Interactive Effects of Long-term Exposure to Air Pollutants on SARS-CoV-2 Infection and Severity: A Northern Italian Population-based Cohort Study.

IF 4.7 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Epidemiology Pub Date : 2025-01-01 Epub Date: 2024-09-24 DOI:10.1097/EDE.0000000000001792

Giovanni Veronesi, Sara De Matteis, Camillo Silibello, Emanuele M Giusti, Walter Ageno, Marco M Ferrario

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Abstract

Background: We examined interactions, to our knowledge not yet explored, between long-term exposures to particulate matter (PM 10 ) with nitrogen dioxide (NO 2 ) and ozone (O 3 ) on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectivity and severity.

Methods: We followed 709,864 adult residents of Varese Province from 1 February 2020 until the first positive test, COVID-19 hospitalization, or death, up to 31 December 2020. We estimated residential annual means of PM 10 , NO 2 , and O 3 in 2019 from chemical transport and random-forest models. We estimated the interactive effects of pollutants with urbanicity on SARS-CoV-2 infectivity, hospitalization, and mortality endpoints using Cox regression models adjusted for socio-demographic factors and comorbidities, and additional cases due to interactions using Poisson models.

Results: In total 41,065 individuals were infected, 5203 were hospitalized and 1543 died from COVID-19 during follow-up. Mean PM 10 was 1.6 times higher and NO 2 2.6 times higher than WHO limits, with wide gradients between urban and nonurban areas. PM 10 and NO 2 were positively associated with SARS-CoV-2 infectivity and mortality, and PM 10 with hospitalizations in urban areas. Interaction analyses estimated that the effect of PM 10 (per 3.5 µg/m 3 ) on infectivity was strongest in urban areas [hazard ratio (HR) = 1.12; 95% CI =1.09, 1.16], corresponding to 854 additional cases per 100,000 person-years, and in areas at high NO 2 co-exposure (HR = 1.15; 1.08, 1.22). At higher levels of PM 10 co-exposure, the protective association of O 3 reversed (HR =1.32, 1.17, 1.49), yielding 278 additional cases per µg/m 3 increase in O 3 . We estimated similar interactive effects for severity endpoints.

Conclusions: We estimate that interactive effects between pollutants exacerbated the burden of the SARS-CoV-2 pandemic in urban areas.

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长期暴露于空气污染物对 SARS-CoV-2 感染和严重程度的交互影响：一项基于意大利北部人群的队列研究。

背景：我们研究了长期暴露于颗粒物（PM 10）、二氧化氮（NO 2）和臭氧（O 3）对 SARS-CoV-2 感染性和严重程度的交互作用：我们对瓦雷泽省的 709 864 名成年居民进行了跟踪调查，时间从 2020 年 2 月 1 日开始，直到首次检测呈阳性、COVID-19 住院或死亡，直至 2020 年 12 月 31 日。我们利用化学传输模型和随机森林模型估算了 2019 年居民区 PM 10、NO 2 和 O 3 的年均值。我们利用经社会人口因素和合并症调整的 Cox 回归模型估算了污染物与城市化程度对 SARS-CoV-2 感染率、住院率和死亡率终点的交互影响，并利用泊松模型估算了交互影响导致的额外病例：41,065人受到感染，5,203人住院治疗，1,543人在随访期间死于COVID-19。PM 10 的平均值比世界卫生组织的限值高 1.6 倍，NO 2 的平均值比世界卫生组织的限值高 2.6 倍，城市和非城市地区之间的梯度很大。PM 10 和 NO 2 与 SARS-CoV-2 感染率和死亡率呈正相关，PM 10 与城市地区的住院率呈正相关。据交互分析估计，PM 10（每 3.5 微克/米 3）对感染率的影响在城市地区最强（HR=1.12，95%CI：1.09-1.16），相当于每 10 万人年增加 854 个病例，在二氧化氮共同暴露水平较高的地区也是如此（HR=1.15，1.08-1.22）。在 PM 10 共同暴露水平较高的地区，臭氧的保护作用发生逆转（HR=1.32，1.17-1.49），O 3 每增加 1 µg/m 3，病例数增加 278 例。我们对严重性终点的交互效应进行了类似的估计：我们估计，污染物之间的交互效应加剧了 SARS-CoV-2 在城市地区的流行。

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来源期刊

Epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

6.70

自引率

3.70%

发文量

177

审稿时长

6-12 weeks

期刊介绍： Epidemiology publishes original research from all fields of epidemiology. The journal also welcomes review articles and meta-analyses, novel hypotheses, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.