The effect of the urban exposome on COVID-19 health outcomes: A systematic review and meta-analysis

Laura Houweling; Anke-Hilse Maitland-Van der Zee; Judith C S Holtjer; Somayeh Bazdar; Roel C H Vermeulen; George S Downward; Lizan D Bloemsma

doi:10.1016/j.envres.2023.117351

The effect of the urban exposome on COVID-19 health outcomes: A systematic review and meta-analysis

Laura Houweling^*
, Anke-Hilse Maitland-Van der Zee
, Judith C S Holtjer
, Somayeh Bazdar
, Roel C H Vermeulen
, George S Downward
, Lizan D Bloemsma

^*Corresponding author for this work

Amsterdam Institute for Infection and Immunity
Academic Medical Center
University Medical Center Utrecht

Research output: Contribution to journal › Review article › peer-review

Abstract

BACKGROUND: The global severity of SARS-CoV-2 illness has been associated with various urban characteristics, including exposure to ambient air pollutants. This systematic review and meta-analysis aims to synthesize findings from ecological and non-ecological studies to investigate the impact of multiple urban-related features on a variety of COVID-19 health outcomes.

METHODS: On December 5, 2022, PubMed was searched to identify all types of observational studies that examined one or more urban exposome characteristics in relation to various COVID-19 health outcomes such as infection severity, the need for hospitalization, ICU admission, COVID pneumonia, and mortality.

RESULTS: A total of 38 non-ecological and 241 ecological studies were included in this review. Non-ecological studies highlighted the significant effects of population density, urbanization, and exposure to ambient air pollutants, particularly PM 2.5. The meta-analyses revealed that a 1 μg/m 3 increase in PM 2.5 was associated with a higher likelihood of COVID-19 hospitalization (pooled OR 1.08 (95% CI:1.02-1.14)) and death (pooled OR 1.06 (95% CI:1.03-1.09)). Ecological studies, in addition to confirming the findings of non-ecological studies, also indicated that higher exposure to nitrogen dioxide (NO 2), ozone (O 3), sulphur dioxide (SO 2), and carbon monoxide (CO), as well as lower ambient temperature, humidity, ultraviolet (UV) radiation, and less green and blue space exposure, were associated with increased COVID-19 morbidity and mortality.

CONCLUSION: This systematic review has identified several key vulnerability features related to urban areas in the context of the recent COVID-19 pandemic. The findings underscore the importance of improving policies related to urban exposures and implementing measures to protect individuals from these harmful environmental stressors.

Original language	English
Article number	117351
Number of pages	20
Journal	Environmental Research
Volume	240
Issue number	Pt 2
Early online date	17 Oct 2023
DOIs	https://doi.org/10.1016/j.envres.2023.117351
Publication status	Published - 1 Jan 2024

Bibliographical note

Publisher Copyright:
© 2023 The Authors

Funding

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Anke-Hilse Maitland-Van der Zee reports financial support was provided by Partners in the Precision Medicine for more Oxygen (P4O2) consortium. George S. Downward reports financial support was provided by Partners in the Precision Medicine for more Oxygen (P4O2) consortium. Lizan D. Bloemsma reports financial support was provided by Partners in the Precision Medicine for more Oxygen (P4O2) consortium. Prof. Dr. Anke-Hilse Maitland-Van der Zee received the following grants (money paid to institution): ZonMW grant Long Covid - Stichting TAAI research grant CF - EUROSTARS research grant COPDetect - Unrestricted research grant Boehringer Ingelheim - Vertex Innovation Award (unrestricted research grant) - Dutch Lung Foundation grant - Stichting Astma Bestrijding grant - Innovative Medicine Initiative (IMI) 3 TR research grantGeorge S. Downward recieved the following grants (money paid to institution): Eindhoven, Wageningen, Utrecht, UMC Utrecht Alliance (EWUU) Interdisciplinary Teaching Grant National Institutes of Health (NIH) grant on “Relative and Absolute Risk for site-Specific Cancer Mortality attributed to Household Air Pollution” NUFFIC Capacity Building Education Grant

Funders
EWUU
UMC Utrecht Alliance
National Institutes of Health
Boehringer Ingelheim
ZonMw
Stichting Astma Bestrijding
Innovative Medicines Initiative
Lung Foundation Netherlands

UN SDGs

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

SDG 11 Sustainable Cities and Communities

Keywords

COVID-19
Health outcomes
Mortality
Urban exposome
Air pollution

Access to Document

10.1016/j.envres.2023.117351Licence: CC BY

1-s2.0-S0013935123021552-mainFinal published version, 3.08 MBLicence: CC BY

Cite this

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title = "The effect of the urban exposome on COVID-19 health outcomes: A systematic review and meta-analysis",

abstract = "BACKGROUND: The global severity of SARS-CoV-2 illness has been associated with various urban characteristics, including exposure to ambient air pollutants. This systematic review and meta-analysis aims to synthesize findings from ecological and non-ecological studies to investigate the impact of multiple urban-related features on a variety of COVID-19 health outcomes.METHODS: On December 5, 2022, PubMed was searched to identify all types of observational studies that examined one or more urban exposome characteristics in relation to various COVID-19 health outcomes such as infection severity, the need for hospitalization, ICU admission, COVID pneumonia, and mortality.RESULTS: A total of 38 non-ecological and 241 ecological studies were included in this review. Non-ecological studies highlighted the significant effects of population density, urbanization, and exposure to ambient air pollutants, particularly PM 2.5. The meta-analyses revealed that a 1 μg/m 3 increase in PM 2.5 was associated with a higher likelihood of COVID-19 hospitalization (pooled OR 1.08 (95\% CI:1.02-1.14)) and death (pooled OR 1.06 (95\% CI:1.03-1.09)). Ecological studies, in addition to confirming the findings of non-ecological studies, also indicated that higher exposure to nitrogen dioxide (NO 2), ozone (O 3), sulphur dioxide (SO 2), and carbon monoxide (CO), as well as lower ambient temperature, humidity, ultraviolet (UV) radiation, and less green and blue space exposure, were associated with increased COVID-19 morbidity and mortality. CONCLUSION: This systematic review has identified several key vulnerability features related to urban areas in the context of the recent COVID-19 pandemic. The findings underscore the importance of improving policies related to urban exposures and implementing measures to protect individuals from these harmful environmental stressors.",

