Open AccessLong-Term Air Pollution Exposure and COVID-19 Mortality: A Patient-Level Analysis from New York City
Author(s) -
Anne K. Bozack,
Stanley Pierre,
Nicholas DeFelice,
Elena Colicino,
Darby Jack,
Steven N. Chillrud,
Andrew Rundle,
Alfredo Astua,
James Quinn,
Laura A. McGuinn,
Qiang Yang,
Kerry Johnson,
Joseph R. Masci,
Laureen Lukban,
Duncan Maru,
Alison G. Lee
Publication year - 2022
Publication title -
american journal of respiratory and critical care medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.272
H-Index - 374
eISSN - 1535-4970
pISSN - 1073-449X
DOI - 10.1164/rccm.202104-0845oc
Subject(s) - medicine , interquartile range , poisson regression , retrospective cohort study , intubation , epidemiology , pneumonia , air pollution , emergency medicine , pediatrics , environmental health , population , surgery , chemistry , organic chemistry
Rationale: Risk factors for coronavirus disease (COVID-19) mortality may include environmental exposures such as air pollution. Objectives: To determine whether, among adults hospitalized with PCR-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), long-term air pollution exposure is associated with the risk of mortality, ICU admission, or intubation. Methods: We performed a retrospective analysis of SARS-CoV-2 PCR-positive patients admitted to seven New York City hospitals from March 8, 2020, to August 30, 2020. The primary outcome was mortality; secondary outcomes were ICU admission and intubation. We estimated the annual average fine particulate matter (particulate matter ⩽2.5 μm in aerodynamic diameter [PM 2.5 ]), nitrogen dioxide (NO 2 ), and black carbon (BC) concentrations at patients' residential address. We employed double robust Poisson regression to analyze associations between the annual average PM 2.5 , NO 2 , and BC exposure level and COVID-19 outcomes, adjusting for age, sex, race or ethnicity, hospital, insurance, and the time from the onset of the pandemic. Results: Among the 6,542 patients, 41% were female and the median age was 65 (interquartile range, 53-77) years. Over 50% self-identified as a person of color ( n = 1,687 [26%] Hispanic patients; n = 1,659 [25%] Black patients). Air pollution exposure levels were generally low. Overall, 31% ( n = 2,044) of the cohort died, 19% ( n = 1,237) were admitted to the ICU, and 16% ( n = 1,051) were intubated. In multivariable models, a higher level of long-term exposure to PM 2.5 was associated with an increased risk of mortality (risk ratio, 1.11 [95% confidence interval, 1.02-1.21] per 1-μg/m 3 increase in PM 2.5 ) and ICU admission (risk ratio, 1.13 [95% confidence interval, 1.00-1.28] per 1-μg/m 3 increase in PM 2.5 ). In multivariable models, neither NO 2 nor BC exposure was associated with COVID-19 mortality, ICU admission, or intubation. Conclusions: Among patients hospitalized with COVID-19, a higher long-term PM 2.5 exposure level was associated with an increased risk of mortality and ICU admission.