Journal Article

Association between long-term exposure to ambient air pollution and COVID-19 severity: a prospective cohort study

Wang, John, Kirby-McGregor, Megan, Kim, JinHee, Su, Yushan, Kwong, Jeff, Lavigne, Eric, Benmarhnia, Tarik, Chen, Hong, Hystad, Perry, Kaufman, Jay S., Chen, Chen, van Donkelaar, Aaron, Martin, Randall V.

2022

Overview

The tremendous global health burden related to COVID-19 means that identifying determinants of COVID-19 severity is important for prevention and intervention. We aimed to explore long-term exposure to ambient air pollution as a potential contributor to COVID-19 severity, given its known impact on the respiratory system. We used a cohort of all people with confirmed SARS-CoV-2 infection, aged 20 years and older and not residing in a long-term care facility in Ontario, Canada, during 2020. We evaluated the association between long-term exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2) and ground-level ozone (O3), and risk of COVID-19-related hospital admission, intensive care unit (ICU) admission and death. We ascertained individuals’ long-term exposures to each air pollutant based on their residence from 2015 to 2019. We used logistic regression and adjusted for confounders and selection bias using various individual and contextual covariates obtained through data linkage. Among the 151 105 people with confirmed SARS-CoV-2 infection in Ontario in 2020, we observed 8630 hospital admissions, 1912 ICU admissions and 2137 deaths related to COVID-19. For each interquartile range increase in exposure to PM2.5 (1.70 μg/m3), we estimated odds ratios of 1.06 (95% confidence interval [CI] 1.01–1.12), 1.09 (95% CI 0.98–1.21) and 1.00 (95% CI 0.90–1.11) for hospital admission, ICU admission and death, respectively. Estimates were smaller for NO2. We also estimated odds ratios of 1.15 (95% CI 1.06–1.23), 1.30 (95% CI 1.12–1.50) and 1.18 (95% CI 1.02–1.36) per interquartile range increase of 5.14 ppb in O3 for hospital admission, ICU admission and death, respectively. Chronic exposure to air pollution may contribute to severe outcomes after SARS-CoV-2 infection, particularly exposure to O3.

• Publisher: Elsevier Inc,CMA Impact Inc,CMA Impact, Inc,Ottawa Canadian Medical Association
• Subject: 60 APPLIED LIFE SCIENCES / Air Pollutants - adverse effects / Air pollution / Air Pollution - adverse effects / Air Pollution - analysis / Chronic illnesses / Cohort analysis / Cohort Studies / Coronaviruses / COVID-19 - epidemiology / COVID-19 vaccines / Environmental aspects / Environmental Exposure - adverse effects / environmental issues / Fatalities / Health aspects / Health care access / Health insurance / Hospitals / Humans / Immunization / Infections / infectious diseases / Intensive care / Internal Medicine / Long term health care / Lung diseases / Neighborhoods / Nitrogen dioxide / Nitrogen Dioxide - adverse effects / Nitrogen Dioxide - analysis / Ontario - epidemiology / Outdoor air quality / Particulate Matter - adverse effects / Particulate Matter - analysis / Pollutants / Population / Prospective Studies / Public health / respiratory medicine / Risk factors / SARS-CoV-2 / Severe acute respiratory syndrome coronavirus 2 / Social exclusion / Socioeconomic factors / Statistics / VOCs / Volatile organic compounds