Dataset Information

Long-term exposure to air-pollution and COVID-19 mortality in England: a hierarchical spatial analysis.

ABSTRACT:

Background

Recent studies suggested a link between long-term exposure to air-pollution and COVID-19 mortality. However, due to their ecological design, based on large spatial units, they neglect the strong localised air-pollution patterns, and potentially lead to inadequate confounding adjustment. We investigated the effect of long-term exposure to NO2 and PM2.5 on COVID-19 deaths up to June 30, 2020 in England using high geographical resolution.

Methods

We included 38 573 COVID-19 deaths up to June 30, 2020 at the Lower Layer Super Output Area level in England (n=32 844 small areas). We retrieved averaged NO2 and PM2.5 concentration during 2014-2018 from the Pollution Climate Mapping. We used Bayesian hierarchical models to quantify the effect of air-pollution while adjusting for a series of confounding and spatial autocorrelation.

Findings

We find a 0.5% (95% credible interval: -0.2%-1.2%) and 1.4% (-2.1%-5.1%) increase in COVID-19 mortality rate for every 1?g/m3 increase in NO2 and PM2.5 respectively, after adjusting for confounding and spatial autocorrelation. This corresponds to a posterior probability of a positive effect of 0.93 and 0.78 respectively. The spatial relative risk at LSOA level revealed strong patterns, similar for the different pollutants. This potentially captures the spread of the disease during the first wave of the epidemic.

Interpretation

Our study provides some evidence of an effect of long-term NO2 exposure on COVID-19 mortality, while the effect of PM2.5 remains more uncertain.

Funding

Medical Research Council, Wellcome Trust, Environmental Protection Agency and National Institutes of Health.

SUBMITTER: Konstantinoudis G

PROVIDER: S-EPMC7430619 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Publications

Long-term exposure to air-pollution and COVID-19 mortality in England: a hierarchical spatial analysis.

Konstantinoudis Garyfallos G Padellini Tullia T Bennett James J Davies Bethan B Ezzati Majid M Blangiardo Marta M

medRxiv : the preprint server for health sciences 20200811

<h4>Background</h4>Recent studies suggested a link between long-term exposure to air-pollution and COVID-19 mortality. However, due to their ecological design, based on large spatial units, they neglect the strong localised air-pollution patterns, and potentially lead to inadequate confounding adjustment. We investigated the effect of long-term exposure to NO2 and PM2.5 on COVID-19 deaths up to June 30, 2020 in England using high geographical resolution.<h4>Methods</h4>We included 38 573 COVID-1 ...[more]

PMID: 32817974

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Project description:BackgroundThe role of chronic exposure to ambient air pollutants in increasing COVID-19 fatality is still unclear.ObjectivesThe study aimed to investigate the association between long-term exposure to air pollutants and mortality among 4 million COVID-19 cases in Italy.MethodsWe obtained individual records of all COVID-19 cases identified in Italy from February 2020 to June 2021. We assigned 2016-2019 mean concentrations of particulate matter (PM) with aerodynamic diameter ≤10μm (PM10), PM with aerodynamic diameter ≤2.5μm (PM2.5), and nitrogen dioxide (NO2) to each municipality (n=7,800) as estimates of chronic exposures. We applied a principal component analysis (PCA) and a generalized propensity score (GPS) approach to an extensive list of area-level covariates to account for major determinants of the spatial distribution of COVID-19 case-fatality rates. Then, we applied generalized negative binomial models matched on GPS, age, sex, province, and month. As additional analyses, we fit separate models by pandemic periods, age, and sex; we quantified the numbers of COVID-19 deaths attributable to exceedances in annual air pollutant concentrations above predefined thresholds; and we explored associations between air pollution and alternative outcomes of COVID-19 severity, namely hospitalizations or accesses to intensive care units.ResultsWe analyzed 3,995,202 COVID-19 cases, which generated 124,346 deaths. Overall, case-fatality rates increased by 0.7% [95% confidence interval (CI): 0.5%, 0.9%], 0.3% (95% CI: 0.2%, 0.5%), and 0.6% (95% CI: 0.5%, 0.8%) per 1 μg/m3 increment in PM2.5, PM10, and NO2, respectively. Associations were higher among elderly subjects and during the first (February 2020-June 2020) and the third (December 2020-June 2021) pandemic waves. We estimated ∼8% COVID-19 deaths were attributable to pollutant levels above the World Health Organization 2021 air quality guidelines.DiscussionWe found suggestive evidence of an association between long-term exposure to ambient air pollutants with mortality among 4 million COVID-19 cases in Italy. https://doi.org/10.1289/EHP11882.

Dataset Information

Long-term exposure to air-pollution and COVID-19 mortality in England: a hierarchical spatial analysis.

Background

Methods

Findings

Interpretation

Funding

Publications

Long-term exposure to air-pollution and COVID-19 mortality in England: a hierarchical spatial analysis.

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