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Palandri L, Rizzi C, Vandelli V, Filippini T, Ghinoi A, Carrozzi G, Girolamo GD, Morlini I, Coratza P, Giovannetti E, Russo M, Soldati M, Righi E. Environmental, climatic, socio-economic factors and non-pharmacological interventions: A comprehensive four-domain risk assessment of COVID-19 hospitalization and death in Northern Italy. Int J Hyg Environ Health 2024; 263:114471. [PMID: 39366078 DOI: 10.1016/j.ijheh.2024.114471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 09/06/2024] [Accepted: 09/24/2024] [Indexed: 10/06/2024]
Abstract
INTRODUCTION Up to now, studies on environmental, climatic, socio-economic factors, and non-pharmacological interventions (NPI) show diverse associations, often contrasting, with COVID-19 spread or severity. Most studies used large-scale, aggregated data, with limited adjustment for individual factors, most of them focused on viral spread than severe outcomes. Moreover, evidence simultaneously evaluating variables belonging to different exposure domains is scarce, and none analysing their collective impact on an individual level. METHODS Our population-based retrospective cohort study aimed to assess the comprehensive role played by exposure variables belonging to four different domains, environmental, climatic, socio-economic, and non-pharmacological interventions (NPI), on individual COVID-19-related risk of hospitalization and death, analysing data from all patients (no. 68472) tested positive to a SARS-CoV-2 swab in Modena Province (Northern Italy) between February 2020 and August 2021. Using adjusted Cox proportional hazard models, we estimated the risk of severe COVID-19 outcomes, investigating dose-response relationships through restricted cubic spline modelling for hazard ratios. RESULTS Several significant associations emerged: long-term exposure to air pollutants (NO2, PM10, PM2.5) was linked to hospitalization risk in a complex way and showed an increased risk for death; while humidity was inversely associated; temperature showed a U-shaped risk; wind speed showed a linear association with both outcomes. Precipitation increased hospitalization risk but decreased mortality. Socio-economic and NPI indices showed clear linear associations, respectively negative and positive, with both outcomes. CONCLUSIONS Our findings offer insights for evidence-based policy decisions, improving precision healthcare practices, and safeguarding public health in future pandemics. Refinement of pandemic response plans by healthcare authorities could benefit significantly.
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Affiliation(s)
- Lucia Palandri
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy; PhD Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristiana Rizzi
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Vittoria Vandelli
- Department of Chemical and Geological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy; Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy; School of Public Health, University of California Berkeley, Berkeley, CA, USA.
| | - Alessandro Ghinoi
- Department of Chemical and Geological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuliano Carrozzi
- Epidemiology and Risk Communication Service, Department of Public Health, Local Health Authority of Modena, Modena, Italy
| | - Gianfranco De Girolamo
- Epidemiology and Risk Communication Service, Department of Public Health, Local Health Authority of Modena, Modena, Italy
| | - Isabella Morlini
- Department of Communication and Economics, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Paola Coratza
- Department of Chemical and Geological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Giovannetti
- Marco Biagi Department of Economics, University of Modena and Reggio Emilia, Modena, Italy
| | - Margherita Russo
- Marco Biagi Department of Economics, University of Modena and Reggio Emilia, Modena, Italy
| | - Mauro Soldati
- Department of Chemical and Geological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Righi
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
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Huang Q. Spatial, temporal, and demographic nonstationary dynamics of COVID-19 exposure among older adults in the U.S. PLoS One 2024; 19:e0307303. [PMID: 39172979 PMCID: PMC11341038 DOI: 10.1371/journal.pone.0307303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 07/01/2024] [Indexed: 08/24/2024] Open
Abstract
This study examines demographic disparities in COVID-19 exposures across older adults age 60-79 and older adults age 80 and over, and explores the factors driving these dynamics in the United States (U.S.) from January 2020 to July 2022. Spatial clusters were identified, and 14 main health determinants were synthesized from 62 pre-existing county-level variables. The study also assessed the correlation between these health determinants and COVID-19 incidence rates for both age groups during the pandemic years. Further examination of incidence rates in relation to health determinants was carried out through statistical and spatial regression models. Results show that individuals aged 80 and over had much higher hospitalization rates, death rates, and case-fatality rates in 2020-2022. Spatial results indicate that the geographical cluster of high incidence rates for both groups shifted from the Midwest at the beginning of the pandemic to the Southwest in 2022. The study revealed marked spatial, temporal, and demographic nonstationary dynamics in COVID-19 exposures, indicating that the health effects of contextual factors vary across age groups. COVID-19 incidence rates in older adults were strongly influenced by race, healthcare access, social capital, environment, household composition, and mobility. Future public health policies and mitigations should further their efforts by considering temporal and demographic nonstationarity as well as local conditions.
