Poster abstract for HEI Annual Conference 2023
Air Pollution and COVID-19 severity among hospitalized COVID-19 Patients: A Multistate Survival Analysis
Michael Jerrett1, Michael Kleeman2, Jason Su3, Claudia Nau4, Deborah Young4, Rebecca Butler4, Christina Batteate1, Ariadna Padilla4, Sara Y. Tartof4, Richard Burnett
1University of California at Los Angeles, Los Angeles, CA, USA; 2University of California at Davis, Davis, CA, USA; 3University of California at Berkeley, Berkeley, USA; 4Kaiser Permanente Southern California, Los Angeles, CA, USA
Background: Efforts to limit the severity of COVID-19 outcomes have faced challenges due in part to vaccine hesitancy and low uptake of boosters. Growing interest centers on modifiable environmental risk factors such as air pollution that may limit the severity of COVID-19 in infected patients. Some evidence implicates air pollution as a risk factor for more severe outcomes in COVID-19 patients. To date, however, no studies have examined comprehensively how air pollution affects the severity of COVID-19 outcomes as measured by admission to the intensive care units, death and time to hospital discharge.
Methods: A multistate survival model was developed in a cohort of 15,978 hospitalized patients with COVID-19 who were members of Kaiser Permanente Southern California (KPSC), a large, integrated health care system with membership that is highly diverse. KPSC documents all care in its electronic health records. The multistate model captured all possible states of transition between standard hospital care, intensive care and discharged from the hospital to quantify the association of air pollution exposure on the transition between states in patients with COVID-19: hospitalization, admission to ICU, recovery and discharge, or death (in or out of hospital Chronic air pollution exposure fields were developed across Southern California using chemical transport models (CTMs) and Land Use Regression Models (LURMs) with a spatial resolution of 1 km. Results were analyzed for PM2.5 mass, O3, and NO2 in single pollutant models and two pollutant models for all possible combinations.
Results: Increased exposure to PM2.5 mass and O3 was associated with the transition to more severe COVID states, including: ICU admission after hospitalization, death after hospitalization, and death after recovery or discharge from hospital. Effects for NO2 were somewhat weaker than for PM2.5 mass and O3. Lower air pollution concentrations were associated with recovery after hospitalization.
Conclusions: Given the public health challenges of mitigating COVID-19 and potential new viruses, other approaches to limiting the severity of COVID-19 infection are essential. Reducing air pollution may provide another effective means of reducing the severity of the current pandemic, while also by limiting the impact of future novel viruses.