Impact of outdoor air pollution on severity and mortality in COVID-19 pneumonia.

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  • Additional Information
    • Corporate Authors:
      COVID-19 & Air Pollution Working Group
    • Source:
      Publisher: Elsevier Country of Publication: Netherlands NLM ID: 0330500 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1026 (Electronic) Linking ISSN: 00489697 NLM ISO Abbreviation: Sci Total Environ Subsets: MEDLINE
    • Publication Information:
      Original Publication: Amsterdam, Elsevier.
    • Subject Terms:
      COVID-19* ; Air Pollution*/analysis ; Air Pollutants*/analysis ; Pneumonia*/epidemiology ; Pneumonia*/chemically induced; Humans ; Nitrogen Dioxide/analysis ; Bayes Theorem ; Cohort Studies ; Inflammation/chemically induced ; Particulate Matter/analysis ; Environmental Exposure/analysis
    • Abstract:
      The relationship between exposure to air pollution and the severity of coronavirus disease 2019 (COVID-19) pneumonia and other outcomes is poorly understood. Beyond age and comorbidity, risk factors for adverse outcomes including death have been poorly studied. The main objective of our study was to examine the relationship between exposure to outdoor air pollution and the risk of death in patients with COVID-19 pneumonia using individual-level data. The secondary objective was to investigate the impact of air pollutants on gas exchange and systemic inflammation in this disease. This cohort study included 1548 patients hospitalised for COVID-19 pneumonia between February and May 2020 in one of four hospitals. Local agencies supplied daily data on environmental air pollutants (PM 10 , PM 2.5 , O 3 , NO 2 , NO and NO X ) and meteorological conditions (temperature and humidity) in the year before hospital admission (from January 2019 to December 2019). Daily exposure to pollution and meteorological conditions by individual postcode of residence was estimated using geospatial Bayesian generalised additive models. The influence of air pollution on pneumonia severity was studied using generalised additive models which included: age, sex, Charlson comorbidity index, hospital, average income, air temperature and humidity, and exposure to each pollutant. Additionally, generalised additive models were generated for exploring the effect of air pollution on C-reactive protein (CRP) level and SpO 2 /FiO 2 at admission. According to our results, both risk of COVID-19 death and CRP level increased significantly with median exposure to PM 10 , NO 2 , NO and NO X , while higher exposure to NO 2 , NO and NO X was associated with lower SpO 2 /FiO 2 ratios. In conclusion, after controlling for socioeconomic, demographic and health-related variables, we found evidence of a significant positive relationship between air pollution and mortality in patients hospitalised for COVID-19 pneumonia. Additionally, inflammation (CRP) and gas exchange (SpO 2 /FiO 2 ) in these patients were significantly related to exposure to air pollution.
      Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
      (Copyright © 2023. Published by Elsevier B.V.)
    • Contributed Indexing:
      Keywords: Air pollution; COVID-19; Individual-level data; Mortality; Pneumonia; SARS-CoV-2
    • Accession Number:
      S7G510RUBH (Nitrogen Dioxide)
      0 (Air Pollutants)
      0 (Particulate Matter)
    • Publication Date:
      Date Created: 20230618 Date Completed: 20231023 Latest Revision: 20231023
    • Publication Date:
      20240628
    • Accession Number:
      PMC10275649
    • Accession Number:
      10.1016/j.scitotenv.2023.164877
    • Accession Number:
      37331396