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Affiliation(s)
- Qian Huang
- Center for Rural Health Research, College of Public Health, East Tennessee State University, Johnson City, Tennessee, United States of America
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Botto L, Bulbarelli A, Lonati E, Cazzaniga E, Palestini P. Correlation between Exposure to UFP and ACE/ACE2 Pathway: Looking for Possible Involvement in COVID-19 Pandemic. TOXICS 2024; 12:560. [PMID: 39195662 PMCID: PMC11359209 DOI: 10.3390/toxics12080560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/29/2024]
Abstract
The overlap between the geographic distribution of COVID-19 outbreaks and pollution levels confirmed a correlation between exposure to atmospheric particulate matter (PM) and the SARS-CoV-2 pandemic. The RAS system is essential in the pathogenesis of inflammatory diseases caused by pollution: the ACE/AngII/AT1 axis activates a pro-inflammatory pathway, which is counteracted by the ACE2/Ang(1-7)/MAS axis, which activates an anti-inflammatory and protective pathway. However, ACE2 is also known to act as a receptor through which SARS-CoV-2 enters host cells to replicate. Furthermore, in vivo systems have demonstrated that exposure to PM increases ACE2 expression. In this study, the effects of acute and sub-acute exposure to ultrafine particles (UFP), originating from different anthropogenic sources (DEP and BB), on the levels of ACE2, ACE, COX-2, HO-1, and iNOS in the lungs and other organs implicated in the pathogenesis of COVID-19 were analyzed in the in vivo BALB/c male mice model. Exposure to UFP alters the levels of ACE2 and/or ACE in all examined organs, and exposure to sub-acute DEP also results in the release of s-ACE2. Furthermore, as evidenced in this and our previous works, COX-2, HO-1, and iNOS levels also demonstrated organ-specific alterations. These proteins play a pivotal role in the UFP-induced inflammatory and oxidative stress responses, and their dysregulation is linked to the development of severe symptoms in individuals infected with SARS-CoV-2, suggesting a heightened vulnerability or a more severe clinical course of the disease. UFP and SARS-CoV-2 share common pathways; therefore, in a "risk stratification" concept, daily exposure to air pollution may significantly increase the likelihood of developing a severe form of COVID-19, explaining, at least in part, the greater lethality of the virus observed in highly polluted areas.
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Affiliation(s)
- Laura Botto
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (L.B.); (A.B.); (E.L.); (E.C.)
| | - Alessandra Bulbarelli
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (L.B.); (A.B.); (E.L.); (E.C.)
- POLARIS Research Centre, University of Milano-Bicocca, 20900 Monza, Italy
| | - Elena Lonati
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (L.B.); (A.B.); (E.L.); (E.C.)
| | - Emanuela Cazzaniga
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (L.B.); (A.B.); (E.L.); (E.C.)
| | - Paola Palestini
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (L.B.); (A.B.); (E.L.); (E.C.)
- POLARIS Research Centre, University of Milano-Bicocca, 20900 Monza, Italy
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Bayram H, Konyalilar N, Elci MA, Rajabi H, Aksoy GT, Mortazavi D, Kayalar Ö, Dikensoy Ö, Taborda-Barata L, Viegi G. Issue 4 - Impact of air pollution on COVID-19 mortality and morbidity: An epidemiological and mechanistic review. Pulmonology 2024:S2531-0437(24)00051-5. [PMID: 38755091 DOI: 10.1016/j.pulmoe.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
Air pollution is a major global environment and health concern. Recent studies have suggested an association between air pollution and COVID-19 mortality and morbidity. In this context, a close association between increased levels of air pollutants such as particulate matter ≤2.5 to 10 µM, ozone and nitrogen dioxide and SARS-CoV-2 infection, hospital admissions and mortality due to COVID 19 has been reported. Air pollutants can make individuals more susceptible to SARS-CoV-2 infection by inducing the expression of proteins such as angiotensin converting enzyme (ACE)2 and transmembrane protease, serine 2 (TMPRSS2) that are required for viral entry into the host cell, while causing impairment in the host defence system by damaging the epithelial barrier, muco-ciliary clearance, inhibiting the antiviral response and causing immune dysregulation. The aim of this review is to report the epidemiological evidence on impact of air pollutants on COVID 19 in an up-to-date manner, as well as to provide insights on in vivo and in vitro mechanisms.
