Department of Hospital Infection Management, Chengdu First People's Hospital, Chengdu, China.
Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China.
Front Public Health. 2023 Dec 22;11:1308775. doi: 10.3389/fpubh.2023.1308775. eCollection 2023.
BACKGROUND: Numerous studies have demonstrated that fine particulate matter (PM) is adversely associated with COVID-19 incidence. However, few studies have explored the spatiotemporal heterogeneity in this association, which is critical for developing cost-effective pollution-related policies for a specific location and epidemic stage, as well as, understanding the temporal change of association between PM and an emerging infectious disease like COVID-19. METHODS: The outcome was state-level daily COVID-19 cases in 49 native United States between April 1, 2020 and December 31, 2021. The exposure variable was the moving average of PM with a lag range of 0-14 days. A latest proposed strategy was used to investigate the spatial distribution of PM-COVID-19 association in state level. First, generalized additive models were independently constructed for each state to obtain the rough association estimations, which then were smoothed using a Leroux-prior-based conditional autoregression. Finally, a modified time-varying approach was used to analyze the temporal change of association and explore the potential causes spatiotemporal heterogeneity. RESULTS: In all states, a positive association between PM and COVID-19 incidence was observed. Nearly one-third of these states, mainly located in the northeastern and middle-northern United States, exhibited statistically significant. On average, a 1 μg/m increase in PM concentration led to an increase in COVID-19 incidence by 0.92% (95%CI: 0.63-1.23%). A U-shaped temporal change of association was examined, with the strongest association occurring in the end of 2021 and the weakest association occurring in September 1, 2020 and July 1, 2021. Vaccination rate was identified as a significant cause for the association heterogeneity, with a stronger association occurring at a higher vaccination rate. CONCLUSION: Short-term exposure to PM and COVID-19 incidence presented positive association in the United States, which exhibited a significant spatiotemporal heterogeneity with strong association in the eastern and middle regions and with a U-shaped temporal change.
背景：大量研究表明，细颗粒物（PM）与 COVID-19 发病率呈负相关。然而，很少有研究探讨这种关联的时空异质性，这对于为特定地点和流行阶段制定具有成本效益的污染相关政策以及理解 PM 与 COVID-19 等新兴传染病之间的关联的时间变化至关重要。
方法：本研究的结果为 2020 年 4 月 1 日至 2021 年 12 月 31 日期间美国本土 49 个州的每日 COVID-19 病例。暴露变量为滞后范围为 0-14 天的 PM 的移动平均值。采用最新提出的策略来研究州级 PM-COVID-19 关联的空间分布。首先，为每个州独立构建广义加性模型，以获得大致的关联估计，然后使用基于 Leroux-prior 的条件自回归对其进行平滑。最后，采用修正的时变方法分析关联的时间变化，并探讨潜在的时空异质性原因。
结果：在美国所有州，均观察到 PM 与 COVID-19 发病率之间存在正相关关系。其中近三分之一的州，主要位于美国东北部和中北部，表现出统计学上的显著相关性。平均而言，PM 浓度每增加 1μg/m，COVID-19 发病率增加 0.92%（95%CI：0.63-1.23%）。还研究了关联的 U 形时间变化，在 2021 年底关联最强，而在 2020 年 9 月 1 日和 2021 年 7 月 1 日关联最弱。疫苗接种率被确定为关联异质性的一个重要原因，随着疫苗接种率的提高，关联越强。
结论：在美国，短期暴露于 PM 与 COVID-19 发病率呈正相关，具有显著的时空异质性，在东部和中部地区关联较强，且呈 U 形时间变化。
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