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1.
Am J Respir Crit Care Med ; 2022 May 10.
Article in English | MEDLINE | ID: covidwho-1832816

ABSTRACT

RATIONAL: Ecological studies have shown air pollution associations with COVID-19 outcomes. However, few cohort studies have been conducted. OBJECTIVES: To conduct a cohort study investigating the association between air pollution and COVID-19 severity using individual-level data from electronic medical records. METHODS: This cohort included all individuals diagnosed with COVID-19 from Kaiser Permanente Southern California between 3/1/2020 and 8/31/2020. 1-year and 1-month averaged ambient air pollutant (PM2.5, NO2 and O3) exposures before COVID-19 diagnosis were estimated based on residential address history. Outcomes included COVID-19-related hospitalizations, intensive respiratory support (IRS), and intensive care unit (ICU) admissions within 30 days, and mortality within 60 days after COVID-19 diagnosis. Covariates included socio-characteristics and comorbidities. MEASUREMENTS AND MAIN RESULTS: Among 74,915 individuals (mean age 42.5 years, 54% female, 66% Hispanic), rates of hospitalization, IRS, ICU, and mortality were 6.3%, 2.4%, 1.5% and 1.5% respectively. Using multi-pollutant models adjusted for covariates, 1-year PM2.5 and 1-month NO2 average exposures were associated with COVID-19 severity. The odds ratios (ORs [95% CI]) associated with one standard deviation (SD) increase in 1-year PM2.5 (SD 1.5 µg/m3) were 1.24 [1.16-1.32] for COVID-19-related hospitalization, 1.33 [1.20-1.47] for IRS, 1.32 [1.16-1.51] for ICU; the corresponding ORs [95% CI] associated with 1-month NO2 (SD 3.3 ppb) were 1.12 [1.06-1.17] for hospitalization, 1.18 [1.10-1.27] for IRS, and 1.21 [1.11-1.33] for ICU. The hazard ratios (HR [95% CI]) for mortality were 1.14 [1.02-1.27] for 1-year PM2.5 and 1.07 [0.98-1.16] for 1-month NO2. No significant interactions with age, sex or ethnicity were observed. CONCLUSIONS: Ambient PM2.5 and NO2 exposures may affect COVID-19 severity and mortality. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

3.
Environ Res ; 208: 112758, 2022 05 15.
Article in English | MEDLINE | ID: covidwho-1637740

ABSTRACT

BACKGROUND: Air pollution exposure may make people more vulnerable to COVID-19 infection. However, previous studies in this area mostly focused on infection before May 2020 and long-term exposure. OBJECTIVE: To assess both long-term and short-term exposure to air pollution and COVID-19 incidence across four case surges from 03/1/2020 to 02/28/2021. METHODS: The cohort included 4.6 million members from a large integrated health care system in southern California with comprehensive electronic medical records (EMR). COVID-19 cases were identified from EMR. Incidence of COVID-19 was computed at the census tract-level among members. Prior 1-month and 1-year averaged air pollutant levels (PM2.5, NO2, and O3) at the census tract-level were estimated based on hourly and daily air quality data. Data analyses were conducted by each wave: 3/1/2020-5/31/2020, 6/1/202-9/30/2020, 10/1/2020-12/31/2020, and 1/1/2021-2/28/2021 and pooled across waves using meta-analysis. Generalized linear mixed effects models with Poisson distribution and spatial autocorrelation were used with adjustment for meteorological factors and census tract-level social and health characteristics. Results were expressed as relative risk (RR) per 1 standard deviation. RESULTS: The cohort included 446,440 COVID-19 cases covering 4609 census tracts. The pooled RRs (95% CI) of COVID-19 incidence associated with 1-year exposures to PM2.5, NO2, and O3 were 1.11 (1.04, 1.18) per 2.3 µg/m3,1.09 (1.02, 1.17) per 3.2 ppb, and 1.06 (1.00, 1.12) per 5.5 ppb respectively. The corresponding RRs (95% CI) associated with prior 1-month exposures were 1.11 (1.03, 1.20) per 5.2 µg/m3 for PM2.5, 1.09 (1.01, 1.17) per 6.0 ppb for NO2 and 0.96 (0.85, 1.08) per 12.0 ppb for O3. CONCLUSION: Long-term PM2.5 and NO2 exposures were associated with increased risk of COVID-19 incidence across all case surges before February 2021. Short-term PM2.5 and NO2 exposures were also associated. Our findings suggest that air pollution may play a role in increasing the risk of COVID-19 infection.


Subject(s)
Air Pollutants , Air Pollution , COVID-19 , Air Pollutants/analysis , Air Pollutants/toxicity , Air Pollution/analysis , COVID-19/epidemiology , Environmental Exposure/analysis , Humans , Incidence , Particulate Matter/analysis , Particulate Matter/toxicity , SARS-CoV-2
4.
Prev Med ; 154: 106863, 2022 01.
Article in English | MEDLINE | ID: covidwho-1510415

ABSTRACT

Stressors associated with COVID-19 pandemic stay-at-home orders are associated with increased depression and anxiety and decreased physical activity. Given that physical activity and time spent outdoors in nature are associated with improved mental health, we examined the longitudinal association of these variables during the pandemic. Over 20,000 adults who participated in the U.S. Kaiser Permanente Research Bank, did not report COVID-19 symptoms, and responded to an online baseline and 3 follow-up surveys over approximately 3 months formed the cohort. Physical activity was assessed from a modified survey, time spent outdoors was assessed from one question, and anxiety and depression scores were assessed from validated instruments. Almost 60% were women, 82.8% were non-Hispanic white, and more than 93% of respondents were over the age of 50. Less in-person contact with friends and visiting crowded places was highly prevalent (>80%) initially and decreased somewhat (>70%). Participants in the lowest physical activity category (no physical activity) had the highest depression and anxiety scores compared to each successive physical activity category (p < 0.001). Spending less time outdoors was associated with higher depression and anxiety scores. This effect was greater for participants in the younger age categories compared with older age categories. The effect of less time spent outdoors on anxiety (p = 0.012) and depression (p < 0.001) scores was smaller for males than females. Results suggest that physical activity and time outdoors is associated with better mental health. People should be encouraged to continue physical activity participation during public health emergencies.


