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Alari A, Ranzani O, Olmos S, Milà C, Rico A, Ballester J, Basagaña X, Dadvand P, Duarte-Salles T, Nieuwenhuijsen M, Vivanco-Hidalgo RM, Tonne C. Short-term exposure to air pollution and hospital admission after COVID-19 in Catalonia: the COVAIR-CAT study. Int J Epidemiol 2024; 53:dyae041. [PMID: 38514998 DOI: 10.1093/ije/dyae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/01/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND A growing body of evidence has reported positive associations between long-term exposure to air pollution and poor COVID-19 outcomes. Inconsistent findings have been reported for short-term air pollution, mostly from ecological study designs. Using individual-level data, we studied the association between short-term variation in air pollutants [nitrogen dioxide (NO2), particulate matter with a diameter of <2.5 µm (PM2.5) and a diameter of <10 µm (PM10) and ozone (O3)] and hospital admission among individuals diagnosed with COVID-19. METHODS The COVAIR-CAT (Air pollution in relation to COVID-19 morbidity and mortality: a large population-based cohort study in Catalonia, Spain) cohort is a large population-based cohort in Catalonia, Spain including 240 902 individuals diagnosed with COVID-19 in the primary care system from 1 March until 31 December 2020. Our outcome was hospitalization within 30 days of COVID-19 diagnosis. We used individual residential address to assign daily air-pollution exposure, estimated using machine-learning methods for spatiotemporal prediction. For each pandemic wave, we fitted Cox proportional-hazards models accounting for non-linear-distributed lagged exposure over the previous 7 days. RESULTS Results differed considerably by pandemic wave. During the second wave, an interquartile-range increase in cumulative weekly exposure to air pollution (lag0_7) was associated with a 12% increase (95% CI: 4% to 20%) in COVID-19 hospitalizations for NO2, 8% (95% CI: 1% to 16%) for PM2.5 and 9% (95% CI: 3% to 15%) for PM10. We observed consistent positive associations for same-day (lag0) exposure, whereas lag-specific associations beyond lag0 were generally not statistically significant. CONCLUSIONS Our study suggests positive associations between NO2, PM2.5 and PM10 and hospitalization risk among individuals diagnosed with COVID-19 during the second wave. Cumulative hazard ratios were largely driven by exposure on the same day as hospitalization.
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Affiliation(s)
- Anna Alari
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Otavio Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sergio Olmos
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carles Milà
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alex Rico
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joan Ballester
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
| | - Xavier Basagaña
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Payam Dadvand
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mark Nieuwenhuijsen
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Cathryn Tonne
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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2
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Houweling L, Maitland-Van der Zee AH, Holtjer JCS, Bazdar S, Vermeulen RCH, Downward GS, Bloemsma LD. The effect of the urban exposome on COVID-19 health outcomes: A systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2024; 240:117351. [PMID: 37852458 DOI: 10.1016/j.envres.2023.117351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The global severity of SARS-CoV-2 illness has been associated with various urban characteristics, including exposure to ambient air pollutants. This systematic review and meta-analysis aims to synthesize findings from ecological and non-ecological studies to investigate the impact of multiple urban-related features on a variety of COVID-19 health outcomes. METHODS On December 5, 2022, PubMed was searched to identify all types of observational studies that examined one or more urban exposome characteristics in relation to various COVID-19 health outcomes such as infection severity, the need for hospitalization, ICU admission, COVID pneumonia, and mortality. RESULTS A total of 38 non-ecological and 241 ecological studies were included in this review. Non-ecological studies highlighted the significant effects of population density, urbanization, and exposure to ambient air pollutants, particularly PM2.5. The meta-analyses revealed that a 1 μg/m3 increase in PM2.5 was associated with a higher likelihood of COVID-19 hospitalization (pooled OR 1.08 (95% CI:1.02-1.14)) and death (pooled OR 1.06 (95% CI:1.03-1.09)). Ecological studies, in addition to confirming the findings of non-ecological studies, also indicated that higher exposure to nitrogen dioxide (NO2), ozone (O3), sulphur dioxide (SO2), and carbon monoxide (CO), as well as lower ambient temperature, humidity, ultraviolet (UV) radiation, and less green and blue space exposure, were associated with increased COVID-19 morbidity and mortality. CONCLUSION This systematic review has identified several key vulnerability features related to urban areas in the context of the recent COVID-19 pandemic. The findings underscore the importance of improving policies related to urban exposures and implementing measures to protect individuals from these harmful environmental stressors.