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Affiliation(s)
- Hasan Bayram
- Koç University Research Centre for Translational Medicine (KUTTAM), Zeytinburnu, Istanbul, Turkey; Department of Pulmonary Medicine, School of Medicine, Koç University, Zeytinburnu, Istanbul, Turkey.
| | - Nur Konyalilar
- Koç University Research Centre for Translational Medicine (KUTTAM), Zeytinburnu, Istanbul, Turkey
| | | | - Hadi Rajabi
- Koç University Research Centre for Translational Medicine (KUTTAM), Zeytinburnu, Istanbul, Turkey
| | - G Tuşe Aksoy
- Koç University Research Centre for Translational Medicine (KUTTAM), Zeytinburnu, Istanbul, Turkey
| | - Deniz Mortazavi
- Koç University Research Centre for Translational Medicine (KUTTAM), Zeytinburnu, Istanbul, Turkey
| | - Özgecan Kayalar
- Koç University Research Centre for Translational Medicine (KUTTAM), Zeytinburnu, Istanbul, Turkey
| | - Öner Dikensoy
- Department of Pulmonary Medicine, School of Medicine, Koç University, Zeytinburnu, Istanbul, Turkey
| | - Luis Taborda-Barata
- UBIAir - Clinical and Experimental Lung Centre UBIMedical, University of Beira Interior, Covilhã, Portugal; CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
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Ranzani O, Alari A, Olmos S, Milà C, Rico A, Basagaña X, Dadvand P, Duarte-Salles T, Forastiere F, Nieuwenhuijsen M, Vivanco-Hidalgo RM, Tonne C. Who is more vulnerable to effects of long-term exposure to air pollution on COVID-19 hospitalisation? ENVIRONMENT INTERNATIONAL 2024; 185:108530. [PMID: 38422877 DOI: 10.1016/j.envint.2024.108530] [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: 09/06/2023] [Revised: 01/23/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Factors that shape individuals' vulnerability to the effects of air pollution on COVID-19 severity remain poorly understood. We evaluated whether the association between long-term exposure to ambient NO2, PM2.5, and PM10 and COVID-19 hospitalisation differs by age, sex, individual income, area-level socioeconomic status, arterial hypertension, diabetes mellitus, and chronic obstructive pulmonary disease. METHODS We analysed a population-based cohort of 4,639,184 adults in Catalonia, Spain, during 2020. We fitted Cox proportional hazard models adjusted for several potential confounding factors and evaluated the interaction effect between vulnerability indicators and the 2019 annual average of NO2, PM2.5, and PM10. We evaluated interaction on both additive and multiplicative scales. RESULTS Overall, the association was additive between air pollution and the vulnerable groups. Air pollution and vulnerability indicators had a synergistic (greater than additive) effect for males and individuals with low income or living in the most deprived neighbourhoods. The Relative Excess Risk due to Interaction (RERI) was 0.21, 95 % CI, 0.15 to 0.27 for NO2 and 0.16, 95 % CI, 0.11 to 0.22 for PM2.5 for males; 0.13, 95 % CI, 0.09 to 0.18 for NO2 and 0.10, 95 % CI, 0.05 to 0.14 for PM2.5 for lower individual income and 0.17, 95 % CI, 0.12 to 0.22 for NO2 and 0.09, 95 % CI, 0.05 to 0.14 for PM2.5 for lower area-level socioeconomic status. Results for PM10 were similar to PM2.5. Results on multiplicative scale were inconsistent. CONCLUSIONS Long-term exposure to air pollution had a larger synergistic effect on COVID-19 hospitalisation for males and those with lower individual- and area-level socioeconomic status.