Subject(s)
COVID-19 , Adult , Anxiety/epidemiology , Depression/epidemiology , Exercise , Female , Humans , Male , Pandemics , Physical Distancing , Quarantine , SARS-CoV-2 , United States
5.
Environ Int ; 157: 106862, 2021 12.
Article in English | MEDLINE | ID: covidwho-1474522

ABSTRACT

BACKGROUND: Air pollution exposure has been associated with increased risk of COVID-19 incidence and mortality by ecological analyses. Few studies have investigated the specific effect of traffic-related air pollution on COVID-19 severity. OBJECTIVE: To investigate the associations of near-roadway air pollution (NRAP) exposure with COVID-19 severity and mortality using individual-level exposure and outcome data. METHODS: The retrospective cohort includes 75,010 individuals (mean age 42.5 years, 54% female, 66% Hispanic) diagnosed with COVID-19 at Kaiser Permanente Southern California between 3/1/2020-8/31/2020. NRAP exposures from both freeways and non-freeways during 1-year prior to the COVID-19 diagnosis date were estimated based on residential address history using the CALINE4 line source dispersion model. Primary outcomes include COVID-19 severity defined as COVID-19-related hospitalizations, intensive respiratory support (IRS), intensive care unit (ICU) admissions within 30 days, and mortality within 60 days after COVID-19 diagnosis. Covariates including socio-characteristics and comorbidities were adjusted for in the analysis. RESULT: One standard deviation (SD) increase in 1-year-averaged non-freeway NRAP (0.5 ppb NOx) was associated with increased odds of COVID-19-related IRS and ICU admission [OR (95% CI): 1.07 (1.01, 1.13) and 1.11 (1.04, 1.19) respectively] and increased risk of mortality (HR = 1.10, 95% CI = 1.03, 1.18). The associations of non-freeway NRAP with COVID-19 outcomes were largely independent of the effect of regional fine particulate matter and nitrogen dioxide exposures. These associations were generally consistent across age, sex, and race/ethnicity subgroups. The associations of freeway and total NRAP with COVID-19 severity and mortality were not statistically significant. CONCLUSIONS: Data from this multiethnic cohort suggested that NRAP, particularly non-freeway exposure in Southern California, may be associated with increased risk of COVID-19 severity and mortality among COVID-19 infected patients. Future studies are needed to assess the impact of emerging COVID-19 variants and chemical components from freeway and non-freeway NRAP.


Subject(s)
Air Pollutants , Air Pollution , COVID-19 , Adult , Air Pollutants/analysis , Air Pollutants/toxicity , Air Pollution/adverse effects , Air Pollution/analysis , COVID-19 Testing , California/epidemiology , Cohort Studies , Environmental Exposure/adverse effects , Environmental Exposure/analysis , Female , Humans , Male , Retrospective Studies , SARS-CoV-2
6.
J Allergy Clin Immunol Pract ; 9(10): 3621-3628.e2, 2021 10.
Article in English | MEDLINE | ID: covidwho-1347677

ABSTRACT

BACKGROUND: Current studies of asthma history on coronavirus disease 2019 (COVID-19) outcomes are limited and lack consideration of disease status. OBJECTIVE: To conduct a population-based study to assess asthma disease status and chronic obstructive pulmonary disease (COPD) in relation to COVID-19 severity. METHODS: Patients diagnosed with COVID-19 (n = 61,338) in a large, diverse integrated health care system were identified. Asthma/COPD history, medication use, and covariates were extracted from electronic medical records. Asthma patients were categorized into those with and without clinical visits for asthma 12 or fewer months prior to COVID-19 diagnosis and labeled as active and inactive asthma, respectively. Primary outcomes included COVID-19-related hospitalizations, intensive respiratory support (IRS), and intensive care unit admissions within 30 days, and mortality within 60 days after COVID-19 diagnosis. Logistic and Cox regression were used to relate COVID-19 outcomes to asthma/COPD history. RESULTS: The cohort was 53.9% female and 66% Hispanic and had a mean age of 43.9 years. Patients with active asthma had increased odds of hospitalization, IRS, and intensive care unit admission (odds ratio 1.47-1.66; P < .05) compared with patients without asthma or COPD. No increased risks were observed for patients with inactive asthma. Chronic obstructive pulmonary disease was associated with increased risks of hospitalization, IRS, and mortality (odds ratio and hazard ratio 1.27-1.67; P < .05). Among active asthma patients, those using asthma medications had greater than 25% lower odds for COVID-19 outcomes than those without medication. CONCLUSIONS: Patients with asthma who required clinical care 12 or fewer months prior to COVID-19 or individuals with COPD history are at increased risk for severe COVID-19 outcomes. Proper medication treatment for asthma may lower this risk.


Subject(s)
Asthma , COVID-19 , Pulmonary Disease, Chronic Obstructive , Adult , Asthma/epidemiology , COVID-19 Testing , Female , Hospitalization , Humans , Male , Pulmonary Disease, Chronic Obstructive/epidemiology , SARS-CoV-2
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