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Affiliation(s)
- Laura Houweling
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands; Dept. of Pulmonary Medicine, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Anke-Hilse Maitland-Van der Zee
- Dept. of Pulmonary Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands; Amsterdam Public Health, Amsterdam, the Netherlands
| | - Judith C S Holtjer
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Somayeh Bazdar
- Dept. of Pulmonary Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands; Amsterdam Public Health, Amsterdam, the Netherlands
| | - Roel C H Vermeulen
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - George S Downward
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lizan D Bloemsma
- Dept. of Pulmonary Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands; Amsterdam Public Health, Amsterdam, the Netherlands
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3
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Marchetti S, Gualtieri M, Pozzer A, Lelieveld J, Saliu F, Hansell AL, Colombo A, Mantecca P. On fine particulate matter and COVID-19 spread and severity: An in vitro toxicological plausible mechanism. ENVIRONMENT INTERNATIONAL 2023; 179:108131. [PMID: 37586275 DOI: 10.1016/j.envint.2023.108131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 08/18/2023]
Abstract
COVID-19 pandemic had a significant impact on global public health. The spread of the disease was related to the high transmissibility of SARS-CoV-2 virus but incidence and mortality rate suggested a possible relationship with environmental factors. Air pollution has been hypothesized to play a role in the transmission of the virus and the resulting severity of the disease. Here we report a plausible in vitro toxicological mode of action by which fine particulate matter (PM2.5) could promote a higher infection rate of SARS-CoV-2 and severity of COVID-19 disease. PM2.5 promotes a 1.5 fold over-expression of the angiotensin 2 converting enzyme (ACE2) which is exploited by viral particles to enter human lung alveolar cells (1.5 fold increase in RAB5 protein) and increases their inflammatory state (IL-8 and NF-kB protein expression). Our results provide a basis for further exploring the possible synergy between biological threats and air pollutants and ask for a deeper understanding of how air quality could influence new pandemics in the future.
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Affiliation(s)
- S Marchetti
- POLARIS Research Centre, Dept. of Earth and Environmental Sciences, University of Milano-Bicocca, Italy
| | - M Gualtieri
- POLARIS Research Centre, Dept. of Earth and Environmental Sciences, University of Milano-Bicocca, Italy.
| | - A Pozzer
- Max Planck Institute for Chemistry, Atmospheric Chemistry Department, Mainz, Germany
| | - J Lelieveld
- Max Planck Institute for Chemistry, Atmospheric Chemistry Department, Mainz, Germany
| | - F Saliu
- POLARIS Research Centre, Dept. of Earth and Environmental Sciences, University of Milano-Bicocca, Italy
| | - A L Hansell
- Centre for Environmental Health and Sustainability, University of Leicester, United Kingdom; National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Environmental Exposures and Health at the University of Leicester, United Kingdom; National Institute for Health Research NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, United Kingdom
| | - A Colombo
- POLARIS Research Centre, Dept. of Earth and Environmental Sciences, University of Milano-Bicocca, Italy
| | - P Mantecca
- POLARIS Research Centre, Dept. of Earth and Environmental Sciences, University of Milano-Bicocca, Italy
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de la Fuente J, Armas O, Barroso-Arévalo S, Gortázar C, García-Seco T, Buendía-Andrés A, Villanueva F, Soriano JA, Mazuecos L, Vaz-Rodrigues R, García-Contreras R, García A, Monsalve-Serrano J, Domínguez L, Sánchez-Vizcaíno JM. Good and bad get together: Inactivation of SARS-CoV-2 in particulate matter pollution from different fuels. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 844:157241. [PMID: 35817121 PMCID: PMC9264720 DOI: 10.1016/j.scitotenv.2022.157241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/09/2022] [Accepted: 07/05/2022] [Indexed: 05/15/2023]