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Affiliation(s)
- Otavio Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Anna Alari
- 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
| | - 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
| | - Francesco Forastiere
- National Research Council, IFT, Palermo, Italy; Environmental Research Group, Imperial College London, London, UK
| | - 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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Vandelli V, Palandri L, Coratza P, Rizzi C, Ghinoi A, Righi E, Soldati M. Conditioning factors in the spreading of Covid-19 - Does geography matter? Heliyon 2024; 10:e25810. [PMID: 38356610 PMCID: PMC10865316 DOI: 10.1016/j.heliyon.2024.e25810] [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: 07/07/2023] [Revised: 01/23/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
There is evidence in literature that the spread of COVID-19 can be influenced by various geographic factors, including territorial features, climate, population density, socioeconomic conditions, and mobility. The objective of the paper is to provide an updated literature review on geographical studies analysing the factors which influenced COVID-19 spreading. This literature review took into account not only the geographical aspects but also the COVID-19-related outcomes (infections and deaths) allowing to discern the potential influencing role of the geographic factors per type of outcome. A total of 112 scientific articles were selected, reviewed and categorized according to subject area, aim, country/region of study, considered geographic and COVID-19 variables, spatial and temporal units of analysis, methodologies, and main findings. Our literature review showed that territorial features may have played a role in determining the uneven geography of COVID-19; for instance, a certain agreement was found regarding the direct relationship between urbanization degree and COVID-19 infections. For what concerns climatic factors, temperature was the variable that correlated the best with COVID-19 infections. Together with climatic factors, socio-demographic ones were extensively taken into account. Most of the analysed studies agreed that population density and human mobility had a significant and direct relationship with COVID-19 infections and deaths. The analysis of the different approaches used to investigate the role of geographic factors in the spreading of the COVID-19 pandemic revealed that the significance/representativeness of the outputs is influenced by the scale considered due to the great spatial variability of geographic aspects. In fact, a more robust and significant association between geographic factors and COVID-19 was found by studies conducted at subnational or local scale rather than at country scale.
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Affiliation(s)
- Vittoria Vandelli
- Department of Chemical and Geological Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy
| | - Lucia Palandri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy
| | - Paola Coratza
- Department of Chemical and Geological Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy
| | - Cristiana Rizzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy
| | - Alessandro Ghinoi
- Department of Chemical and Geological Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy
| | - Elena Righi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy
| | - Mauro Soldati
- Department of Chemical and Geological Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy
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Ngatu NR, Tonduangu DK, Munyeshyaka E, Hirao T, Balenda GM, Yamadori Y, Deguchi T, Nsadi-Fwene B, Lami JN, Akumwami S, Kanda K, Murakami A, Yandju MC, Nyembue DT, Tshimpi A, Wembonyama SO. COVID-19 fatality and DALYs, and associated metabolic disorders and ambient air pollutants in pre-Omicron era of the pandemic: an international comparative study. Environ Health Prev Med 2024; 29:24. [PMID: 38599849 PMCID: PMC11016372 DOI: 10.1265/ehpm.23-00350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Air pollution and a number of metabolic disorders have been reported to increase the risk of severe COVID-19 outcomes. This study explored the association between severe COVID-19 outcomes, metabolic disorders and environmental air pollutants, at regional level, across 38 countries. METHODS We conducted an ecological study using COVID-19 data related to countries of the Organization for Economic Cooperation and Development (OECD), with an estimated population of 1.4 billion. They were divided into 3 regions: 1. Europe & Middle east; 2. Americas (north, central & south America); 3. East-Asia & West Pacific. The outcome variables were: COVID-19 case-fatality rate (CFR) and disability-adjusted life years (DALYs) at regional level. Freely accessible datasets related to regional DALYs, demographics and other environmental pollutants were obtained from OECD, WHO and the World in Data websites. Generalized linear model (GLM) was performed to determine the regional determinants of COVID-19 CFR and DALYs using the aggregate epidemiologic data (Dec. 2019-Dec. 2021). RESULTS Overall cumulative deaths were 65,000 per million, for mean CFR and DALYs of 1.31 (1.2)% and 17.35 (2.3) years, respectively. Globally, GLM analysis with adjustment for elderly population rate, showed that COVID-19 CFR was positively associated with atmospheric PM2.5 level (beta = 0.64(0.0), 95%CI: 0.06-1.35; p < 0.05), diabetes prevalence (beta = 0.26(0.1), 95%CI: 0.12-0.41; p < 0.001). For COVID-19 DALYs, positive associations were observed with atmospheric NOx level (beta = 0.06(0.0), 95%CI: 0.02-0.82; p < 0.05) and diabetes prevalence (beta = 0.32(0.2), 95%CI: 0.04-0.69; p < 0.05). At regional level, adjusted GLM analysis showed that COVID-19 CFR was associated with atmospheric PM2.5 level in the Americas and East-Asia & Western Pacific region; it was associated with diabetes prevalence for countries of Europe & Middle east and East-Asia & Western Pacific region. Furthermore, COVID-19 DALYs were positively associated with atmospheric PM2.5 and diabetes prevalence for countries of the Americas only. CONCLUSION These findings confirm that diabetes and air pollution increase the risk of disability and fatality due to COVID-19, with disparities in terms of their impact. They suggest that efficient preventive and management programs for diabetes and air pollution countermeasures would have curtailed severe COVID-19 outcome rates.
