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

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Environ Pollut


. 2022 Jun 29;119686.
doi: 10.1016/j.envpol.2022.119686. Online ahead of print.
Associations of air pollution with COVID-19 positivity, hospitalisations, and mortality: Observational evidence from UK Biobank


Charlotte Sheridan ¹ , Jochem Klompmaker ² , Steven Cummins ³ , Peter James ⁴ , Daniela Fecht ⁵ , Charlotte Roscoe ⁶



Affiliations

• PMID: 35779662
• DOI: 10.1016/j.envpol.2022.119686

Abstract

Individual-level studies with adjustment for important COVID-19 risk factors suggest positive associations of long-term air pollution exposure (particulate matter and nitrogen dioxide) with COVID-19 infection, hospitalisations and mortality. The evidence, however, remains limited and mechanisms unclear. We aimed to investigate these associations within UK Biobank, and to examine the role of underlying chronic disease as a potential mechanism. UK Biobank COVID-19 positive laboratory test results were ascertained via Public Health England and general practitioner record linkage, COVID-19 hospitalisations via Hospital Episode Statistics, and COVID-19 mortality via Office for National Statistics mortality records from March-December 2020. We used annual average outdoor air pollution modelled at 2010 residential addresses of UK Biobank participants who resided in England (n = 424,721). We obtained important COVID-19 risk factors from baseline UK Biobank questionnaire responses (2006-2010) and general practitioner record linkage. We used logistic regression models to assess associations of air pollution with COVID-19 outcomes, adjusted for relevant confounders, and conducted sensitivity analyses. We found positive associations of fine particulate matter (PM 2.5) and nitrogen dioxide (NO 2) with COVID-19 positive test result after adjustment for confounders and COVID-19 risk factors, with odds ratios of 1.05 (95% confidence intervals (CI) = 1.02, 1.08), and 1.05 (95% CI = 1.01, 1.08), respectively. PM 2.5 and NO 2 were positively associated with COVID-19 hospitalisations and deaths in minimally adjusted models, but not in fully adjusted models. No associations for PM 10 were found. In analyses with additional adjustment for pre-existing chronic disease, effect estimates were not substantially attenuated, indicating that underlying chronic disease may not fully explain associations. We found some evidence that long-term exposure to PM 2.5 and NO 2 was associated with a COVID-19 positive test result in UK Biobank, though not with COVID-19 hospitalisations or deaths.

Keywords: Air pollution; COVID-19; Cohort study; Coronavirus; NO(2); Nitrogen dioxide; PM(2.5); Particulate matter; SARS-CoV-2.