Long-term exposure to air pollution and the incidence of multiple sclerosis: A population-based cohort study

Bai, Li; Burnett, Richard T.; Kwong, Jeffrey C.; Hystad, Perry; Donkelaar, Aaron van; Brook, Jeffrey R.; Tu, Karen; Copes, Ray; Goldberg, Mark S.; Martin, Randall V.; Murray, Brian J.; Kopp, Alexander; Chen, Hong

doi:10.1016/j.envres.2018.06.003

Cited by 41 publications

(31 citation statements)

References 42 publications

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“…The few studies available failed to find an association between exposure to PM2.5 and MS incidence. 13–15 However, these studies differ in the methodological approach, in the patient populations analyzed and in the average PM2.5 concentrations detected in the study territory. To date, no study has investigated the prevalence of MS in relation to the exposure to PM2.5 in a large industrialized and highly polluted area of Italy.…”

Section: Introductionmentioning

confidence: 99%

PM2.5 levels strongly associate with multiple sclerosis prevalence in the Province of Padua, Veneto Region, North-East Italy

et al. 2018

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Background: Incidence and prevalence trends of multiple sclerosis (MS) in the Province of Padua, North-East Italy, suggest that environmental factors may be associated with increased MS risk. Objective: To investigate the association of PM2.5 with MS prevalence in one of the most polluted geographical area of Italy. Methods: In total, 1435 Italian MS patients residing in the Province of Padua were enrolled. The province surface was classified into urban areas, isolated villages, industrialized places, and countryside. Satellite-derived dust-free and sea salt-free PM2.5 concentrations (annual average 1998–2015, μg/m3) allowed the identification of 18 classes of territorial sections with statistically evaluable numbers of inhabitants. Possible correlations between residential locality types, PM2.5 concentrations, and MS prevalence were investigated. Results: MS prevalence was significantly ( p < 0.0001) higher in urban areas (ranging from 219 in Padua City to 169/100,000 in other urban areas) compared to isolated villages (116/100,000) or rural domains (109/100,000) and strongly correlated with the annual average concentration of PM2.5 ( r = 0.81, p < 0.001). Regression analysis further associated MS cases with PM.2.5 average concentration ( β = 0.11, p < 0.001). Conclusion: In the Province of Padua, MS prevalence is strongly associated with PM2.5 exposure suggesting that air pollutants may be one of the possible environmental risk factors for MS.

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Section: Introductionmentioning

confidence: 99%

PM2.5 levels strongly associate with multiple sclerosis prevalence in the Province of Padua, Veneto Region, North-East Italy

et al. 2018

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“…Tehran has been recognized as one of the most polluted cities in the world [27]. Although some studies have not reported a significant association between MS and air pollution markers such as PM 2.5 , NO 2 , and O 3 [28], several studies [23][24][25] have shown some evidences that air pollution can have a significant relationship with the incidence and recurrence of MS. Air pollution leads to deficiency of vitamin D, production of excessive free radical, expression of inflammatory factors, induction of chronic inflammation, dysfunction of mitochondrial, and increase of oxidative stress, all of which can be linked to MS incidence and recurrence [24,25]. Therefore, as previous studies have shown [29], it can be hypothesized that a portion of the high prevalence of MS in Tehran may be attributable to the air pollution.…”

Section: Discussionmentioning

confidence: 99%

Evidence of an increased prevalence of multiple sclerosis: a population-based study of Tehran registry during 1999–2018

2020

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Background: The epidemiological characteristics of multiple sclerosis (MS) have been investigated in various studies, which have revealed that the prevalence of MS varies across countries. The present study was conducted to investigate the longitudinal prevalence of MS in Tehran, Iran. Methods: The present population-based study was conducted in Tehran, the capital of Iran from 1999 to 2018 based on the annual report data provided by the Iranian MS Society (IMSS) registry system. The age-standardized and crude prevalence were estimated using population data presented by the Statistical Centre of Iran. Results: A total of 21,580 MS cases were registered and included in the analysis. Among the participant patients, 24.99% (5393) and 75.01% (16,187) of cases were male and female, respectively. The mean age of MS onset was 28.8 years (S.D: 8.7). The age-standardized prevalence (ASP) of MS increased from 73.7 (95%CI: 72.1-75.2) per 100,000 people in 2006 to 137.6 (95% CI: 135.7-139.5) per 100,000 people in 2018. The ASP of MS in 2018 was estimated to be 67.9 (95%CI: 66.0-69.8) and 207.3 (95%CI: 204.0-210.7) per 100,000 people among males and females, respectively. The age-standardized female-to-male ratio of MS ranged from 3.7 (in 2010) to 2.06 (in 2017). Conclusion: The findings of this study suggested that the prevalence of MS in Tehran province is relatively high, and the occurrence of the disease is more common in the age groups under 40 years as compared with olderaged groups. In line with reports provided for various regions of the world, the prevalence of MS was higher among women. Similarly, the findings of this study revealed that the female-to-male ratio was 2.14 in 2018.

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“…Another limitation was that in this study we focused only on the statistical test results while assessing the effect size gives additional information about the extent of the effected values. Since the incidence and prevalence rates are different in male and female [20], further investigations on the impact of other important covariates, such as climate, sunlight, and air pollution should be conducted [13,17,[44][45][46][47][48].…”

Section: Discussionmentioning

confidence: 99%

Multiple Sclerosis incidence rate in southern Iran: A Bayesian epidemiological study

Asmarian

Sharafi

Mousavi

et al. 2020

Preprint

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Background: Multiple Sclerosis (MS) remains to be a public health challenge, due to its unknown biological mechanism and clinical impact on young people. The prevalence of this disease in Iran is reported to be 5.3 to 74.28 per 100000 cases. Due to high prevalence of this disease in Fars province, this study aimed to assess the distribution of MS in this region in southern Iran by evaluating its covariates.Method: Data from 5,468 patients diagnosed with MS were collected, according to the McDonald’s criteria, which was reported by the MS Society of Fars from 1991 until 2016. Bayesian spatio-temporal models was also used to describe MS incidence in Fars province. We also investigated the association between overall MS incidence rate and the overall percentage of vitamin D intake, smokers in the population as well as the overall percentage of people with normal BMI as well as alcohol consumption in a population from 1991 until 2016 by Besag, York and Mollie's (BYM) model.Results: County-level crude incidence rates ranged from 0.22 to 11.31 cases per 100,000 population. The highest relative risk was estimated at 1.8 in the city of Shiraz, the capital of Fars province while the lowest relative risk was estimated at 0.11 in Zarindasht County in southern Fars. The percentages of vitamin D3 intake was significantly associated with the incidence of MS. Although 1% increase in Vitamin D3 intake is associated with 2% decrease in the risk of MS, 1% increase in smoking is associated with 16% increase in the risk of MS, respectively.Conclusion: Spatial analysis of MS showed low incidence rate of this disease in the south and south east of Fars province, which is due to the effect of different covariates. As suggested by previous studies, vitamin D and smoking among all covaiates might be associated with high incidence of MS.

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Long-term exposure to air pollution and the incidence of multiple sclerosis: A population-based cohort study

Cited by 41 publications

References 42 publications

PM2.5 levels strongly associate with multiple sclerosis prevalence in the Province of Padua, Veneto Region, North-East Italy

PM2.5 levels strongly associate with multiple sclerosis prevalence in the Province of Padua, Veneto Region, North-East Italy

Evidence of an increased prevalence of multiple sclerosis: a population-based study of Tehran registry during 1999–2018

Multiple Sclerosis incidence rate in southern Iran: A Bayesian epidemiological study

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