Background

Ecologic analyses suggest that living in areas with higher levels of ambient fine particulate matter air pollution (PM_2.5) is associated with higher risk of adverse COVID-19 outcomes. Studies accounting for individual-level health characteristics are lacking.

Methods

We leveraged the breadth and depth of the US Department of Veterans Affairs national healthcare databases and built a national cohort of 169,102 COVID-19 positive United States Veterans, enrolled between March 2, 2020 and January 31, 2021, and followed them through February 15, 2021. Annual average 2018 PM_2.5 exposure, at an approximately 1 km² resolution, was linked with residential street address at the year prior to COVID-19 positive test. COVID-19 hospitalization was defined as first hospital admission between 7 days prior to, and 15 days after, the first COVID-19 positive date. Adjusted Poisson regression assessed the association of PM_2.5 with risk of hospitalization.

Results

There were 25,422 (15.0%) hospitalizations; 5,448 (11.9%), 5,056 (13.0%), 7,159 (16.1%), and 7,759 (19.4%) were in the lowest to highest PM_2.5 quartile, respectively. In models adjusted for State, demographic and behavioral factors, contextual characteristics, and characteristics of the pandemic a one interquartile range increase in PM_2.5 (1.9 µg/m³) was associated with a 10% (95% CI: 8%-12%) increase in risk of hospitalization. The association of PM_2.5 and risk of hospitalization among COVID-19 individuals was present in each wave of the pandemic. Models of non-linear exposure-response suggested increased risk at PM_2.5 concentrations below the national standard 12 µg/m³. Formal effect modification analyses suggested higher risk of hospitalization associated with PM_2.5 in Black people compared to White people (p=0.045), and in those living in socioeconomically disadvantaged neighborhoods (p<0.001).

Conclusions

Exposure to higher levels of PM_2.5 was associated with increased risk of hospitalization among COVID-19 infected individuals. The risk was evident at PM_2.5 levels below the regulatory standards. The analysis identified those of Black race and those living in disadvantaged neighborhoods as population groups that may be more susceptible to the untoward effect of PM_2.5 on risk of hospitalization in the setting of COVID-19.

中文翻译：

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环境细颗粒物空气污染与 COVID-19 阳性个体住院风险：队列研究

背景

生态分析表明，生活在环境细颗粒物空气污染 (PM _2.5 ) 水平较高的地区与发生 COVID-19 不良结果的风险较高相关。缺乏考虑个人健康特征的研究。

方法

我们利用美国退伍军人事务部国家医疗保健数据库的广度和深度，建立了一个由 169,102 名 COVID-19 阳性美国退伍军人组成的全国队列，这些人于 2020 年 3 月 2 日至 2021 年 1 月 31 日期间入组，并对他们进行跟踪直至 2 月 15 日， 2021 年。2018 年平均 PM _2.5暴露（分辨率约为 1 km ²）与 COVID-19 阳性检测前一年的住宅街道地址相关联。COVID-19 住院治疗的定义是在首次出现 COVID-19 阳性日期之前 7 天到之后 15 天期间首次入院。调整后的泊松回归评估了 PM _2.5与住院风险的关联。

结果

住院治疗人数为 25,422 人（15.0%）；分别有 5,448 (11.9%)、5,056 (13.0%)、7,159 (16.1%) 和 7,759 (19.4%) 处于 PM _2.5最低至最高四分位数。_{在根据州、人口和行为因素、背景特征以及大流行特征进行调整的模型中，PM 2.5} (1.9 µg/m ³ )的四分位间距增加与 10% 相关（95% CI：8%-12% ）住院风险增加。_{PM 2.5}与 COVID-19 个体住院风险之间的关联在每一波大流行中都存在。非线性暴露反应模型表明，PM _2.5浓度低于国家标准 12 µg/m ³时，风险会增加。正式效应修正分析表明，与白人相比，黑人与PM _2.5相关的住院风险更高(p=0.045)，而生活在社会经济弱势社区的人 (p<0.001) 则更高。

结论

暴露于较高水平的 PM _2.5与 COVID-19 感染者住院风险增加相关。_{当 PM 2.5}水平低于监管标准时，风险就很明显。该分析确定，黑人种族和生活在贫困社区的人群可能更容易受到 PM _2.5在 COVID-19 背景下住院风险的不良影响。