Effects of long-term exposure to outdoor air pollution on COVID-19 incidence: A population-based cohort study accounting for SARS-CoV-2 exposure levels in the Netherlands

Jelle Zorn; Mariana Simões; Guus J M Velders; Miriam Gerlofs-Nijland; Maciek Strak; José Jacobs; Marieke B A Dijkema; Thomas J Hagenaars; Lidwien A M Smit; Roel Vermeulen; Lapo Mughini-Gras; Lenny Hogerwerf; Don Klinkenberg

doi:10.1016/j.envres.2024.118812

Effects of long-term exposure to outdoor air pollution on COVID-19 incidence: A population-based cohort study accounting for SARS-CoV-2 exposure levels in the Netherlands

Jelle Zorn, Mariana Simões, Guus J M Velders, Miriam Gerlofs-Nijland, Maciek Strak, José Jacobs, Marieke B A Dijkema, Thomas J Hagenaars, Lidwien A M Smit, Roel Vermeulen, Lapo Mughini-Gras^*, Lenny Hogerwerf, Don Klinkenberg

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Several studies have linked air pollution to COVID-19 morbidity and severity. However, these studies do not account for exposure levels to SARS-CoV-2, nor for different sources of air pollution. We analyzed individual-level data for 8.3 million adults in the Netherlands to assess associations between long-term exposure to ambient air pollution and SARS-CoV-2 infection (i.e., positive test) and COVID-19 hospitalisation risks, accounting for spatiotemporal variation in SARS-CoV-2 exposure levels during the first two major epidemic waves (February 2020-February 2021). We estimated average annual concentrations of PM 10, PM 2.5 and NO 2 at residential addresses, overall and by PM source (road traffic, industry, livestock, other agricultural sources, foreign sources, other Dutch sources), at 1 × 1 km resolution, and weekly SARS-CoV-2 exposure at municipal level. Using generalized additive models, we performed interval-censored survival analyses to assess associations between individuals' average exposure to PM 10, PM 2.5 and NO 2 in the three years before the pandemic (2017-2019) and COVID-19-outcomes, adjusting for SARS-CoV-2 exposure, individual and area-specific confounders. In single-pollutant models, per interquartile (IQR) increase in exposure, PM 10 was associated with 7% increased infection risk and 16% increased hospitalisation risk, PM 2.5 with 8% increased infection risk and 18% increased hospitalisation risk, and NO 2 with 3% increased infection risk and 11% increased hospitalisation risk. Bi-pollutant models suggested that effects were mainly driven by PM. Associations for PM were confirmed when stratifying by urbanization degree, epidemic wave and testing policy. All emission sources of PM, except industry, showed adverse effects on both outcomes. Livestock showed the most detrimental effects per unit exposure, whereas road traffic affected severity (hospitalisation) more than infection risk. This study shows that long-term exposure to air pollution increases both SARS-CoV-2 infection and COVID-19 hospitalisation risks, even after controlling for SARS-CoV-2 exposure levels, and that PM may have differential effects on these COVID-19 outcomes depending on the emission source.

Original language	English
Article number	118812
Pages (from-to)	1-13
Number of pages	13
Journal	Environmental Research
Volume	252
Issue number	Part 1
Early online date	30 Mar 2024
DOIs	https://doi.org/10.1016/j.envres.2024.118812 https://doi.org/10.1016/j.envres.2024.118812
Publication status	Published - Jul 2024

