Ambient air pollution and low temperature associated with case fatality of COVID-19: A nationwide retrospective cohort study in China

Fei Tian; Xiaobo Liu; Qingchen Chao; Zhengmin (Min) Qian; Siqi Zhang; Li Qi; Yanlin Niu; Lauren D. Arnold; Shiyu Zhang; Huan Li; Hualiang Lin; Qiyong Liu

The Innovation (Aug 2021)

Ambient air pollution and low temperature associated with case fatality of COVID-19: A nationwide retrospective cohort study in China

Fei Tian,
Xiaobo Liu,
Qingchen Chao,
Zhengmin (Min) Qian,
Siqi Zhang,
Li Qi,
Yanlin Niu,
Lauren D. Arnold,
Shiyu Zhang,
Huan Li,
Hualiang Lin,
Qiyong Liu

Affiliations

Fei Tian: Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
Xiaobo Liu: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, WHO Collaborating Centre for Vector Surveillance and Management, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Qingchen Chao: Laboratory for Climate Studies, National Climate Center, China Meteorological Administration, Beijing 100081, China
Zhengmin (Min) Qian: Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
Siqi Zhang: Laboratory for Climate Studies, National Climate Center, China Meteorological Administration, Beijing 100081, China
Li Qi: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, WHO Collaborating Centre for Vector Surveillance and Management, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Yanlin Niu: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, WHO Collaborating Centre for Vector Surveillance and Management, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Lauren D. Arnold: Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
Shiyu Zhang: Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
Huan Li: Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
Hualiang Lin: Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Corresponding author
Qiyong Liu: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, WHO Collaborating Centre for Vector Surveillance and Management, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Corresponding author

Journal volume & issue: Vol. 2, no. 3
p. 100139

Abstract

Read online

The evidence for the effects of environmental factors on COVID-19 case fatality remains controversial, and it is crucial to understand the role of preventable environmental factors in driving COVID-19 fatality. We thus conducted a nationwide cohort study to estimate the effects of environmental factors (temperature, particulate matter [PM2.5, PM10], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]) on COVID-19 case fatality. A total of 71,808 confirmed COVID-19 cases were identified and followed up for their vital status through April 25, 2020. Exposures to ambient air pollution and temperature were estimated by linking the city- and county-level monitoring data to the residential community of each participant. For each participant, two windows were defined: the period from symptom onset to diagnosis (exposure window I) and the period from diagnosis date to date of death/recovery or end of the study period (exposure window II). Cox proportional hazards models were used to estimate the associations between these environmental factors and COVID-19 case fatality. COVID-19 case fatality increased in association with environmental factors for the two exposure windows. For example, each 10 μg/m3 increase in PM2.5, PM10, O3, and NO2 in window I was associated with a hazard ratio of 1.11 (95% CI 1.09, 1.13), 1.10 (95% CI 1.08, 1.13), 1.09 (95 CI 1.03, 1.14), and 1.27 (95% CI 1.19, 1.35) for COVID-19 fatality, respectively. A significant effect was also observed for low temperature, with a hazard ratio of 1.03 (95% CI 1.01, 1.04) for COVID-19 case fatality per 1°C decrease. Subgroup analysis indicated that these effects were stronger in the elderly, as well as in those with mild symptoms and living in Wuhan or Hubei. Overall, the sensitivity analyses also yielded consistent estimates. Short-term exposure to ambient air pollution and low temperature during the illness would play a nonnegligible part in causing case fatality due to COVID-19. Reduced exposures to high concentrations of PM2.5, PM10, O3, SO2, and NO2 and low temperature would help improve the prognosis and reduce public health burden. Public summary: • A national retrospective cohort study was performed to quantify the effects of environmental exposure • Low temperature was observed to be associated with COVID-19 case fatality • Exposure to ambient air pollution played a nonnegligible part in COVID-19 case fatality • COVID-19 patients were more susceptible to external environmental stimulus as COVID-19 progressed from the period of symptom onset to diagnosis

Published in The Innovation

ISSN: 2666-6758 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Science: Science (General)
Website: https://www.cell.com/the-innovation

About the journal

Abstract

Keywords