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Particulate matter air pollution and COVID-19 infection, severity, and mortality: A systematic review and meta-analysis.


ABSTRACT: Ecological evidence links ambient particulate matter ≤2.5 mm (PM2.5) and the rate of COVID-19 infections, severity, and deaths. However, such studies are unable to account for individual-level differences in major confounders like socioeconomic status and often rely on imprecise measures of PM2.5. We conducted a systematic review of case-control and cohort studies, which rely on individual-level data, searching Medline, Embase, and the WHO COVID-19 database up to 30 June 2022. Study quality was evaluated using the Newcastle-Ottawa Scale. Results were pooled with a random effects meta-analysis, with Egger's regression, funnel plots, and leave-one-out/trim-and-fill sensitivity analyses to account for publication bias. N = 18 studies met inclusion criteria. A 10 μg/m3 increase in PM2.5 was associated with 66 % (95 % CI: 1.31-2.11) greater odds of COVID-19 infection (N = 7) and 127 % (95 % CI: 1.41-3.66) odds of severe illness (hospitalisation, ICU admission, or requiring respiratory support) (N = 6). Pooled mortality results (N = 5) indicated increased deaths due to PM2.5 but were non-significant (OR 1.40; 0.94 to 2.10). Most studies were rated "good" quality (14/18 studies), though there were numerous methodological issues; few used individual-level data to adjust for socioeconomic status (4/18 studies), instead using area-based indicators (11/18 studies) or no such adjustments (3/18 studies). Most severity (9/10 studies) and mortality studies (5/6 studies) were based on people already diagnosed COVID-19, potentially introducing collider bias. There was evidence of publication bias in studies of infection (p = 0.012) but not severity (p = 0.132) or mortality (p = 0.100). While methodological limits and evidence of bias require cautious interpretation of the findings, we found compelling evidence that PM2.5 increases the risk of COVID-19 infection and severe disease, and weaker evidence of an increase in mortality risk.

SUBMITTER: Sheppard N 

PROVIDER: S-EPMC10079587 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

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Particulate matter air pollution and COVID-19 infection, severity, and mortality: A systematic review and meta-analysis.

Sheppard Nicola N   Carroll Matthew M   Gao Caroline C   Lane Tyler T  

The Science of the total environment 20230407


Ecological evidence links ambient particulate matter ≤2.5 mm (PM<sub>2.5</sub>) and the rate of COVID-19 infections, severity, and deaths. However, such studies are unable to account for individual-level differences in major confounders like socioeconomic status and often rely on imprecise measures of PM<sub>2.5</sub>. We conducted a systematic review of case-control and cohort studies, which rely on individual-level data, searching Medline, Embase, and the WHO COVID-19 database up to 30 June 20  ...[more]

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