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. 2024 Jan:135:610-618.
doi: 10.1016/j.jes.2022.09.040. Epub 2022 Oct 11.

Impact of short-term ambient air pollution exposure on the risk of severe COVID-19

Baihuan Feng  1 , Jiangshan Lian  2 , Fei Yu  1 , Dan Zhang  1 , Weizhen Chen  1 , Qi Wang  1 , Yifei Shen  1 , Guoliang Xie  1 , Ruonan Wang  1 , Yun Teng  1 , Bin Lou  1 , Shufa Zheng  3 , Yida Yang  4 , Yu Chen  5
Affiliations

Impact of short-term ambient air pollution exposure on the risk of severe COVID-19

Baihuan Feng et al. J Environ Sci (China). 2024 Jan.

Abstract

Ecological studies suggested a link between air pollution and severe COVID-19 outcomes, while studies accounting for individual-level characteristics are limited. In the present study, we aimed to investigate the impact of short-term ambient air pollution exposure on disease severity among a cohort of 569 laboratory confirmed COVID-19 patients admitted to designated hospitals in Zhejiang province, China, from January 17 to March 3, 2020, and elucidate the possible biological processes involved using transcriptomics. Compared with mild cases, severe cases had higher proportion of medical conditions as well as unfavorable results in most of the laboratory tests, and manifested higher air pollution exposure levels. Higher exposure to air pollutants was associated with increased risk of severe COVID-19 with odds ratio (OR) of 1.89 (95% confidence interval (CI): 1.01, 3.53), 2.35 (95% CI: 1.20, 4.61), 2.87 (95% CI: 1.68, 4.91), and 2.01 (95% CI: 1.10, 3.69) for PM2.5, PM10, NO2 and CO, respectively. OR for NO2 remained significant in two-pollutant models after adjusting for other pollutants. Transcriptional analysis showed 884 differentially expressed genes which mainly were enriched in virus clearance related biological processes between patients with high and low NO2 exposure levels, indicating that compromised immune response might be a potential underlying mechanistic pathway. These findings highlight the impact of short-term air pollution exposure, particularly for NO2, on COVID-19 severity, and emphasize the significance in mitigating the COVID-19 burden of commitments to improve air quality.

Keywords: Air pollution; COVID-19; Immune response; Severity; Transcriptomics.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image, graphical abstract
Graphical abstract
Fig 1
Fig. 1
Spatial distribution of monitoring stations and COVID-19 patients admitted from January 17 to March 3, 2020 in Zhejiang province. (a) Spatial distribution of 141 air quality monitoring stations and 569 COVID-19 patients’ home addresses in Zhejiang province, China; (b) The distance from each patient’ residential address to the nearest station.
Fig 2
Fig. 2
Air pollution exposure associated with COVID-19 severity. (a) Spearman's correlations between selected air pollutants and laboratory findings; (b) Odds ratios and respective 95% CI for the associations between exposure to air pollutants and COVID-19 severity.
Fig 3
Fig. 3
GO-term and KEGG pathway enrichment of differentially expressed genes between low- and high-exposure groups, based on the NO2 exposure level.
See this image and copyright information in PMC

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