Abstract
Air pollution and associated particulate matter (PM) affect environmental and human health worldwide. The intense vehicle usage and the high population density in urban areas are the main causes of this public health impact. Epidemiological studies have provided evidence on the effect of air pollution on airborne SARS-CoV-2 transmission and COVID-19 disease prevalence and symptomatology. However, the causal relationship between air pollution and COVID-19 is still under investigation. Based on these results, the question addressed in this study was how long SARS-CoV-2 survives on the surface of PM from different origin to evaluate the relationship between fuel and atmospheric pollution and virus transmission risk. The persistence and viability of SARS-CoV-2 virus was characterized in 5 engine exhaust PM and 4 samples of atmospheric PM10. The results showed that SARS-CoV-2 remains on the surface of PM10 from air pollutants but interaction with engine exhaust PM inactivates the virus. Consequently, atmospheric PM10 levels may increase SARS-CoV-2 transmission risk thus supporting a causal relationship between these factors. Furthermore, the relationship of pollution PM and particularly engine exhaust PM with virus transmission risk and COVID-19 is also affected by the impact of these pollutants on host oxidative stress and immunity. Therefore, although fuel PM inactivates SARS-CoV-2, the conclusion of the study is that both atmospheric and engine exhaust PM negatively impact human health with implications for COVID-19 and other diseases.
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Affiliation(s)
- José de la Fuente
- SaBio, Instituto de Investigación en Recursos Cinegéticos IREC-CSIC-UCLM-JCCM, Ronda de Toledo s/n, 13005 Ciudad Real, Spain; Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA.
| | - Octavio Armas
- Escuela de Ingeniería Industrial y Aeroespacial, Universidad de Castilla - La Mancha, Campus de Excelencia Internacional en Energía y Medioambiente, Real Fábrica de Armas, Edif. Sabatini, Av. Carlos III, s/n, 45071 Toledo, Spain
| | - Sandra Barroso-Arévalo
- VISAVET Health Surveillance Centre, Universidad Complutense de Madrid, Puerta de Hierro s/n, 28040 Madrid, Spain; Department of Animal Health, Faculty of Veterinary, Universidad Complutense de Madrid, Av. Puerta de Hierro s/n, 28040 Madrid, Spain
| | - Christian Gortázar
- SaBio, Instituto de Investigación en Recursos Cinegéticos IREC-CSIC-UCLM-JCCM, Ronda de Toledo s/n, 13005 Ciudad Real, Spain
| | - Teresa García-Seco
- VISAVET Health Surveillance Centre, Universidad Complutense de Madrid, Puerta de Hierro s/n, 28040 Madrid, Spain
| | - Aránzazu Buendía-Andrés
- VISAVET Health Surveillance Centre, Universidad Complutense de Madrid, Puerta de Hierro s/n, 28040 Madrid, Spain
| | - Florentina Villanueva
- Instituto de Investigación en Combustión y Contaminación Atmosférica, Universidad de Castilla La Mancha, Camino de Moledores s/n, 13071 Ciudad Real, Spain; Parque Científico y Tecnológico de Castilla La Mancha, Paseo de La Innovación 1, 02006 Albacete, Spain
| | - José A Soriano
- Escuela de Ingeniería Industrial y Aeroespacial, Universidad de Castilla - La Mancha, Campus de Excelencia Internacional en Energía y Medioambiente, Real Fábrica de Armas, Edif. Sabatini, Av. Carlos III, s/n, 45071 Toledo, Spain
| | - Lorena Mazuecos
- SaBio, Instituto de Investigación en Recursos Cinegéticos IREC-CSIC-UCLM-JCCM, Ronda de Toledo s/n, 13005 Ciudad Real, Spain
| | - Rita Vaz-Rodrigues
- SaBio, Instituto de Investigación en Recursos Cinegéticos IREC-CSIC-UCLM-JCCM, Ronda de Toledo s/n, 13005 Ciudad Real, Spain
| | - Reyes García-Contreras
- Escuela de Ingeniería Industrial y Aeroespacial, Universidad de Castilla - La Mancha, Campus de Excelencia Internacional en Energía y Medioambiente, Real Fábrica de Armas, Edif. Sabatini, Av. Carlos III, s/n, 45071 Toledo, Spain
| | - Antonio García
- CMT-Motores Térmicos, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Javier Monsalve-Serrano
- CMT-Motores Térmicos, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Lucas Domínguez
