Ambient Air Pollution Exposure Linked to Long COVID Among Young Adults: a Nested Survey in a Population-based Cohort In Sweden

Overview

Journal Lancet Reg Health Eur

Specialty Health Services

Date 2023 May 3

PMID 37131862

Authors

Zhebin Yu

Sandra Ekstrom

Tom Bellander

Petter Ljungman

Goran Pershagen

Kristina Eneroth

Inger Kull

Anna Bergstrom

Antonios Georgelis

Massimo Stafoggia

Olena Gruzieva

Erik Melen

Affiliations

Soon will be listed here.

Abstract

Background: Post COVID-19 conditions, also known as long COVID, are of public health concern, but little is known about their underlying risk factors. We aimed to investigate associations of air pollution exposure with long COVID among Swedish young adults.

Methods: We used data from the BAMSE (Children, Allergy, Environment, Stockholm, Epidemiology [in Swedish]) cohort. From October 2021 to February 2022 participants answered a web-questionnaire focusing on persistent symptoms following acute SARS-CoV-2 infection. Long COVID was defined as symptoms after confirmed infection with SARS-CoV-2 lasting for two months or longer. Ambient air pollution levels (particulate matter ≤2.5 μm [PM], ≤10 μm [PM], black carbon [BC] and nitrogen oxides [NO]) at individual-level addresses were estimated using dispersion modelling.

Findings: A total of 753 participants with SARS-CoV-2 infection were included of whom 116 (15.4%) reported having long COVID. The most common symptoms were altered smell/taste (n = 80, 10.6%), dyspnea (n = 36, 4.8%) and fatigue (n = 34, 4.5%). Median annual PM exposure in 2019 (pre-pandemic) was 6.39 (interquartile range [IQR] 6.06-6.71) μg/m. Adjusted Odds Ratios (95% confidence intervals) of PM per IQR increase were 1.28 (1.02-1.60) for long COVID, 1.65 (1.09-2.50) for dyspnea symptoms and 1.29 (0.97-1.70) for altered smell/taste. Positive associations were found for the other air pollutants and remained consistent across sensitivity analyses. Associations tended to be stronger among participants with asthma, and those having had COVID during 2020 (versus 2021).

Interpretation: Ambient long-term PM exposure may affect the risk of long COVID in young adults, supporting efforts for continuously improving air quality.

Funding: The study received funding from the Swedish Research Council (grant no. 2020-01886, 2022-06340), the Swedish Research Council for Health, Working life and Welfare (FORTE grant no. 2017-01146), the Swedish Heart-Lung Foundation, Karolinska Institute (no. 2022-01807) and Region Stockholm (ALF project for cohort and database maintenance).

Citing Articles

Variation in the Impact of New York on Pause on Traffic Congestion by Racialized Economic Segregation and Environmental Burden.

Shearston J, Saxena R, Casey J, Kioumourtzoglou M, Hilpert M Geohealth. 2024; 8(12):e2024GH001050.

PMID: 39664924 PMC: 11632250. DOI: 10.1029/2024GH001050.

Environmental Exposures and Long COVID in a Prospective Population-Based Study in Catalonia (COVICAT Study).

Saucy A, Espinosa A, Iraola-Guzman S, Castano-Vinyals G, Harding B, Karachaliou M Environ Health Perspect. 2024; 132(11):117701.

PMID: 39601588 PMC: 11601095. DOI: 10.1289/EHP15377.

Long COVID: A Comprehensive Overview of the Signs and Symptoms across Multiple Organ Systems.

Merhavy Z, Junor T, Gonzalez A, De Filippis S, Oveisitork S, Rivera E Korean J Fam Med. 2024; 45(6):305-316.

PMID: 39600184 PMC: 11605154. DOI: 10.4082/kjfm.24.0085.

Temporal changes in the risk of six-month post-COVID symptoms: a national population-based cohort study.

Pastorello A, Meyer L, Coste J, Davisse-Paturet C, de Lamballerie X, Melchior M Am J Epidemiol. 2024; 194(1):162-171.

PMID: 38960664 PMC: 11735949. DOI: 10.1093/aje/kwae174.

Improved Air Quality and Asthma Incidence from School Age to Young Adulthood: A Population-based Prospective Cohort Study.

Yu Z, Merid S, Bellander T, Bergstrom A, Eneroth K, Merritt A Ann Am Thorac Soc. 2024; 21(10):1432-1440.

PMID: 38959417 PMC: 11451890. DOI: 10.1513/AnnalsATS.202402-200OC.

