Long-Term Air Pollution Exposure and COVID-19 Mortality: A Patient-Level Analysis from New York City

Abstract

Rationale: Risk factors for COVID-19 mortality may include environmental exposures, such as air pollution.Objectives: Determine whether, amongst adults hospitalized with PCR-confirmed COVID-19, long-term air pollution exposure is associated with risk for mortality, intensive care unit (ICU) admission or intubation. Methods:We performed a retrospective analysis of SARS-CoV-2 PCR positive patients admitted to seven New York City hospitals from March 8, 2020 to August 30, 2020. The primary outcome was mortality; secondary outcomes were ICU admission and intubation. We estimated the annual average fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ) and black carbon (BC) concentrations at patients' residential addresses. We employed double-robust Poisson regression to analyze associations between annual average PM 2.5 , NO 2 and BC exposure and COVID-19 outcomes, adjusting for age, sex, race/ethnicity, hospital, insurance and time from onset of the pandemic.Results: Of the 6,542 patients, 41% were female and aged median 65 years (IQR 53, 77). Over 50% selfidentified as a person of color [N=1,687 (26%) Hispanic, N=1,659 (25%) Black]. Air pollution exposures were generally low. Overall, 31% (N=2,044) of the cohort died, 19% (N=1,237) were admitted to the ICU and 16% (1,051) were intubated. In multivariable models, higher long-term exposure to PM 2.5 was associated with increased risk of mortality (RR 1.11, 95% CI 1.02, 1.21 per 1µg/m 3 increase in PM 2.5 ) and ICU admission (RR 1.13, 95% CI 1.00, 1.28 per 1µg/m 3 increase in PM 2.5 ). In multivariable models, neither NO 2 nor BC exposure was associated with COVID-19 mortality, ICU admission or intubation.Conclusions: Amongst patients hospitalized with COVID-19, higher long-term PM 2.5 exposure was associated with increased risk of mortality and ICU admission.

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

“…Previous ecological studies found positive associations between long-term exposure to PM 2.5 , NO 2 and O 3 , and COVID-19 mortality and case fatality rate. 29 , 38 , 39 In other, more limited, cohort studies, Bowe and colleagues found a relative risk of 1.09 (95% CI 1.07–1.11) per 1.70 μg/m 3 increase in PM 2.5 concentration for hospital admission among American veterans who received a diagnosis of COVID-19, 16 while Bozack and colleagues 15 found relative risks of 1.23 (95% CI 1.00–1.53) for ICU admission and 1.20 (95% CI 1.03–1.39) for death, but no association with NO 2 among people admitted to hospital with COVID-19. Using slightly different methods, a cohort study in Spain and a cohort study in the Mexico City metropolitan area also found a positive association between PM 2.5 and COVID-19 severity.…”

“…Therefore, a cohort study with data on individuals with SARS-CoV-2 is a more appropriate design. 6 , 14 Studies that have used individual data were conducted in specific subpopulations 15 , 16 or populations with few severe cases, 17 or had limited data on individual exposure to air pollutants. 18 In Canada, 1 ecological study found a positive association between long-term exposure to PM 2.5 and COVID-19 incidence, 19 but no published study has explored the association between air pollution and COVID-19 severity.…”

Associations of air pollution with COVID-19 positivity, hospitalisations, and mortality: Observational evidence from UK Biobank

“…In addition, some individual-level studies used spatially inaccurate or area-level estimates of long-term air pollution exposure ( Bowe et al, 2021 ; López-Feldman et al, 2021 ; Marquès et al, 2022 ; Mendy et al, 2021 ; Travaglio et al, 2021 ), which may have resulted in exposure misclassification. Furthermore, some individual-level studies included only hospitalised patients in retrospective study designs ( Bozack et al, 2022 ; Marquès et al, 2022 ; Mendy et al, 2021 ), which limits causal interpretation and generalisability.…”

Air pollution and health impacts during the COVID-19 lockdowns in Grenoble, France

“…One of the main consequences of the changes in air quality is to be sought on the health of populations. Although epidemiological studies have highlighted the relationship between mortality records or hospital admissions and changes in air quality during COVID-19 restrictions ( Bozack et al, 2021 ; Hameed et al, 2021 ; Naqvi et al, 2021 ), little work has been done on the health impacts resulting from these changes in air pollutant levels compared to the number of studies on air quality during lockdowns. Table 1 summarizes the result of the comprehensive literature review on health risks related to changes in air pollution during lockdowns.…”