학술논문

Association between Short-Term Exposure to Air Pollution and COVID-19 Mortality: A Population-Based Case-Crossover Study Using Individual-Level Mortality Registry Confirmed by Medical Examiners
Document Type
Report
Source
Environmental Health Perspectives. November 2022, Vol. 130 Issue 11, 117006
Subject
United States
Language
English
ISSN
0091-6765
Abstract
Background: Studies have suggested links between ambient air pollution and coronavirus 2019 (COVID-19) mortality, yet confirmation by well-designed epidemiological studies with individual data is needed. Objectives: We aimed to examine whether short-term exposure to air pollution is associated with risk of mortality from COVID-19 for those infected with COVID-19. Methods: The Cook County Medical Examiner's Office reports individual-level data for deaths from COVID-19 that occur in its jurisdiction, which includes all confirmed COVID-19 deaths in Cook County, Illinois. Case-crossover analysis was conducted to estimate the associations of estimated short-term exposures to particulate matter (PM) with aerodynamic diameter [less than or equal to]2.5 [micro]m (P[M.sub.2.5]) and ozone ([O.sub.3]) on the day of death and up to 21 d before death at location of death with COVID-19. A total of 7,462 deaths from COVID-19 that occurred up to 28 February 2021 were included in the final analysis. We adjusted for potential confounders by time-stratified case-crossover design and by covariate adjustments (i.e., time-invariant factors, meteorological factors, viral transmission, seasonality, and time trend). Results: Of the 7,462 case and 25,457 self-control days, almost all were days with exposure levels below the P[M.sub.2.5] 24-h National Ambient Air Quality Standard (NAAQS) (35 [micro]g/[m.sup.3]); 98.9% had [O.sub.3] levels below the maximum 8-h NAAQS (35.7 [micro]g/[m.sup.3] or 70 parts per billion). An interquartile range (IQR) increase (5.2 [micro]g/[m.sup.3]) in cumulative 3-wk P[M.sub.2.5] exposure was associated with a 69.6% [95% confidence interval (CI): 34.6, 113.8] increase in risk of COVID-19 mortality. An IQR increase (8.2 [micro]g/[m.sup.3]) in 3-d [O.sub.3] exposure was associated with a 29.0% (95% CI: 9.9, 51.5) increase in risk of COVID-19 mortality. The associations differed by demographics or race/ethnicity. There was indication of modification of the associations by some comorbid conditions. Discussion: Short-term exposure to air pollution below the NAAQS may increase the mortality burden from COVID-19. https://doi.org/10.1289/EHP10836
Introduction Because the coronavirus disease 2019 (COVID-19) pandemic has claimed millions of lives worldwide since December 2019, a better understanding of drivers of risk for severe disease and death is [...]