Universitat Rovira i Virgili, Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Sant Llorenç 21, 43201 Reus, Catalonia, Spain.
Universitat Rovira i Virgili, Department of Biostatistics, Sant Llorenç 21, 43201 Reus, Catalonia, Spain.
Environ Int. 2022 Jan;158:106930. doi: 10.1016/j.envint.2021.106930. Epub 2021 Oct 16.
Age, sex, race and comorbidities are insufficient to explain why some individuals remain asymptomatic after SARS-CoV-2 infection, while others die. In this sense, the increased risk caused by the long-term exposure to air pollution is being investigated to understand the high heterogeneity of the COVID-19 infection course.
We aimed to assess the underlying effect of long-term exposure to NO and PM on the severity and mortality of COVID-19.
A retrospective observational study was conducted with 2112 patients suffering COVID-19 infection. We built two sets of multivariate predictive models to assess the relationship between the long-term exposure to NO and PM and COVID-19 outcome. First, the probability of either death or severe COVID-19 outcome was predicted as a function of all the clinical variables together with the pollutants exposure by means of two regularized logistic regressions. Subsequently, two regularized linear regressions were constructed to predict the percentage of dead or severe patients. Finally, odds ratios and effects estimates were calculated.
We found that the long-term exposure to PM is a more important variable than some already stated comorbidities (i.e.: COPD/Asthma, diabetes, obesity) in the prediction of COVID-19 severity and mortality. PM showed the highest effects estimates (1.65, 95% CI 1.32-2.06) on COVID-19 severity. For mortality, the highest effect estimates corresponded to age (3.59, 95% CI 2.94-4.40), followed by PM (2.37, 95% CI 1.71-3.32). Finally, an increase of 1 µg/m in PM concentration causes an increase of 3.06% (95% CI 1.11%-4.25%) of patients suffering COVID-19 as a severe disease and an increase of 2.68% (95% CI 0.53%-5.58%) of deaths.
These results demonstrate that long-term PM burdens above WHO guidelines exacerbate COVID-19 health outcomes. Hence, WHO guidelines, the air quality standard established by the Directive 2008/50/EU, and that of the US-EPA should be updated accordingly to protect human health.
年龄、性别、种族和合并症等因素不足以解释为什么有些人在感染 SARS-CoV-2 后仍然无症状，而有些人则死亡。在这种情况下，人们正在研究长期暴露于空气污染所导致的风险增加，以了解 COVID-19 感染过程的高度异质性。
我们旨在评估长期暴露于 NO 和 PM 对 COVID-19 严重程度和死亡率的潜在影响。
对 2112 名 COVID-19 感染患者进行了回顾性观察性研究。我们建立了两套多变量预测模型，以评估长期暴露于 NO 和 PM 与 COVID-19 结果之间的关系。首先，通过两种正则化逻辑回归，将死亡或严重 COVID-19 结果的概率作为所有临床变量与污染物暴露的函数进行预测。随后，构建了两个正则化线性回归模型来预测死亡或严重患者的百分比。最后，计算了比值比和效应估计值。
我们发现，与一些已确定的合并症（即 COPD/哮喘、糖尿病、肥胖症）相比，长期暴露于 PM 是预测 COVID-19 严重程度和死亡率的更重要变量。PM 对 COVID-19 严重程度的影响估计值最高（1.65，95%CI 1.32-2.06）。对于死亡率，最高的效应估计值对应于年龄（3.59，95%CI 2.94-4.40），其次是 PM（2.37，95%CI 1.71-3.32）。最后，PM 浓度增加 1μg/m 会导致 COVID-19 患者患严重疾病的比例增加 3.06%（95%CI 1.11%-4.25%），死亡率增加 2.68%（95%CI 0.53%-5.58%）。
这些结果表明，长期 PM 负担超过世卫组织指南会加重 COVID-19 的健康结果。因此，世卫组织指南、2008/50/EU 指令制定的空气质量标准以及美国环保署的标准应相应更新，以保护人类健康。
