Investigating links between long-term air pollution exposure and the risk of SARS-CoV-2 infection, COVID-19 hospitalisation and mortality: a systematic review and meta-analysis of cohort studies

IF 7.3 2区环境科学与生态学 Q1 ENVIRONMENTAL SCIENCES

Environmental Pollution Pub Date : 2025-10-10 DOI:10.1016/j.envpol.2025.127222

Shawn Y. Lee, Abigail B. Schneider, Heather Walton, James Isaac, Anna Hansell, Klea Katsouyanni, Dylan Wood, Dimitris Evangelopoulos

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引用次数: 0

Abstract

Air pollution exposure is suggested to be associated with SARS-CoV-2 infection and COVID-19 outcomes. Available systematic reviews and meta-analyses included studies of various study designs which could be vulnerable to ecological bias. We systematically reviewed the association between particulate matter less than 2.5 aerodynamic diameter (PM_2.5), nitrogen dioxide (NO₂), and ozone (O₃) and the risk of SARS-CoV-2 infection, COVID-19 hospitalisation, and COVID-19 mortality, focusing on cohort studies with individual-level data.A systematic literature search was conducted on MEDLINE and Scopus in July 2023 and subsequently updated in April 2025. The risk of bias of eligible studies was assessed using a modified Risk of Bias assessment instrument developed by the World Health Organization. Qualitative synthesis was performed on all eligible studies, and random-effects meta-analyses were performed when more than three studies were available for an exposure-outcome pair, after removing studies with overlapping populations.Long-term PM_2.5 exposure was associated with an increased risk of all outcomes investigated (RR for SARS-CoV-2 infection: 1.04 [1.02-1.07], RR for COVID-19 hospitalisation: 1.11 [1.06-1.15], RR for COVID-19 mortality: 1.09 [1.03-1.15], per 1 μg/m³ increase), whereas NO₂ exposure was associated with an increased risk of COVID-19 hospitalisation (RR: 1.02 [1.01-1.03], per 1 μg/m³ increase) and COVID-19 mortality (RR: 1.01 [1.01-1.02], per 1 μg/m³ increase). No associations were found for O₃ exposure. Univariate meta-regression suggested that country of study accounted for a substantial proportion of the heterogeneity observed in meta-analyses.This review presents a comprehensive, up-to-date synthesis of the evidence regarding the adverse effects of air pollutant exposure on COVID-19 outcomes based on robustly conducted cohort studies with individual-level information.

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调查长期空气污染暴露与SARS-CoV-2感染风险、COVID-19住院和死亡率之间的联系：队列研究的系统回顾和荟萃分析

空气污染暴露与SARS-CoV-2感染和COVID-19结局有关。现有的系统综述和荟萃分析包括各种研究设计的研究，这些研究设计可能容易受到生态偏倚的影响。我们系统地回顾了空气动力学直径小于2.5的颗粒物（PM2.5）、二氧化氮（NO2）和臭氧（O3）与SARS-CoV-2感染风险、COVID-19住院率和COVID-19死亡率之间的关系，重点关注具有个体水平数据的队列研究。我们于2023年7月在MEDLINE和Scopus上进行了系统的文献检索，并于2025年4月更新。使用世界卫生组织开发的改进的偏倚风险评估工具评估符合条件的研究的偏倚风险。对所有符合条件的研究进行定性综合，在排除重叠人群的研究后，当有超过三项研究可用于暴露-结果对时，进行随机效应荟萃分析。长期PM2.5暴露与所有调查结果的风险增加相关（SARS-CoV-2感染的RR: 1.04 [1.02-1.07]， COVID-19住院的RR: 1.11 [1.06-1.15]， COVID-19死亡率的RR: 1.09[1.03-1.15]，每增加1 μg/m3），而二氧化氮暴露与COVID-19住院的风险增加相关（RR: 1.02[1.01-1.03]，每增加1 μg/m3）和COVID-19死亡率（RR: 1.01[1.01-1.02]，每增加1 μg/m3）。没有发现与臭氧暴露有关。单变量荟萃回归表明，在荟萃分析中观察到的异质性中，研究国家占了很大比例。本综述基于具有个人层面信息的可靠队列研究，对空气污染物暴露对COVID-19结局的不利影响的证据进行了全面、最新的综合。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Environmental Pollution 环境科学-环境科学

CiteScore

16.00

自引率

6.70%

发文量

2082

审稿时长

2.9 months

期刊介绍： Environmental Pollution is an international peer-reviewed journal that publishes high-quality research papers and review articles covering all aspects of environmental pollution and its impacts on ecosystems and human health. Subject areas include, but are not limited to: • Sources and occurrences of pollutants that are clearly defined and measured in environmental compartments, food and food-related items, and human bodies; • Interlinks between contaminant exposure and biological, ecological, and human health effects, including those of climate change; • Contaminants of emerging concerns (including but not limited to antibiotic resistant microorganisms or genes, microplastics/nanoplastics, electronic wastes, light, and noise) and/or their biological, ecological, or human health effects; • Laboratory and field studies on the remediation/mitigation of environmental pollution via new techniques and with clear links to biological, ecological, or human health effects; • Modeling of pollution processes, patterns, or trends that is of clear environmental and/or human health interest; • New techniques that measure and examine environmental occurrences, transport, behavior, and effects of pollutants within the environment or the laboratory, provided that they can be clearly used to address problems within regional or global environmental compartments.