Urban air pollution may enhance COVID-19 case-fatality and mortality rates in the United States
Liang, D; Shi, L; Zhao, J; Liu, P; Sarnat, JA; Gao, S; Schwartz, J; Liu, Y; Ebeit, ST; Scovronick, N; Chang, HH
HERO ID
7681707
Reference Type
Journal Article
Year
2020
Language
English
PMID
| HERO ID | 7681707 |
|---|---|
| In Press | No |
| Year | 2020 |
| Title | Urban air pollution may enhance COVID-19 case-fatality and mortality rates in the United States |
| Authors | Liang, D; Shi, L; Zhao, J; Liu, P; Sarnat, JA; Gao, S; Schwartz, J; Liu, Y; Ebeit, ST; Scovronick, N; Chang, HH |
| Journal | The Innovation |
| Volume | 1 |
| Issue | 3 |
| Page Numbers | 100047 |
| Abstract | Background: The novel human coronavirus disease 2019 (COVID-19) pandemic has claimed more than 600,000 lives worldwide, causing tremendous public health, social, and economic damages. Although the risk factors of COVID-19 are still under investigation, environmental factors, such as urban air pollution, may play an important role in increasing population susceptibility to COVID-19 pathogenesis. Methods: We conducted a cross-sectional nationwide study using zero-inflated negative binomial models to estimate the association between long-term (2010-2016) county-level exposures to NO2, PM2.5, and O3 and county-level COVID-19 case-fatality and mortality rates in the United States. We used both single- and multi-pollutant models and controlled for spatial trends and a comprehensive set of potential confounders, including state-level test positive rate, county-level health care capacity, phase of epidemic, population mobility, population density, sociodemographics, socioeconomic status, race and ethnicity, behavioral risk factors, and meteorology. Results: From January 22, 2020, to July 17, 2020, 3,659,828 COVID-19 cases and 138,552 deaths were reported in 3,076 US counties, with an overall observed case-fatality rate of 3.8%. County-level average NO2 concentrations were positively associated with both COVID-19 case-fatality rate and mortality rate in single-, bi-, and tri-pollutant models. When adjusted for co-pollutants, per interquartile-range (IQR) increase in NO2 (4.6 ppb), COVID-19 case-fatality rate and mortality rate were associated with an increase of 11.3% (95% CI 4.9%-18.2%) and 16.2% (95% CI 8.7%-24.0%), respectively. We did not observe significant associations between COVID-19 case-fatality rate and long-term exposure to PM2.5 or O3, although per IQR increase in PM2.5 (2.6 μg/m3) was marginally associated, with a 14.9% (95% CI 0.0%-31.9%) increase in COVID-19 mortality rate when adjusted for co-pollutants. Discussion: Long-term exposure to NO2, which largely arises from urban combustion sources such as traffic, may enhance susceptibility to severe COVID-19 outcomes, independent of long-term PM2.5 and O3 exposure. The results support targeted public health actions to protect residents from COVID-19 in heavily polluted regions with historically high NO2 levels. Continuation of current efforts to lower traffic emissions and ambient air pollution may be an important component of reducing population-level risk of COVID-19 case fatality and mortality. |
| Doi | 10.1016/j.xinn.2020.100047 |
| Pmid | 32984861 |
| Url | https://linkinghub.elsevier.com/retrieve/pii/S2666675820300503 |
| Is Certified Translation | No |
| Dupe Override | No |
| Is Public | Yes |
| Language Text | English |
| Keyword | COVID-19; air pollution; case-fatality rate; mortality; nitrogen dioxide |