keywords = "COVID-19, Health outcomes, Mortality, Urban exposome, Air pollution",

author = "Laura Houweling and \{Maitland-Van der Zee\}, Anke-Hilse and Holtjer, \{Judith C S\} and Somayeh Bazdar and Vermeulen, \{Roel C H\} and Downward, \{George S\} and Bloemsma, \{Lizan D\}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2024",

month = jan,

day = "1",

doi = "10.1016/j.envres.2023.117351",

language = "English",

volume = "240",

journal = "Environmental Research",

issn = "0013-9351",

publisher = "Academic Press Inc.",

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T1 - The effect of the urban exposome on COVID-19 health outcomes

T2 - A systematic review and meta-analysis

AU - Houweling, Laura

AU - Maitland-Van der Zee, Anke-Hilse

AU - Holtjer, Judith C S

AU - Bazdar, Somayeh

AU - Vermeulen, Roel C H

AU - Downward, George S

AU - Bloemsma, Lizan D

PY - 2024/1/1

Y1 - 2024/1/1

N2 - BACKGROUND: The global severity of SARS-CoV-2 illness has been associated with various urban characteristics, including exposure to ambient air pollutants. This systematic review and meta-analysis aims to synthesize findings from ecological and non-ecological studies to investigate the impact of multiple urban-related features on a variety of COVID-19 health outcomes.METHODS: On December 5, 2022, PubMed was searched to identify all types of observational studies that examined one or more urban exposome characteristics in relation to various COVID-19 health outcomes such as infection severity, the need for hospitalization, ICU admission, COVID pneumonia, and mortality.RESULTS: A total of 38 non-ecological and 241 ecological studies were included in this review. Non-ecological studies highlighted the significant effects of population density, urbanization, and exposure to ambient air pollutants, particularly PM 2.5. The meta-analyses revealed that a 1 μg/m 3 increase in PM 2.5 was associated with a higher likelihood of COVID-19 hospitalization (pooled OR 1.08 (95% CI:1.02-1.14)) and death (pooled OR 1.06 (95% CI:1.03-1.09)). Ecological studies, in addition to confirming the findings of non-ecological studies, also indicated that higher exposure to nitrogen dioxide (NO 2), ozone (O 3), sulphur dioxide (SO 2), and carbon monoxide (CO), as well as lower ambient temperature, humidity, ultraviolet (UV) radiation, and less green and blue space exposure, were associated with increased COVID-19 morbidity and mortality. CONCLUSION: This systematic review has identified several key vulnerability features related to urban areas in the context of the recent COVID-19 pandemic. The findings underscore the importance of improving policies related to urban exposures and implementing measures to protect individuals from these harmful environmental stressors.

AB - BACKGROUND: The global severity of SARS-CoV-2 illness has been associated with various urban characteristics, including exposure to ambient air pollutants. This systematic review and meta-analysis aims to synthesize findings from ecological and non-ecological studies to investigate the impact of multiple urban-related features on a variety of COVID-19 health outcomes.METHODS: On December 5, 2022, PubMed was searched to identify all types of observational studies that examined one or more urban exposome characteristics in relation to various COVID-19 health outcomes such as infection severity, the need for hospitalization, ICU admission, COVID pneumonia, and mortality.RESULTS: A total of 38 non-ecological and 241 ecological studies were included in this review. Non-ecological studies highlighted the significant effects of population density, urbanization, and exposure to ambient air pollutants, particularly PM 2.5. The meta-analyses revealed that a 1 μg/m 3 increase in PM 2.5 was associated with a higher likelihood of COVID-19 hospitalization (pooled OR 1.08 (95% CI:1.02-1.14)) and death (pooled OR 1.06 (95% CI:1.03-1.09)). Ecological studies, in addition to confirming the findings of non-ecological studies, also indicated that higher exposure to nitrogen dioxide (NO 2), ozone (O 3), sulphur dioxide (SO 2), and carbon monoxide (CO), as well as lower ambient temperature, humidity, ultraviolet (UV) radiation, and less green and blue space exposure, were associated with increased COVID-19 morbidity and mortality. CONCLUSION: This systematic review has identified several key vulnerability features related to urban areas in the context of the recent COVID-19 pandemic. The findings underscore the importance of improving policies related to urban exposures and implementing measures to protect individuals from these harmful environmental stressors.

KW - COVID-19

KW - Health outcomes

KW - Mortality

KW - Urban exposome

KW - Air pollution

UR - https://www.scopus.com/pages/publications/85174698349

U2 - 10.1016/j.envres.2023.117351

DO - 10.1016/j.envres.2023.117351

M3 - Review article

C2 - 37852458

SN - 0013-9351

VL - 240

JO - Environmental Research

JF - Environmental Research

IS - Pt 2

M1 - 117351

ER -

The effect of the urban exposome on COVID-19 health outcomes: A systematic review and meta-analysis

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

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