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Observational Study
. 2022 Nov;214(Pt 2):113896.
doi: 10.1016/j.envres.2022.113896. Epub 2022 Jul 13.

Air quality in Germany as a contributing factor to morbidity from COVID-19

Susanne Koch  1 , Christina Hoffmann  2 , Alexandre Caseiro  3 , Marie Ledebur  4 , Mario Menk  4 , Erika von Schneidemesser  3
Affiliations
Observational Study

Air quality in Germany as a contributing factor to morbidity from COVID-19

Susanne Koch et al. Environ Res. 2022 Nov.

Abstract

Background: The SARS-CoV-2 virus has been spreading in Germany since January 2020, with regional differences in incidence, morbidity, and mortality. Long-term exposure to air pollutants as nitrogen dioxide (NO2), nitrogen monoxide (NO), ozone (O3), and particulate matter (<10 μm PM10, <2.5 μm PM2.5) has a negative impact on respiratory functions. We analyze the association between long-term air pollution and the outcome of SARS-CoV-2 infections in Germany.

Methods: We conducted an observational study in Germany on county-level, investigating the association between long-term (2010-2019) air pollutant exposure (European Environment Agency, AirBase data set) and COVID-19 incidence, morbidity, and mortality rate during the first outbreak of SARS-CoV-2 (open source data Robert Koch Institute). We used negative binominal models, including adjustment for risk factors (age, sex, days since first COVID-19 case, population density, socio-economic and health parameters).

Results: After adjustment for risk factors in the tri-pollutant model (NO2, O3, PM2.5) an increase of 1 μg/m³ NO2 was associated with an increase of the need for intensive care due to COVID-19 by 4.2% (95% CI 1.011-1.074), and mechanical ventilation by 4.6% (95% CI 1.010-1.084). A tendency towards an association of NO2 with COVID-19 incidence was indicated, as the results were just outside of the defined statistical significance (+1.6% (95% CI 1.000-1.032)). Long-term annual mean NO2 level ranged from 4.6 μg/m³ to 32 μg/m³.

Conclusions: Our results indicate that long-term NO2 exposure may have increased susceptibility for COVID-19 morbidity in Germany. The results demonstrate the need to reduce ambient air pollution to improve public health.

Keywords: Air pollution; Intensive care medicine; Mechanical ventilation; Mortality; Nitrogen dioxide; SARS-CoV-2.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:

Erika von Schneidemesser, Alexandre Caseiro reports financial support was provided by Federal Ministry of Education and Research of Germany (BMBF). Erika von Schneidemesser, Alexandre Caseiro reports financial support was provided by Ministry for Science, Research and Culture of the State of Brandenburg (MWFK).

Figures

Fig. 1
Fig. 1
Title: Air pollution metrics for 2010 through 2019, Legend: The plots show air pollution metrics that are averaged across all 10 years by county on a log scale.
Fig. 2
Fig. 2
Title: COVID-19 parameters in numbers and per 100,000 residents by county, Legend: COVID-19 parameters in numbers and per 100,000 residents by county evaluated in the models for the dates given above on a log scale. For counties that were reporting but had e.g., no deaths, a zero is shown. The counties that are white had no hospitals reporting DIVI data and were therefore left out of the analysis.
See this image and copyright information in PMC

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