PMID- 32511493
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240328
DP  - 2020 May 7
TI  - Urban Air Pollution May Enhance COVID-19 Case-Fatality and Mortality Rates in the 
      United States.
LID - 2020.05.04.20090746 [pii]
LID - 10.1101/2020.05.04.20090746 [doi]
AB  - BACKGROUND: The novel human coronavirus disease 2019 (COVID-19) pandemic has 
      claimed more than 240,000 lives worldwide, causing tremendous public health, 
      social, and economic damages. While the risk factors of COVID-19 are still under 
      investigation, environmental factors, such as urban air pollution, may play an 
      important role in increasing population susceptibility to COVID-19 pathogenesis. 
      METHODS: We conducted a cross-sectional nationwide study using zero-inflated 
      negative binomial models to estimate the association between long-term 
      (2010-2016) county-level exposures to NO(2), PM(2.5) and O(3) and county-level 
      COVID-19 case-fatality and mortality rates in the US. We used both single and 
      multipollutant models and controlled for spatial trends and a comprehensive set 
      of potential confounders, including state-level test positive rate, county-level 
      healthcare capacity, phase-of-epidemic, population mobility, sociodemographic, 
      socioeconomic status, behavior risk factors, and meteorological factors. RESULTS: 
      1,027,799 COVID-19 cases and 58,489 deaths were reported in 3,122 US counties 
      from January 22, 2020 to April 29, 2020, with an overall observed case-fatality 
      rate of 5.8%. Spatial variations were observed for both COVID-19 death outcomes 
      and long-term ambient air pollutant levels. County-level average NO(2) 
      concentrations were positively associated with both COVID-19 case-fatality rate 
      and mortality rate in single-, bi-, and tri-pollutant models (p-values<0.05). Per 
      inter-quartile range (IQR) increase in NO(2) (4.6 ppb), COVID-19 case-fatality 
      rate and mortality rate were associated with an increase of 7.1% (95% CI 1.2% to 
      13.4%) and 11.2% (95% CI 3.4% to 19.5%), respectively. We did not observe 
      significant associations between long-term exposures to PM(2.5) or O(3) and 
      COVID-19 death outcomes (p-values>0.05), although per IQR increase in PM(2.5) 
      (3.4 ug/m(3)) was marginally associated with 10.8% (95% CI: -1.1% to 24.1%) 
      increase in COVID-19 mortality rate. DISCUSSIONS AND CONCLUSIONS: Long-term 
      exposure to NO(2), which largely arises from urban combustion sources such as 
      traffic, may enhance susceptibility to severe COVID-19 outcomes, independent of 
      long-term PM(2.5) and O(3) exposure. The results support targeted public health 
      actions to protect residents from COVID-19 in heavily polluted regions with 
      historically high NO(2) levels. Moreover, continuation of current efforts to 
      lower traffic emissions and ambient air pollution levels may be an important 
      component of reducing population-level risk of COVID-19 deaths.
FAU - Liang, Donghai
AU  - Liang D
AD  - Gangarosa Department of Environmental Health, Rollins School of Public Health, 
      Emory University, Atlanta, Georgia, USA.
FAU - Shi, Liuhua
AU  - Shi L
AD  - Gangarosa Department of Environmental Health, Rollins School of Public Health, 
      Emory University, Atlanta, Georgia, USA.
FAU - Zhao, Jingxuan
AU  - Zhao J
AD  - Surveillance and Health Services Research Program, American Cancer Society, 
      Atlanta, Georgia, USA.
FAU - Liu, Pengfei
AU  - Liu P
AD  - School of Earth and Atmospheric Sciences, Georgia Institute of Technology, 
      Atlanta, Georgia, USA.
FAU - Schwartz, Joel
AU  - Schwartz J
AD  - Department of Environmental Health, Harvard T.H. Chan School of Public Health, 
      Boston, Massachusetts, USA.
FAU - Gao, Song
AU  - Gao S
AD  - GeoDS Lab, Department of Geography, University of Wisconsin-Madison, Madison, WI, 
      USA.
FAU - Sarnat, Jeremy
AU  - Sarnat J
AD  - Gangarosa Department of Environmental Health, Rollins School of Public Health, 
      Emory University, Atlanta, Georgia, USA.
FAU - Liu, Yang
AU  - Liu Y
AD  - Gangarosa Department of Environmental Health, Rollins School of Public Health, 
      Emory University, Atlanta, Georgia, USA.
FAU - Ebelt, Stefanie
AU  - Ebelt S
AD  - Gangarosa Department of Environmental Health, Rollins School of Public Health, 
      Emory University, Atlanta, Georgia, USA.
FAU - Scovronick, Noah
AU  - Scovronick N
AD  - Gangarosa Department of Environmental Health, Rollins School of Public Health, 
      Emory University, Atlanta, Georgia, USA.
FAU - Chang, Howard H
AU  - Chang HH
AD  - Department of Biostatistics and Bioinformatics, Rollins School of Public Health, 
      Emory University, Atlanta, Georgia, USA.
LA  - eng
GR  - P30 ES019776/ES/NIEHS NIH HHS/United States
PT  - Preprint
DEP - 20200507
PL  - United States
TA  - medRxiv
JT  - medRxiv : the preprint server for health sciences
JID - 101767986
UIN - Innovation (N Y). 2020 Sep 21;:100047. PMID: 32984861
PMC - PMC7273261
OTO - NOTNLM
OT  - Air pollution
OT  - COVID-19
OT  - Case-fatality rate
OT  - Mortality
OT  - Nitrogen dioxide
COIS- Potential Conflicts of Interest: The authors have no conflicts of interest 
      relevant to this article to disclose
EDAT- 2020/06/09 06:00
MHDA- 2020/06/09 06:01
PMCR- 2020/06/05
CRDT- 2020/06/09 06:00
PHST- 2020/06/09 06:00 [entrez]
PHST- 2020/06/09 06:00 [pubmed]
PHST- 2020/06/09 06:01 [medline]
PHST- 2020/06/05 00:00 [pmc-release]
AID - 2020.05.04.20090746 [pii]
AID - 10.1101/2020.05.04.20090746 [doi]
PST - epublish
SO  - medRxiv [Preprint]. 2020 May 7:2020.05.04.20090746. doi: 
      10.1101/2020.05.04.20090746.