approaches.
Main Methods:
- A cohort of 287 MS patients in Southern Israel (2000-2017) was studied.
- Exposure to PM2.5, PM10, NO2, SO2, and O3 was assessed using satellite-based models and monitoring stations.
- Time-series and case-crossover analyses were employed, adjusting for relevant covariates.
Main Results:
- Particulate matter (PM2.5) showed an independent association with MS relapses in non-smokers (RR=1.28).
- Ozone (O3) was linked to increased relapses in patients under 40 (RR=1.58).
- Elevated PM10 and NO2 levels were associated with relapses across all subjects (OR=1.05 and OR=1.85, respectively).
Conclusions:
- Ambient exposure to particulate matter (PM) and nitrogen dioxide (NO2) is adversely associated with MS relapses.
- These findings underscore the role of air pollution as an environmental risk factor in MS exacerbations.
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