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J Hazard Mater . Subtype-specific associations between ambient air pollution and influenza virus infection: A nationwide case-crossover study in Chi

tetano

Editor, Senior Moderator
J Hazard Mater


. 2026 Jun 10:514:142661.
doi: 10.1016/j.jhazmat.2026.142661. Online ahead of print.
Subtype-specific associations between ambient air pollution and influenza virus infection: A nationwide case-crossover study in China

Shimeng Cai[SUP] 1 [/SUP], Xin Liu[SUP] 2 [/SUP], Bin Zhu[SUP] 2 [/SUP], Dayan Wang[SUP] 3 [/SUP], Hao Lei[SUP] 4 [/SUP]


Affiliations
Abstract

With the advancement of industrialization and the acceleration of urbanization, air pollution has become a major environmental health issue worldwide. However, the subtype-specific associations between air pollution and influenza virus infection remains unclear. In this nationwide individual-level case-crossover study, conditional logistic regression models combined with distributed lag models were applied to quantify the associations between exposure to PM[SUB]2.5[/SUB], PM[SUB]10[/SUB], O[SUB]3[/SUB], CO, NO[SUB]2[/SUB], SO[SUB]2[/SUB] and influenza virus infection in China. From 2013 to 2017, we included 257,763 laboratory-confirmed influenza-positive cases that had residential address information at the street or township level or finer, of which 177,794 (68.98%) were infected by influenza A. Our results indicated that for each 10 μg/m³ increase in PM[SUB]2.5[/SUB], PM[SUB]10[/SUB], CO, NO₂, and SO₂, the cumulative 7-day (lag06) effects on influenza virus infection increased by 1.54% (95% CI: 1.33-1.76%), 1.05% (95% CI: 0.90-1.19%), 0.11% (95% CI: 0.10-0.13%), 4.68% (95% CI: 4.10-5.26%), and 4.34% (95% CI: 3.84-4.83%), whereas O[SUB]3[/SUB] showed a significant protective effect, with 10 μg/m³ increase, the cumulative influenza virus infection would decreased by 2.96% (95% CI: 2.60-3.32%). The associations between all six air pollutants and influenza A virus infection were stronger than those for influenza B virus infection. With per 10 μg/m³ increase in PM[SUB]2.5[/SUB] the cumulative 7-day risk of influenza A and B virus infection increased by 1.92% (95% CI: 1.66-2.18%) and 0.75% (95% CI: 0.37-1.13%), respectively. Given the rapid urbanization process in China, our findings support professionals in developing public health policies that balance socioeconomic development with the environmental burden of influenza.

Keywords: Air pollution; Case-crossover study; Distributed lag model; Influenza; Subtype.

 
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