Pre-admission ambient air pollution and blood soot particles predict hospitalisation outcomes in COVID-19 patients

Air pollution exposure is one of the major risk factors for aggravation of respiratory diseases. We investigated whether exposure to air pollution and accumulated black carbon (BC) particles in blood were associated with coronavirus disease 2019 (COVID-19) disease severity, including the risk for in...

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Bibliographic Details
Published in:	The European respiratory journal Vol. 62; no. 1
Main Authors:	Vos, Stijn, De Waele, Elien, Goeminne, Pieter, Bijnens, Esmée M, Bongaerts, Eva, Martens, Dries S, Malina, Robert, Ameloot, Marcel, Dams, Karolien, De Weerdt, Annick, Dewyspelaere, Geert, Jacobs, Rita, Mistiaen, Geert, Jorens, Philippe, Nawrot, Tim S
Format:	Journal Article
Language:	English
Published:	England 01-07-2023
Subjects:	Air Pollutants - adverse effects Air Pollutants - analysis Air Pollution - adverse effects Air Pollution - analysis COVID-19 Environmental Exposure - adverse effects Environmental Exposure - analysis Hospitalization Humans Nitrogen Dioxide - adverse effects Pandemics Particulate Matter - adverse effects Particulate Matter - analysis Soot
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Summary:	Air pollution exposure is one of the major risk factors for aggravation of respiratory diseases. We investigated whether exposure to air pollution and accumulated black carbon (BC) particles in blood were associated with coronavirus disease 2019 (COVID-19) disease severity, including the risk for intensive care unit (ICU) admission and duration of hospitalisation. From May 2020 until March 2021, 328 hospitalised COVID-19 patients (29% at intensive care) were recruited from two hospitals in Belgium. Daily exposure levels (from 2016 to 2019) for particulate matter with aerodynamic diameter <2.5 µm and <10 µm (PM and PM , respectively), nitrogen dioxide (NO ) and BC were modelled using a high-resolution spatiotemporal model. Blood BC particles (internal exposure to nano-sized particles) were quantified using pulsed laser illumination. Primary clinical parameters and outcomes included duration of hospitalisation and risk of ICU admission. Independent of potential confounders, an interquartile range (IQR) increase in exposure in the week before admission was associated with increased duration of hospitalisation (PM +4.13 (95% CI 0.74-7.53) days, PM +4.04 (95% CI 1.24-6.83) days and NO +4.54 (95% CI 1.53-7.54) days); similar effects were observed for long-term NO and BC exposure on hospitalisation duration. These effect sizes for an IQR increase in air pollution on hospitalisation duration were equivalent to the effect of a 10-year increase in age on hospitalisation duration. Furthermore, for an IQR higher blood BC load, the OR for ICU admission was 1.33 (95% CI 1.07-1.65). In hospitalised COVID-19 patients, higher pre-admission ambient air pollution and blood BC levels predicted adverse outcomes. Our findings imply that air pollution exposure influences COVID-19 severity and therefore the burden on medical care systems during the COVID-19 pandemic.
ISSN:	1399-3003
DOI:	10.1183/13993003.00309-2023