Long-Term Exposure to Fine Particulate Matter and Hospitalization in COVID-19 Patients

Mendy, Angelico; Wu, Xiao; Keller, Jason L.; Fassler, Cecily S.; Apewokin, Senu; Mersha, Tesfaye B.; Xie, Changchun; Pinney, Susan M.

BACKGROUND: Ecological evidence suggests that exposure to air pollution affects coronavirus disease 2019 (COVID-19) outcomes. However, no individual-level study has confirmed the association to date. METHODS: We identified COVID-19 patients diagnosed at the University of Cincinnati hospitals and clinics and estimated particulate matter ≤2.5 μm (PM(2.5)) exposure over a 10-year period (2008-2017) at their residential zip codes. We used logistic regression to evaluate the association between PM(2.5) exposure and hospitalizations for COVID-19, adjusting for socioeconomic characteristics and comorbidities. RESULTS: Among the 1,128 patients included in our study, the mean (standard deviation) PM(2.5) was 11.34 (0.70) μg/m(3) for the 10-year average exposure and 13.83 (1.03) μg/m(3) for the 10-year maximal exposures. The association between long-term PM(2.5) exposure and hospitalization for COVID-19 was contingent upon having pre-existing asthma or chronic obstructive pulmonary (COPD) (P(interaction)=0.030 for average PM(2.5) and P(interaction)=0.001 for maximal PM(2.5)). In COVID-19 patients with asthma or COPD, the odds of hospitalization were 62% higher with 1 μg/m(3) increment in 10-year average PM(2.5) (odds ratio [OR]: 1.62, 95% confidence interval [CI]: 1.00-2.64) and 65% higher with 1 μg/m(3) increase in 10-year maximal PM(2.5) levels (OR: 1.65, 95% CI: 1.16-2.35). However, among COVID-19 patients without asthma or COPD, PM(2.5) exposure was not associated with higher hospitalizations (OR: 0.84, 95% CI: 0.65-1.09 for average PM(2.5) and OR: 0.78, 95% CI: 0.65-0.95 for maximal PM(2.5)). CONCLUSIONS: Long-term exposure to PM(2.5) is associated with higher odds of hospitalization in COVID-19 patients with pre-existing asthma or COPD.