Effects of long-term exposure to outdoor air pollution on COVID-19 incidence: A population-based cohort study accounting for SARS-CoV-2 exposure levels in the Netherlands

• DOI: 10.1016/j.envres.2024.118812
• Publication Date: 2024-03-30T23:36:23Z
• Authors: Jelle Zorn; Mariana Simões; Guus J.M. Velders; Miriam Gerlofs-Ni...; Maciek Strak; José Jacobs; Marieke B.A. Dijkema; Thomas J. Hagenaars; Lidwien A.M. Smit; Roel Vermeulen; Lapo Mughini-Gras; Lenny Hogerwerf; Don Klinkenberg
• Keywords: Interquartile range; Inhalation exposure; Exposure Assessment

Several studies have linked air pollution to COVID-19 morbidity and severity. However, these do not account for exposure levels SARS-CoV-2, nor different sources of pollution. We analyzed individual-level data 8.3 million adults in the Netherlands assess associations between long-term ambient SARS-CoV-2 infection (i.e., positive test) hospitalisation risks, accounting spatiotemporal variation during first two major epidemic waves (February 2020–February 2021). estimated average annual concentrations PM10, PM2.5 NO2 at residential addresses, overall by PM source (road traffic, industry, livestock, other agricultural sources, foreign Dutch sources), 1 × km resolution, weekly municipal level. Using generalized additive models, we performed interval-censored survival analyses individuals' three years before pandemic (2017–2019) COVID-19-outcomes, adjusting exposure, individual area-specific confounders. In single-pollutant per interquartile (IQR) increase PM10 was associated with 7% increased risk 16% risk, 8% 18% 3% 11% risk. Bi-pollutant models suggested that effects were mainly driven PM. Associations confirmed when stratifying urbanization degree, wave testing policy. All emission PM, except showed adverse on both outcomes. Livestock most detrimental unit whereas road traffic affected severity (hospitalisation) more than This study shows increases even after controlling levels, may differential outcomes depending source.