Effects of long-term exposure to air pollutants on the spatial spread of COVID-19 in Catalonia, Spain

Highlights

• Long-term exposure to NO₂ and to PM₁₀ are predictors of the spread of COVID-19.

• Air pollutants could have actually been surrogates of the mobility of people.

• High mobility implied a greater possibility of contact.

• More contact could imply a higher probability of infection.

Abstract

Background

The risk of infection and death by COVID-19 could be associated with a heterogeneous distribution at a small area level of environmental, socioeconomic and demographic factors. Our objective was to investigate, at a small area level, whether long-term exposure to air pollutants increased the risk of COVID-19 incidence and death in Catalonia, Spain, controlling for socioeconomic and demographic factors.

Methods

We used a mixed longitudinal ecological design with the study population consisting of small areas in Catalonia for the period February 25 to May 16, 2020. We estimated Generalized Linear Mixed models in which we controlled for a wide range of observed and unobserved confounders as well as spatial and temporal dependence.

Results

We have found that long-term exposure to nitrogen dioxide (NO₂) and, to a lesser extent, to coarse particles (PM₁₀) have been independent predictors of the spatial spread of COVID-19. For every 1 μm/m³ above the mean the risk of a positive test case increased by 2.7% (95% credibility interval, ICr: 0.8%, 4.7%) for NO₂ and 3.0% (95% ICr: -1.4%,7.44%) for PM₁₀. Regions with levels of NO₂ exposure in the third and fourth quartile had 28.8% and 35.7% greater risk of a death, respectively, than regions located in the first two quartiles.

Conclusion

Although it is possible that there are biological mechanisms that explain, at least partially, the association between long-term exposure to air pollutants and COVID-19, we hypothesize that the spatial spread of COVID-19 in Catalonia is attributed to the different ease with which some people, the hosts of the virus, have infected others. That facility depends on the heterogeneous distribution at a small area level of variables such as population density, poor housing and the mobility of its residents, for which exposure to pollutants has been a surrogate.