Abstract

Background:

Emerging evidence links ambient air pollution with coronavirus 2019 (COVID-19) disease, an association that is methodologically challenging to investigate.

Objectives:

We examined the association between long-term exposure to air pollution with SARS-CoV-2 infection measured through antibody response, level of antibody response among those infected, and COVID-19 disease.

Methods:

We contacted 9,605 adult participants from a population-based cohort study in Catalonia between June and November 2020; most participants were between 40 and 65 years of age. We drew blood samples from 4,103 participants and measured immunoglobulin M (IgM), IgA, and IgG antibodies against five viral target antigens to establish infection to the virus and levels of antibody response among those infected. We defined COVID-19 disease using self-reported hospital admission, prior positive diagnostic test, or more than three self-reported COVID-19 symptoms after contact with a COVID-19 case. We estimated prepandemic (2018–2019) exposure to fine particulate matter [PM with an aerodynamic diameter of $\le 2.5\mathrm{\mu }\mathrm{m}$ (${\mathrm{PM}}_{2.5}$)], nitrogen dioxide (${\mathrm{NO}}_2$), black carbon (BC), and ozone (${\mathrm{O}}_3$) at the residential address using hybrid land-use regression models. We calculated log-binomial risk ratios (RRs), adjusting for individual- and area-level covariates.

Results:

Among those tested for SARS-CoV-2 antibodies, 743 (18.1%) were seropositive. Air pollution levels were not statistically significantly associated with SARS-CoV-2 infection: Adjusted RRs per interquartile range were 1.07 (95% CI: 0.97, 1.18) for ${\mathrm{NO}}_2$, 1.04 (95% CI: 0.94, 1.14) for ${\mathrm{PM}}_{2.5}$, 1.00 (95% CI: 0.92, 1.09) for BC, and 0.97 (95% CI: 0.89, 1.06) for ${\mathrm{O}}_3$. Among infected participants, exposure to ${\mathrm{NO}}_2$ and ${\mathrm{PM}}_{2.5}$ were positively associated with IgG levels for all viral target antigens. Among all participants, 481 (5.0%) had COVID-19 disease. Air pollution levels were associated with COVID-19 disease: adjusted $\text{RRs}=1.14$ (95% CI: 1.00, 1.29) for ${\mathrm{NO}}_2$ and 1.17 (95% CI: 1.03, 1.32) for ${\mathrm{PM}}_{2.5}$. Exposure to ${\mathrm{O}}_3$ was associated with a slightly decreased risk ($\text{RR}=0.92$; 95% CI: 0.83, 1.03). Associations of air pollution with COVID-19 disease were more pronounced for severe COVID-19, with $\text{RRs}=1.26$ (95% CI: 0.89, 1.79) for ${\mathrm{NO}}_2$ and 1.51 (95% CI: 1.06, 2.16) for ${\mathrm{PM}}_{2.5}$.

Discussion:

Exposure to air pollution was associated with a higher risk of COVID-19 disease and level of antibody response among infected but not with SARS-CoV-2 infection. https://doi.org/10.1289/EHP9726

中文翻译：

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与 SARS-CoV-2 感染、抗体反应和 COVID-19 疾病相关的环境空气污染：西班牙加泰罗尼亚的一项队列研究（COVICAT 研究）

摘要

背景：

新出现的证据表明环境空气污染与 2019 年冠状病毒 (COVID-19) 疾病有关，这种关联在方法论上很难进行调查。

目标：

我们通过抗体反应、感染者的抗体反应水平和 COVID-19 疾病来研究长期暴露于空气污染与 SARS-CoV-2 感染之间的关联。

方法：

我们联系了 2020 年 6 月至 11 月期间在加泰罗尼亚进行的一项基于人群的队列研究中的 9,605 名成年参与者；大多数参与者年龄在 40 至 65 岁之间。我们从 4,103 名参与者中抽取了血液样本，并测量了针对五种病毒靶抗原的免疫球蛋白 M (IgM)、IgA 和 IgG 抗体，以确定病毒感染情况以及感染者的抗体反应水平。我们使用自我报告的入院情况、先前的阳性诊断测试或与 COVID-19 病例接触后自我报告的三种以上的 COVID-19 症状来定义 COVID-19 疾病。我们估计了大流行前（2018-2019 年）细颗粒物 [PM 的空气动力学直径为$\le 2.5\mathrm{\mu }\mathrm{米}$（${\mathrm{下午}}_{2.5}$）]， 二氧化氮 （${\mathrm{不}}_2$）、黑碳（BC）和臭氧（${\mathrm{氧}}_3$）在居住地址使用混合土地利用回归模型。我们计算了对数二项式风险比 (RR)，并针对个体和区域级别的协变量进行了调整。

结果：

在接受 SARS-CoV-2 抗体检测的人中，743 人（18.1%）呈血清阳性。空气污染水平与 SARS-CoV-2 感染没有统计显着相关性：调整后的每四分位数范围 RR 为 1.07（95% CI：0.97，1.18）${\mathrm{不}}_2$, 1.04 (95% CI: 0.94, 1.14)${\mathrm{下午}}_{2.5}$，BC 为 1.00 (95% CI: 0.92, 1.09)，BC 为 0.97 (95% CI: 0.89, 1.06)${\mathrm{氧}}_3$。在受感染的参与者中，暴露于${\mathrm{不}}_2$和${\mathrm{下午}}_{2.5}$与所有病毒靶抗原的 IgG 水平呈正相关。在所有参与者中，481 人 (5.0%) 患有 COVID-19 疾病。空气污染水平与 COVID-19 疾病相关：调整后$\text{RR}=1.14$（95% CI：1.00，1.29）${\mathrm{不}}_2$和 1.17（95% CI：1.03，1.32）${\mathrm{下午}}_{2.5}$。接触${\mathrm{氧}}_3$与风险略有降低相关（$\text{RR}=0.92$; 95% CI：0.83，1.03）。对于严重的 COVID-19，空气污染与 COVID-19 疾病的关联更为明显，其中$\text{RR}=1.26$（95% CI：0.89，1.79）${\mathrm{不}}_2$和 1.51（95% CI：1.06，2.16）${\mathrm{下午}}_{2.5}$。

讨论：

暴露于空气污染与感染者患 COVID-19 疾病的较高风险和抗体反应水平有关，但与 SARS-CoV-2 感染无关。https://doi.org/10.1289/EHP9726