Long-Term Exposure to Ambient Air Pollution and Mortality among Four Million COVID-19 Cases in Italy: The EpiCovAir Study.

Autor: Stafoggia M; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy., Ranzi A; Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Modena, Italy., Ancona C; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy., Bauleo L; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy., Bella A; Italian National Institute of Health (ISS), Rome, Italy., Cattani G; Italian Institute for Environmental Protection and Research (ISPRA), Rome, Italy., Nobile F; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy., Pezzotti P; Italian National Institute of Health (ISS), Rome, Italy., Iavarone I; Italian National Institute of Health (ISS), Rome, Italy.
Jazyk: angličtina
Zdroj: Environmental health perspectives [Environ Health Perspect] 2023 May; Vol. 131 (5), pp. 57004. Date of Electronic Publication: 2023 May 11.
DOI: 10.1289/EHP11882
Abstrakt: Background: The role of chronic exposure to ambient air pollutants in increasing COVID-19 fatality is still unclear.
Objectives: The study aimed to investigate the association between long-term exposure to air pollutants and mortality among 4 million COVID-19 cases in Italy.
Methods: We obtained individual records of all COVID-19 cases identified in Italy from February 2020 to June 2021. We assigned 2016-2019 mean concentrations of particulate matter (PM) with aerodynamic diameter ≤ 10 μ m ( PM 10 ), PM with aerodynamic diameter ≤ 2.5 μ m ( PM 2.5 ), and nitrogen dioxide ( NO 2 ) to each municipality ( n = 7,800 ) as estimates of chronic exposures. We applied a principal component analysis (PCA) and a generalized propensity score (GPS) approach to an extensive list of area-level covariates to account for major determinants of the spatial distribution of COVID-19 case-fatality rates. Then, we applied generalized negative binomial models matched on GPS, age, sex, province, and month. As additional analyses, we fit separate models by pandemic periods, age, and sex; we quantified the numbers of COVID-19 deaths attributable to exceedances in annual air pollutant concentrations above predefined thresholds; and we explored associations between air pollution and alternative outcomes of COVID-19 severity, namely hospitalizations or accesses to intensive care units.
Results: We analyzed 3,995,202 COVID-19 cases, which generated 124,346 deaths. Overall, case-fatality rates increased by 0.7% [95% confidence interval (CI): 0.5%, 0.9%], 0.3% (95% CI: 0.2%, 0.5%), and 0.6% (95% CI: 0.5%, 0.8%) per 1   μ g / m 3 increment in PM 2.5 , PM 10 , and NO 2 , respectively. Associations were higher among elderly subjects and during the first (February 2020-June 2020) and the third (December 2020-June 2021) pandemic waves. We estimated ∼ 8 % COVID-19 deaths were attributable to pollutant levels above the World Health Organization 2021 air quality guidelines.
Discussion: We found suggestive evidence of an association between long-term exposure to ambient air pollutants with mortality among 4 million COVID-19 cases in Italy. https://doi.org/10.1289/EHP11882.
Databáze: MEDLINE
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