- VISAVET Health Surveillance Centre, Universidad Complutense de Madrid, Puerta de Hierro s/n, 28040 Madrid, Spain; Department of Animal Health, Faculty of Veterinary, Universidad Complutense de Madrid, Av. Puerta de Hierro s/n, 28040 Madrid, Spain
| | - José Manuel Sánchez-Vizcaíno
- VISAVET Health Surveillance Centre, Universidad Complutense de Madrid, Puerta de Hierro s/n, 28040 Madrid, Spain; Department of Animal Health, Faculty of Veterinary, Universidad Complutense de Madrid, Av. Puerta de Hierro s/n, 28040 Madrid, Spain
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Hogerwerf L, Post PM, Bom B, van der Hoek W, van de Kassteele J, Stemerding AM, de Vries W, Houthuijs D. Proximity to livestock farms and COVID-19 in the Netherlands, 2020-2021. Int J Hyg Environ Health 2022; 245:114022. [PMID: 35987164 PMCID: PMC9376334 DOI: 10.1016/j.ijheh.2022.114022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/12/2022] [Accepted: 08/08/2022] [Indexed: 12/01/2022]
Abstract
Objectives In the Netherlands, during the first phase of the COVID-19 epidemic, the hotspot of COVID-19 overlapped with the country's main livestock area, while in subsequent phases this distinct spatial pattern disappeared. Previous studies show that living near livestock farms influence human respiratory health and immunological responses. This study aimed to explore whether proximity to livestock was associated with SARS-CoV-2 infection. Methods The study population was the population of the Netherlands excluding the very strongly urbanised areas and border areas, on January 1, 2019 (12, 628, 244 individuals). The cases are the individuals reported with a laboratory-confirmed positive SARS-CoV-2 test with onset before January 1, 2022 (2, 223, 692 individuals). For each individual, we calculated distance to nearest livestock farm (cattle, goat, sheep, pig, poultry, horse, rabbit, mink). The associations between residential (6-digit postal-code) distance to the nearest livestock farm and individuals' SARS-CoV-2 status was studied with multilevel logistic regression models. Models were adjusted for individuals' age categories, the social status of the postal code area, particulate matter (PM10)- and nitrogen dioxide (NO2)-concentrations. We analysed data for the entire period and population as well as separately for eight time periods (Jan–Mar, Apr–Jun, Jul–Sep and Oct–Dec in 2020 and 2021), four geographic areas of the Netherlands (north, east, west and south), and for five age categories (0–14, 15–24, 25–44, 45–64 and > 65 years). Results Over the period 2020–2021, individuals' SARS-CoV-2 status was associated with living closer to livestock farms. This association increased from an Odds Ratio (OR) of 1.01 (95% Confidence Interval [CI] 1.01–1.02) for patients living at a distance of 751–1000 m to a farm to an OR of 1.04 (95% CI 1.04–1.04), 1.07 (95% CI 1.06–1.07) and 1.11 (95% CI 1.10–1.12) for patients living in the more proximate 501–750 m, 251–500m and 0–250 m zones around farms, all relative to patients living further than 1000 m around farms. This association was observed in three out of four quarters of the year in both 2020 and 2021, and in all studied geographic areas and age groups. Conclusions In this exploratory study with individual SARS-CoV-2 notification data and high-resolution spatial data associations were found between living near livestock farms and individuals' SARS-CoV-2 status in the Netherlands. Verification of the results in other countries is warranted, as well as investigations into possible underlying exposures and mechanisms.
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Affiliation(s)
- Lenny Hogerwerf
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Pim M Post
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, the Netherlands; Department of Natural Resources, Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, P.O Box 217, Enschede, 7500 AE, the Netherlands.
| | - Ben Bom
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Wim van der Hoek
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Jan van de Kassteele
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, the Netherlands.
| | | | - Wilco de Vries
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Danny Houthuijs
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, the Netherlands.