Bibliographical note

Funding

This study was supported by the Dutch Ministry of Public Health, Welfare and Sport (VWS), Dutch Ministry of Agriculture, Nature and Food Quality (LNV), and Dutch Ministry of Infrastructure and Water Management (IenW).CBS is mandated to collect administrative data on Dutch residents and enterprises for the production of official statistics by law. Under the Statistics Netherlands Act, CBS can grant access to data for research purposes, with the aim of optimizing the value of collected data. Only authorized researchers can access data within CBS\u2019 secured online environment, using a remote-access facility, so that maximum control over intended uses, privacy and information security is guaranteed. Within this framework, the linked and anonymized data sets were made available to the researchers of this study for analysis. Dutch Civil Code allows the use of health records for statistics or research in the field of public health. No informed consent from patients nor approval by a medical ethics committee is required for registry-based health studies of this type in the Netherlands: the Medical Ethical Review Committee of Utrecht University Medical Centre (NedMec) confirmed that the Dutch Scientific Research Involving Human Subjects Act (WMO) does not apply to this study (nr. 22/059). The present study fully complied with EU General Data Protection Regulation (2016/679) and all methods were carried out in accordance with the Declaration of Helsinki. Results of this study are based on calculations by the authors using non-public microdata from CBS. Under certain conditions, these microdata are accessible for statistical and scientific research. For further information: [email protected].

Funders	Funder number
Ministry of Infrastructure and Water Management
Ministerie van Volksgezondheid, Welzijn en Sport
Utrecht University Medical Centre
Dutch Ministry of Agriculture, Nature and Food Quality
Ministerie van Landbouw, Natuur en Voedselkwaliteit
Dutch Scientific Research Involving Human Subjects Act	22/059, 2016/679

Keywords

COVID-19
Force of infection
NO2
PM10
PM2.5
SARS-CoV-2

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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1-s2.0-S0013935124007163-mainFinal published version, 2.8 MBLicence: CC BY

Cite this

Zorn, J., Simões, M., Velders, G. J. M., Gerlofs-Nijland, M., Strak, M., Jacobs, J., Dijkema, M. B. A., Hagenaars, T. J., Smit, L. A. M., Vermeulen, R., Mughini-Gras, L., Hogerwerf, L., & Klinkenberg, D. (2024). Effects of long-term exposure to outdoor air pollution on COVID-19 incidence: A population-based cohort study accounting for SARS-CoV-2 exposure levels in the Netherlands. Environmental Research, 252(Part 1), 1-13. Article 118812. https://doi.org/10.1016/j.envres.2024.118812, https://doi.org/10.1016/j.envres.2024.118812

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abstract = "Several studies have linked air pollution to COVID-19 morbidity and severity. However, these studies do not account for exposure levels to SARS-CoV-2, nor for different sources of air pollution. We analyzed individual-level data for 8.3 million adults in the Netherlands to assess associations between long-term exposure to ambient air pollution and SARS-CoV-2 infection (i.e., positive test) and COVID-19 hospitalisation risks, accounting for spatiotemporal variation in SARS-CoV-2 exposure levels during the first two major epidemic waves (February 2020-February 2021). We estimated average annual concentrations of PM 10, PM 2.5 and NO 2 at residential addresses, overall and by PM source (road traffic, industry, livestock, other agricultural sources, foreign sources, other Dutch sources), at 1 × 1 km resolution, and weekly SARS-CoV-2 exposure at municipal level. Using generalized additive models, we performed interval-censored survival analyses to assess associations between individuals' average exposure to PM 10, PM 2.5 and NO 2 in the three years before the pandemic (2017-2019) and COVID-19-outcomes, adjusting for SARS-CoV-2 exposure, individual and area-specific confounders. In single-pollutant models, per interquartile (IQR) increase in exposure, PM 10 was associated with 7% increased infection risk and 16% increased hospitalisation risk, PM 2.5 with 8% increased infection risk and 18% increased hospitalisation risk, and NO 2 with 3% increased infection risk and 11% increased hospitalisation risk. Bi-pollutant models suggested that effects were mainly driven by PM. Associations for PM were confirmed when stratifying by urbanization degree, epidemic wave and testing policy. All emission sources of PM, except industry, showed adverse effects on both outcomes. Livestock showed the most detrimental effects per unit exposure, whereas road traffic affected severity (hospitalisation) more than infection risk. This study shows that long-term exposure to air pollution increases both SARS-CoV-2 infection and COVID-19 hospitalisation risks, even after controlling for SARS-CoV-2 exposure levels, and that PM may have differential effects on these COVID-19 outcomes depending on the emission source. ",