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Affiliation(s)
- Nlandu-Roger Ngatu
- Department of Public Health, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Daniel-Kuezina Tonduangu
- Department of Internal Medicine, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo (DRC)
| | - Emmanuel Munyeshyaka
- Department of Microbiology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Tomohiro Hirao
- Department of Public Health, Kagawa University Faculty of Medicine, Kagawa, Japan
| | | | - Yusuke Yamadori
- Department of Anesthesiology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Takayuki Deguchi
- Department of Public Health, Kagawa University Faculty of Medicine, Kagawa, Japan
| | | | | | - Steeve Akumwami
- Department of Anesthesiology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Kanae Kanda
- Department of Public Health, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Akitsu Murakami
- Oncology and Palliative Care Center, Kagawa University Faculty of Medicine, Kagawa, Japan
| | | | | | - Antoine Tshimpi
- Department of Internal Medicine, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo (DRC)
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Fedrizzi L, Carugno M, Consonni D, Lombardi A, Bandera A, Bono P, Ceriotti F, Gori A, Pesatori AC. Air pollution exposure, SARS-CoV-2 infection, and immune response in a cohort of healthcare workers of a large university hospital in Milan, Italy. ENVIRONMENTAL RESEARCH 2023; 236:116755. [PMID: 37517490 DOI: 10.1016/j.envres.2023.116755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
Several studies have examined the possible relationship between air pollutants and the risk of COVID-19 but most returned controversial findings. We tried to assess the association between (short- and long-term) exposure to particulate and gaseous pollutants, SARS-CoV-2 infections, and immune response in a population of healthcare workers (HCWs) with well-characterized individual data. We collected occupational and clinical characteristics of all HCWs who performed a nasopharyngeal swab (NPS) for detecting SARS-CoV-2 at the Policlinico Hospital in Milan (Lombardy, Italy) between February 24, 2020 (day after first documented case of COVID-19 in our hospital) and December 26, 2020 (day before start of the vaccination campaign). Each subject was assigned daily average levels of particulate matter ≤10 μm (PM10), nitrogen dioxide (NO2), and ozone (O3) retrieved from the air quality monitoring station closest to his/her residential address. Air pollution data were treated as time-dependent variables, generating person-days at risk. Multivariate Poisson regression models were fit to evaluate the rate of positive NPS and to assess the association between air pollution and antibody titer among NPS-positive HCWs. Among 3712 included HCWs, 635 (17.1%) had at least one positive NPS. A 10 μg/m3 increase in NO2 average concentration in the four days preceding NPS was associated with a higher risk of testing positive [Incidence Rate Ratio (IRR) = 1.08, 95% confidence interval (CI): 1.01; 1.16)]. When considering a 1 μg/m3 increase in 2019 annual NO2 average, we observed a higher risk of infection (IRR: 1.02, 95%CI: 1.00; 1.03) and an increased antibody titer (+2.4%, 95%CI: 1.1; 3.6%). Findings on PM10 and O3 were less consistent and, differently from NO2, were not confirmed in multipollutant models. Our study increases the body of evidence suggesting an active role of air pollution exposure on SARS-CoV-2 infection and confirms the importance of implementing pollution reduction policies to improve public health.
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Affiliation(s)
- Luca Fedrizzi
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Carugno
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Patrizia Bono
- Clinical Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ferruccio Ceriotti
- Clinical Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Angela Cecilia Pesatori
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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