A case-crossover analysis of short-term PM2.5 exposure and COVID19-related hospitalizations in the National Clinical Cohort Collaborative
Year: 2025
Type: article
Study design: Observational Study
Abstract: Studies show associations between air pollution exposure and coronavirus 2019 (COVID19) hospitalizations, but have not substantially explored regional differences. In this study, we estimate associations between shorter-term exposure to fine particulate matter (PM2.5) and hospitalization among individuals with SARS-CoV-2 infection. This study utilized data from 72,385 patients (78,504 hospitalizations) with a hospital-confirmed SARS-CoV-2 infection between January 1, 2020 and December 31, 2020. Daily PM2.5 concentrations from ground-based monitors were averaged to generate 2, 5, and 21-day average exposures prior to hospitalization. We used a time-stratified case-crossover approach to estimate associations between PM2.5 and COVID19-related hospitalizations in 57 Core Based Statistical Areas (CBSAs) across the United States (US). We subsequently conducted nationwide and region-specific random effects meta-analysis. In the random effects meta-analysis, a 1 µg/m3 increase in 2, 5, and 21-day average PM2.5 are associated with a 0.61% (95% Confidence Interval [CI] = 0.12, 1.11); 0.91% (CI = 0.15, 1.67); and 0.04% (CI = −2.70, 2.85) increase in COVID19-related hospitalization risk, respectively. We observe substantial heterogeneity in the associations by region with the largest adverse associations in the South. Higher concentrations of PM2.5 are associated with higher risk of COVID19-related hospitalizations. Given the geographic heterogeneity observed, studies exploring factors, such as PM2.5 exposure, that could explain differences in COVID19 risks may help to understand the COVID19 pandemic and aid in preparing for future ones. Ward-Caviness et al. use a time-stratified case-crossover approach to estimate associations between PM2.5 and COVID19-related hospitalizations across the US. Higher concentrations of PM2.5 are associated with higher risk of COVID19-related hospitalizations, with heterogeneity seen across regions. Exposure to air pollution is shown to have a negative impact on human health. For example, air pollution increases the risk of cardiovascular- and respiratory-related hospitalizations and deaths. Little is known about how air pollution might affect the health of individuals with COVID19. Using hospitalization data from 57 cities across the United States (US), we assess whether individuals who tested positive for COVID19 were more likely to be hospitalized after multiple days of higher air pollution exposures. We find that higher levels of fine particulate matter, a common air pollutant, are associated with increased likelihood of COVID19-related hospitalization, and that the relationship between particulate matter and COVID19 differs across the US regions and cities we examine. The short- and long-term health impacts of air pollution exposure in individuals with COVID19 merits further research and should be considered in public health interventions and planning health care capacity.
Source: Communications Medicine
Authors: Cavin K. Ward-Caviness, Alyssa Platt, Elliott Fisher, Anne M. Weaver, Michelle L. Bell, Mercedes A. Bravo
Institutions: Environmental Protection Agency, Duke University, Yale University
Language: English
Subfield: Health, Toxicology and Mutagenesis
Field: Environmental Science
Domain: Physical Sciences
Open Access status: gold
Estimated APC paid: $3,690
OpenAlex ID: W4415997817