Ambient Air Pollutant Exposures and COVID-19 Severity and Mortality in a Cohort of Patients with COVID-19 in Southern California

• Published in: American journal of respiratory and critical care medicine 2022-08, Vol.206 (4), p.440-448
• Main Authors: Chen, Zhanghua, Sidell, Margo A, Huang, Brian Z, Chow, Ting, Eckel, Sandrah P, Martinez, Mayra P, Gheissari, Roya, Lurmann, Fred, Thomas, Duncan C, Gilliland, Frank D, Xiang, Anny H
• Format: Article
• Language: English
• Subjects: Adult; Air Pollutants - adverse effects; Air Pollutants - analysis; Air pollution; Air Pollution - adverse effects; Air Pollution - analysis; California - epidemiology; Cohort Studies; COVID-19; COVID-19 Testing; Electronic health records; Environmental Exposure - adverse effects; Environmental Exposure - analysis; Environmental Pollutants; Epidemiology; Female; Humans; Intensive care; Male; Medical diagnosis; Mortality; Nitrogen Dioxide; Particulate Matter - adverse effects; Particulate Matter - analysis; Severe acute respiratory syndrome coronavirus 2
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.202108-1909OC

Ecological studies have shown air pollution associations with coronavirus disease (COVID-19) outcomes. However, few cohort studies have been conducted. To conduct a cohort study investigating the association between air pollution and COVID-19 severity using individual-level data from the electronic medical record. This cohort included all individuals who received diagnoses of COVID-19 from Kaiser Permanente Southern California between March 1 and August 31, 2020. One-year and 1-month averaged ambient air pollutant (particulate matter ⩽2.5 μm in aerodynamic diameter [PM ], NO , and O ) exposures before COVID-19 diagnosis were estimated on the basis of residential address history. Outcomes included COVID-19-related hospitalizations, intensive respiratory support (IRS), and ICU admissions within 30 days and mortality within 60 days after COVID-19 diagnosis. Covariates included socioeconomic characteristics and comorbidities. Among 74,915 individuals (mean age, 42.5 years; 54% women; 66% Hispanic), rates of hospitalization, IRS, ICU admission, and mortality were 6.3%, 2.4%, 1.5%, and 1.5%, respectively. Using multipollutant models adjusted for covariates, 1-year PM and 1-month NO average exposures were associated with COVID-19 severity. The odds ratios associated with a 1-SD increase in 1-year PM (SD, 1.5 μg/m ) were 1.24 (95% confidence interval [CI], 1.16-1.32) for COVID-19-related hospitalization, 1.33 (95% CI, 1.20-1.47) for IRS, and 1.32 (95% CI, 1.16-1.51) for ICU admission; the corresponding odds ratios associated with 1-month NO (SD, 3.3 ppb) were 1.12 (95% CI, 1.06-1.17) for hospitalization, 1.18 (95% CI, 1.10-1.27) for IRS, and 1.21 (95% CI, 1.11-1.33) for ICU admission. The hazard ratios for mortality were 1.14 (95% CI, 1.02-1.27) for 1-year PM and 1.07 (95% CI, 0.98-1.16) for 1-month NO . No significant interactions with age, sex or ethnicity were observed. Ambient PM and NO exposures may affect COVID-19 severity and mortality.