Scripps Institution of Oceanography (C. Chen, Benmarhnia), University of California San Diego, La Jolla, Calif.; Public Health Ontario (Wang, Kwong, Kim, H. Chen); ICES Central (Kwong, H. Chen); Dalla Lana School of Public Health (Kwong, Kim, H. Chen), and Department of Family and Community Medicine (Kwong), University of Toronto, Toronto, Ont.; Department of Energy, Environmental, and Chemical Engineering (van Donkelaar, Martin), Washington University in St. Louis, St. Louis, Mo.; College of Public Health and Human Studies (Hystad), Oregon State University, Corvallis, Ore.; Ontario Ministry of the Environment (Su), Conservation and Parks, Toronto, Ont.; Environmental Health Science and Research Bureau (Lavigne, H. Chen), Health Canada, Ottawa, Ont.; Department of Epidemiology and Biostatistics and Occupational Health (Kirby-McGregor, Kaufman), McGill University, Montréal, Que.
CMAJ. 2022 May 24;194(20):E693-E700. doi: 10.1503/cmaj.220068.
BACKGROUND: The tremendous global health burden related to COVID-19 means that identifying determinants of COVID-19 severity is important for prevention and intervention. We aimed to explore long-term exposure to ambient air pollution as a potential contributor to COVID-19 severity, given its known impact on the respiratory system. METHODS: We used a cohort of all people with confirmed SARS-CoV-2 infection, aged 20 years and older and not residing in a long-term care facility in Ontario, Canada, during 2020. We evaluated the association between long-term exposure to fine particulate matter (PM), nitrogen dioxide (NO) and ground-level ozone (O), and risk of COVID-19-related hospital admission, intensive care unit (ICU) admission and death. We ascertained individuals' long-term exposures to each air pollutant based on their residence from 2015 to 2019. We used logistic regression and adjusted for confounders and selection bias using various individual and contextual covariates obtained through data linkage. RESULTS: Among the 151 105 people with confirmed SARS-CoV-2 infection in Ontario in 2020, we observed 8630 hospital admissions, 1912 ICU admissions and 2137 deaths related to COVID-19. For each interquartile range increase in exposure to PM (1.70 μg/m), we estimated odds ratios of 1.06 (95% confidence interval [CI] 1.01-1.12), 1.09 (95% CI 0.98-1.21) and 1.00 (95% CI 0.90-1.11) for hospital admission, ICU admission and death, respectively. Estimates were smaller for NO. We also estimated odds ratios of 1.15 (95% CI 1.06-1.23), 1.30 (95% CI 1.12-1.50) and 1.18 (95% CI 1.02-1.36) per interquartile range increase of 5.14 ppb in O for hospital admission, ICU admission and death, respectively. INTERPRETATION: Chronic exposure to air pollution may contribute to severe outcomes after SARS-CoV-2 infection, particularly exposure to O.
背景：与 COVID-19 相关的巨大全球健康负担意味着，确定 COVID-19 严重程度的决定因素对于预防和干预至关重要。鉴于其对呼吸系统的已知影响，我们旨在探索长期暴露于环境空气污染作为 COVID-19 严重程度的潜在因素。
方法：我们使用了一个在 2020 年期间年龄在 20 岁及以上且不在安大略省长期护理机构居住的所有确诊 SARS-CoV-2 感染患者的队列。我们评估了长期暴露于细颗粒物 (PM)、二氧化氮 (NO) 和地面臭氧 (O) 与 COVID-19 相关住院、重症监护病房 (ICU) 入院和死亡风险之间的关联。我们根据 2015 年至 2019 年的居住地确定了每个个体对每种空气污染物的长期暴露。我们使用逻辑回归，并通过数据链接获得的各种个体和背景协变量来调整混杂因素和选择偏差。
结果：在 2020 年安大略省确诊的 151105 例 SARS-CoV-2 感染患者中，我们观察到与 COVID-19 相关的 8630 例住院、1912 例 ICU 入院和 2137 例死亡。与 PM 暴露每增加一个四分位距（1.70μg/m）相比，我们分别估计住院、ICU 入院和死亡的比值比为 1.06（95%置信区间[CI]1.01-1.12）、1.09（95% CI 0.98-1.21）和 1.00（95% CI 0.90-1.11）。NO 的估计值较小。我们还估计，与 COVID-19 相关的 O 每增加一个四分位距（5.14ppb），住院、ICU 入院和死亡的比值比分别为 1.15（95% CI 1.06-1.23）、1.30（95% CI 1.12-1.50）和 1.18（95% CI 1.02-1.36）。
解释：长期暴露于空气污染可能导致 SARS-CoV-2 感染后的严重后果，特别是暴露于 O。
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