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Zorn, J, Simões, M , Velders, GJM, Gerlofs-Nijland, M, Strak, M, Jacobs, J, Dijkema, MBA, Hagenaars, TJ, Smit, LAM , Vermeulen, R , Mughini-Gras, L, Hogerwerf, L & Klinkenberg, D 2024, 'Effects of long-term exposure to outdoor air pollution on COVID-19 incidence: A population-based cohort study accounting for SARS-CoV-2 exposure levels in the Netherlands', Environmental Research, vol. 252, no. Part 1, 118812, pp. 1-13. https://doi.org/10.1016/j.envres.2024.118812, https://doi.org/10.1016/j.envres.2024.118812

Effects of long-term exposure to outdoor air pollution on COVID-19 incidence: A population-based cohort study accounting for SARS-CoV-2 exposure levels in the Netherlands. / Zorn, Jelle; Simões, Mariana ; Velders, Guus J M et al.
In: Environmental Research, Vol. 252, No. Part 1, 118812, 07.2024, p. 1-13.

Research output: Contribution to journal › Article › Academic › peer-review

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AU - Jacobs, José

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AB - Several studies have linked air pollution to COVID-19 morbidity and severity. However, these studies do not account for exposure levels to SARS-CoV-2, nor for different sources of air pollution. We analyzed individual-level data for 8.3 million adults in the Netherlands to assess associations between long-term exposure to ambient air pollution and SARS-CoV-2 infection (i.e., positive test) and COVID-19 hospitalisation risks, accounting for spatiotemporal variation in SARS-CoV-2 exposure levels during the first two major epidemic waves (February 2020-February 2021). We estimated average annual concentrations of PM 10, PM 2.5 and NO 2 at residential addresses, overall and by PM source (road traffic, industry, livestock, other agricultural sources, foreign sources, other Dutch sources), at 1 × 1 km resolution, and weekly SARS-CoV-2 exposure at municipal level. Using generalized additive models, we performed interval-censored survival analyses to assess associations between individuals' average exposure to PM 10, PM 2.5 and NO 2 in the three years before the pandemic (2017-2019) and COVID-19-outcomes, adjusting for SARS-CoV-2 exposure, individual and area-specific confounders. In single-pollutant models, per interquartile (IQR) increase in exposure, PM 10 was associated with 7% increased infection risk and 16% increased hospitalisation risk, PM 2.5 with 8% increased infection risk and 18% increased hospitalisation risk, and NO 2 with 3% increased infection risk and 11% increased hospitalisation risk. Bi-pollutant models suggested that effects were mainly driven by PM. Associations for PM were confirmed when stratifying by urbanization degree, epidemic wave and testing policy. All emission sources of PM, except industry, showed adverse effects on both outcomes. Livestock showed the most detrimental effects per unit exposure, whereas road traffic affected severity (hospitalisation) more than infection risk. This study shows that long-term exposure to air pollution increases both SARS-CoV-2 infection and COVID-19 hospitalisation risks, even after controlling for SARS-CoV-2 exposure levels, and that PM may have differential effects on these COVID-19 outcomes depending on the emission source.

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Zorn J, Simões M , Velders GJM, Gerlofs-Nijland M, Strak M, Jacobs J et al. Effects of long-term exposure to outdoor air pollution on COVID-19 incidence: A population-based cohort study accounting for SARS-CoV-2 exposure levels in the Netherlands. Environmental Research. 2024 Jul;252(Part 1):1-13. 118812. Epub 2024 Mar 30. doi: 10.1016/j.envres.2024.118812, 10.1016/j.envres.2024.118812

Effects of long-term exposure to outdoor air pollution on COVID-19 incidence: A population-based cohort study accounting for SARS-CoV-2 exposure levels in the Netherlands

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

Access to Document

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