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Journal Article Ppublish 3 citations

PubMed: 39316827 DOI: 10.1097/EDE.0000000000001792

Interactive Effects of Long-term Exposure to Air Pollutants on SARS-CoV-2 Infection and Severity: A Northern Italian Population-based Cohort Study.

Epidemiology 36(1):11-19

Authors: Giovanni Veronesi, Sara De Matteis, Camillo Silibello, Emanuele M Giusti, Walter Ageno, Marco M Ferrario

Affiliations

  • Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy.
  • Department of Health Sciences, University of Milan, Milan, Italy.
  • Arianet, Milano, Italy.

Abstract

BACKGROUND

We examined interactions, to our knowledge not yet explored, between long-term exposures to particulate matter (PM 10 ) with nitrogen dioxide (NO 2 ) and ozone (O 3 ) on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectivity and severity.

METHODS

We followed 709,864 adult residents of Varese Province from 1 February 2020 until the first positive test, COVID-19 hospitalization, or death, up to 31 December 2020. We estimated residential annual means of PM 10 , NO 2 , and O 3 in 2019 from chemical transport and random-forest models. We estimated the interactive effects of pollutants with urbanicity on SARS-CoV-2 infectivity, hospitalization, and mortality endpoints using Cox regression models adjusted for socio-demographic factors and comorbidities, and additional cases due to interactions using Poisson models.

RESULTS

In total 41,065 individuals were infected, 5203 were hospitalized and 1543 died from COVID-19 during follow-up. Mean PM 10 was 1.6 times higher and NO 2 2.6 times higher than WHO limits, with wide gradients between urban and nonurban areas. PM 10 and NO 2 were positively associated with SARS-CoV-2 infectivity and mortality, and PM 10 with hospitalizations in urban areas. Interaction analyses estimated that the effect of PM 10 (per 3.5 µg/m 3 ) on infectivity was strongest in urban areas [hazard ratio (HR) = 1.12; 95% CI =1.09, 1.16], corresponding to 854 additional cases per 100,000 person-years, and in areas at high NO 2 co-exposure (HR = 1.15; 1.08, 1.22). At higher levels of PM 10 co-exposure, the protective association of O 3 reversed (HR =1.32, 1.17, 1.49), yielding 278 additional cases per µg/m 3 increase in O 3 . We estimated similar interactive effects for severity endpoints.

CONCLUSIONS

We estimate that interactive effects between pollutants exacerbated the burden of the SARS-CoV-2 pandemic in urban areas.

MeSH

Sars-Cov-2, Mortality, Epidemiology, Hospitalization, Environmental Pollutants, Cohort Studies, Air, Covid-19, Air Pollutants, Severe Acute Respiratory Syndrome-Related Coronavirus, Infections