Marian Brittney, Yan Ying, Chen Zhanghua, Lurmann Fred, Li Kenan, Gilliland Frank, Eckel Sandrah P, Garcia Erika
Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States of America.
Sonoma Technology, Inc, Petaluma, CA, United States of America.
Environ Adv. 2022 Oct;9:100280. doi: 10.1016/j.envadv.2022.100280. Epub 2022 Aug 9.
The growing literature demonstrating air pollution associations on COVID-19 mortality contains studies predominantly examining long-term exposure, with few on short-term exposure, and rarely both together to estimate independent associations. Because mechanisms by which air pollution may impact COVID-19 mortality risk function over timescales ranging from years to days, and given correlation among exposure time windows, consideration of both short- and long-term exposure is of importance. We assessed the independent associations between COVID-19 mortality rates with short- and long-term air pollution exposure by modeling both concurrently. Using California death certificate data COVID-19-related deaths were identified, and decedent residential information used to assess short- (4-week mean) and long-term (6-year mean) exposure to particulate matter <2.5µm (PM), nitrogen dioxide (NO), and ozone (O). Negative binomial mixed models were fitted on weekly census tract COVID-19 mortality adjusting for potential confounders with random effects for county and census tract and an offset for population. Data were evaluated separately for two time periods March 16, 2020-October 18, 2020 and October 19, 2020-April 25, 2021, representing the Spring/Summer surges and Winter surge. Independent positive associations with COVID-19 mortality were observed for short- and long-term PM in both study periods, with strongest associations observed in the first study period: COVID-19 mortality rate ratio for a 2-μg/m increase in long-term PM was 1.13 (95%CI:1.09,1.17) and for a 4.7-μg/m increase in short-term PM was 1.05 (95%CI:1.02,1.08). Statistically significant positive associations were seen for both short- and long-term NO in study period 1, but short-term NO was not statistically significant in study period 2. Results for long-term O indicate positive associations, however, only marginal significance is achieved in study period 1. These findings support an adverse effect of long-term PM and NO exposure on COVID-19 mortality risk, independent of short-term exposure, and a possible independent effect of short-term PM.
越来越多的文献表明空气污染与新冠病毒病死亡率之间存在关联，这些研究主要考察长期暴露情况，很少涉及短期暴露，并且极少同时考察两者以估计独立关联。由于空气污染可能影响新冠病毒病死亡风险的机制在从数年到数天的时间尺度上发挥作用，而且考虑到不同暴露时间窗之间的相关性，同时考虑短期和长期暴露具有重要意义。我们通过同时对短期和长期空气污染暴露进行建模，评估了它们与新冠病毒病死亡率之间的独立关联。利用加利福尼亚州的死亡证明数据，确定了与新冠病毒病相关的死亡病例，并使用死者的居住信息来评估短期（4周平均值）和长期（6年平均值）对细颗粒物（PM）<2.5微米、二氧化氮（NO）和臭氧（O）的暴露情况。采用负二项混合模型，对每周人口普查区新冠病毒病死亡率进行拟合，对潜在混杂因素进行调整，同时考虑县和人口普查区的随机效应以及人口偏移量。数据分别针对两个时间段进行评估，即2020年3月16日至2020年10月18日以及2020年10月19日至2021年4月25日，分别代表春季/夏季疫情高峰和冬季疫情高峰。在两个研究时间段内，均观察到短期和长期PM与新冠病毒病死亡率之间存在独立的正相关，在第一个研究时间段内观察到的相关性最强：长期PM每增加2微克/立方米，新冠病毒病死亡率比值比为1.13（95%置信区间：1.09，1.17）；短期PM每增加4.7微克/立方米，新冠病毒病死亡率比值比为1.05（95%置信区间：1.02，1.08）。在研究时间段1内，短期和长期NO均呈现出具有统计学意义的正相关，但在研究时间段2内，短期NO无统计学意义。长期O的结果显示存在正相关，然而，仅在研究时间段1内达到边缘显著性。这些发现支持长期暴露于PM和NO会对新冠病毒病死亡风险产生不利影响，且独立于短期暴露，同时短期PM可能也存在独立影响。
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