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Yu Z, Bellander T, Bergström A, Dillner J, Eneroth K, Engardt M, Georgelis A, Kull I, Ljungman P, Pershagen G, Stafoggia M, Melén E, Gruzieva O. Association of Short-term Air Pollution Exposure With SARS-CoV-2 Infection Among Young Adults in Sweden. JAMA Netw Open 2022; 5:e228109. [PMID: 35442452 PMCID: PMC9021914 DOI: 10.1001/jamanetworkopen.2022.8109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Mounting ecological evidence shows an association between short-term air pollution exposure and COVID-19, yet no study has examined this association on an individual level. OBJECTIVE To estimate the association between short-term exposure to ambient air pollution and SARS-CoV-2 infection among Swedish young adults. DESIGN, SETTING, AND PARTICIPANTS This time-stratified case-crossover study linked the prospective BAMSE (Children, Allergy Milieu, Stockholm, Epidemiology [in Swedish]) birth cohort to the Swedish national infectious disease registry to identify cases with positive results for SARS-CoV-2 polymerase chain reaction (PCR) testing from May 5, 2020, to March 31, 2021. Case day was defined as the date of the PCR test, whereas the dates with the same day of the week within the same calendar month and year were selected as control days. Data analysis was conducted from September 1 to December 31, 2021. EXPOSURES Daily air pollutant levels (particulate matter with diameter ≤2.5 μm [PM2.5], particulate matter with diameter ≤10 μm [PM10], black carbon [BC], and nitrogen oxides [NOx]) at residential addresses were estimated using dispersion models with high spatiotemporal resolution. MAIN OUTCOMES AND MEASURES Confirmed SARS-CoV-2 infection among participants within the BAMSE cohort. Distributed-lag models combined with conditional logistic regression models were used to estimate the association. RESULTS A total of 425 cases were identified, of whom 229 (53.9%) were women, and the median age was 25.6 (IQR, 24.9-26.3) years. The median exposure level for PM2.5 was 4.4 [IQR, 2.6-6.8] μg/m3 on case days; for PM10, 7.7 [IQR, 4.6-11.3] μg/m3 on case days; for BC, 0.3 [IQR, 0.2-0.5] μg/m3 on case days; and for NOx, 8.2 [5.6-14.1] μg/m3 on case days. Median exposure levels on control days were 3.8 [IQR, 2.4-5.9] μg/m3 for PM2.5, 6.6 [IQR, 4.5-10.4] μg/m3 for PM10, 0.2 [IQR, 0.2-0.4] μg/m3 for BC, and 7.7 [IQR, 5.3-12.8] μg/m3 for NOx. Each IQR increase in short-term exposure to PM2.5 on lag 2 was associated with a relative increase in positive results of SARS-CoV-2 PCR testing of 6.8% (95% CI, 2.1%-11.8%); exposure to PM10 on lag 2, 6.9% (95% CI, 2.0%-12.1%); and exposure to BC on lag 1, 5.8% (95% CI, 0.3%-11.6%). These findings were not associated with NOx, nor were they modified by sex, smoking, or having asthma, overweight, or self-reported COVID-19 respiratory symptoms. CONCLUSIONS AND RELEVANCE The findings of this case-crossover study of Swedish young adults suggest that short-term exposure to particulate matter and BC was associated with increased risk of positive PRC test results for SARS-CoV-2, supporting the broad public health benefits of reducing ambient air pollution levels.
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Affiliation(s)
- Zhebin Yu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Joakim Dillner
- Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Eneroth
- SLB-analys, Environment and Health Administration, Stockholm, Sweden
| | - Magnuz Engardt
- SLB-analys, Environment and Health Administration, Stockholm, Sweden
| | - Antonios Georgelis
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Sciences and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Pediatrics, Sachs Children’s Hospital, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Erik Melén
- Department of Clinical Sciences and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Pediatrics, Sachs Children’s Hospital, Stockholm, Sweden
| | - Olena Gruzieva
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
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