Galdakao-Usansolo University Hospital, Pulmonology Department, Galdakao, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain.
Basque Center for Applied Mathematics (BCAM), Bilbao, Spain.
Sci Total Environ. 2023 Oct 10;894:164877. doi: 10.1016/j.scitotenv.2023.164877. Epub 2023 Jun 17.
The relationship between exposure to air pollution and the severity of coronavirus disease 2019 (COVID-19) pneumonia and other outcomes is poorly understood. Beyond age and comorbidity, risk factors for adverse outcomes including death have been poorly studied. The main objective of our study was to examine the relationship between exposure to outdoor air pollution and the risk of death in patients with COVID-19 pneumonia using individual-level data. The secondary objective was to investigate the impact of air pollutants on gas exchange and systemic inflammation in this disease. This cohort study included 1548 patients hospitalised for COVID-19 pneumonia between February and May 2020 in one of four hospitals. Local agencies supplied daily data on environmental air pollutants (PM, PM, O, NO, NO and NO) and meteorological conditions (temperature and humidity) in the year before hospital admission (from January 2019 to December 2019). Daily exposure to pollution and meteorological conditions by individual postcode of residence was estimated using geospatial Bayesian generalised additive models. The influence of air pollution on pneumonia severity was studied using generalised additive models which included: age, sex, Charlson comorbidity index, hospital, average income, air temperature and humidity, and exposure to each pollutant. Additionally, generalised additive models were generated for exploring the effect of air pollution on C-reactive protein (CRP) level and SpO/FiO at admission. According to our results, both risk of COVID-19 death and CRP level increased significantly with median exposure to PM, NO, NO and NO, while higher exposure to NO, NO and NO was associated with lower SpO/FiO ratios. In conclusion, after controlling for socioeconomic, demographic and health-related variables, we found evidence of a significant positive relationship between air pollution and mortality in patients hospitalised for COVID-19 pneumonia. Additionally, inflammation (CRP) and gas exchange (SpO/FiO) in these patients were significantly related to exposure to air pollution.
空气污染暴露与 2019 年冠状病毒病（COVID-19）肺炎严重程度和其他结果之间的关系尚未被充分了解。除年龄和合并症外，包括死亡在内的不良结果的危险因素也研究甚少。我们研究的主要目的是使用个体水平数据，研究 COVID-19 肺炎患者暴露于室外空气污染与死亡风险之间的关系。次要目的是研究空气污染物对这种疾病的气体交换和全身炎症的影响。这项队列研究纳入了 2020 年 2 月至 5 月期间在四家医院之一住院的 1548 名 COVID-19 肺炎患者。当地机构提供了入院前一年（2019 年 1 月至 2019 年 12 月）的环境空气污染物（PM、PM、O、NO、NO 和 NO）和气象条件（温度和湿度）的每日数据。使用地理空间贝叶斯广义加性模型，根据患者居住地的邮政编码来估计个人的每日污染和气象条件暴露。使用广义加性模型来研究空气污染对肺炎严重程度的影响，模型中包含了年龄、性别、Charlson 合并症指数、医院、平均收入、空气温度和湿度以及每种污染物的暴露情况。此外，还生成了广义加性模型来探索空气污染对入院时 C 反应蛋白（CRP）水平和 SpO/FiO 的影响。结果表明，PM、NO、NO 和 NO 的中位数暴露与 COVID-19 死亡风险和 CRP 水平的升高显著相关，而较高的 NO、NO 和 NO 暴露与较低的 SpO/FiO 比值相关。综上所述，在控制了社会经济、人口统计学和健康相关变量后，我们发现 COVID-19 肺炎住院患者的空气污染与死亡率之间存在显著的正相关关系。此外，这些患者的炎症（CRP）和气体交换（SpO/FiO）与空气污染暴露显著相关。
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