References

Behnood S, Shafran R, Bennett S, Zhang A, OMahoney L, Stephenson T . Persistent symptoms following SARS-CoV-2 infection amongst children and young people: A meta-analysis of controlled and uncontrolled studies. J Infect. 2021; 84(2):158-170. PMC: 8604800. DOI: 10.1016/j.jinf.2021.11.011. View

Glencross D, Ho T, Camina N, Hawrylowicz C, Pfeffer P . Air pollution and its effects on the immune system. Free Radic Biol Med. 2020; 151:56-68. DOI: 10.1016/j.freeradbiomed.2020.01.179. View

Nobile F, Michelozzi P, Ancona C, Cappai G, Cesaroni G, Davoli M . Air pollution, SARS-CoV-2 incidence and COVID-19 mortality in Rome: a longitudinal study. Eur Respir J. 2022; 60(3. PMC: 9301936. DOI: 10.1183/13993003.00589-2022. View

Rezaie Rahimi N, Fouladi-Fard R, Aali R, Shahryari A, Rezaali M, Ghafouri Y . Bidirectional association between COVID-19 and the environment: A systematic review. Environ Res. 2021; 194:110692. PMC: 7833965. DOI: 10.1016/j.envres.2020.110692. View

Ekstrom S, Mogensen I, Georgelis A, Westman M, Almqvist C, Melen E . General Stress Among Young Adults with Asthma During the COVID-19 Pandemic. J Allergy Clin Immunol Pract. 2021; 10(1):108-115. PMC: 8590620. DOI: 10.1016/j.jaip.2021.10.069. View

Yao Y, Pan J, Wang W, Liu Z, Kan H, Qiu Y . Association of particulate matter pollution and case fatality rate of COVID-19 in 49 Chinese cities. Sci Total Environ. 2020; 741:140396. PMC: 7305499. DOI: 10.1016/j.scitotenv.2020.140396. View

Wang S, Quan L, Chavarro J, Slopen N, Kubzansky L, Koenen K . Associations of Depression, Anxiety, Worry, Perceived Stress, and Loneliness Prior to Infection With Risk of Post-COVID-19 Conditions. JAMA Psychiatry. 2022; 79(11):1081-1091. PMC: 9453634. DOI: 10.1001/jamapsychiatry.2022.2640. View

Yu Z, Bellander T, Bergstrom A, Dillner J, Eneroth K, Engardt M . Association of Short-term Air Pollution Exposure With SARS-CoV-2 Infection Among Young Adults in Sweden. JAMA Netw Open. 2022; 5(4):e228109. PMC: 9021914. DOI: 10.1001/jamanetworkopen.2022.8109. View

Ekstrom S, Andersson N, Lovquist A, Lauber A, Georgelis A, Kull I . COVID-19 among young adults in Sweden: self-reported long-term symptoms and associated factors. Scand J Public Health. 2021; 50(1):85-93. PMC: 8808012. DOI: 10.1177/14034948211025425. View

10.

Coccia M . How do low wind speeds and high levels of air pollution support the spread of COVID-19?. Atmos Pollut Res. 2020; 12(1):437-445. PMC: 7541047. DOI: 10.1016/j.apr.2020.10.002. View

11.

Gruzieva O, Jeong A, He S, Yu Z, Bont J, Pinho M . Air pollution, metabolites and respiratory health across the life-course. Eur Respir Rev. 2022; 31(165). PMC: 9724796. DOI: 10.1183/16000617.0038-2022. View

12.

Augustin M, Schommers P, Stecher M, Dewald F, Gieselmann L, Gruell H . Post-COVID syndrome in non-hospitalised patients with COVID-19: a longitudinal prospective cohort study. Lancet Reg Health Eur. 2021; 6:100122. PMC: 8129613. DOI: 10.1016/j.lanepe.2021.100122. View

13.

Wulf Hanson S, Abbafati C, Aerts J, Al-Aly Z, Ashbaugh C, Ballouz T . Estimated Global Proportions of Individuals With Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021. JAMA. 2022; 328(16):1604-1615. PMC: 9552043. DOI: 10.1001/jama.2022.18931. View

14.

Subramanian A, Nirantharakumar K, Hughes S, Myles P, Williams T, Gokhale K . Symptoms and risk factors for long COVID in non-hospitalized adults. Nat Med. 2022; 28(8):1706-1714. PMC: 9388369. DOI: 10.1038/s41591-022-01909-w. View

15.

Ekstrom I, Rizzuto D, Grande G, Bellander T, Laukka E . Environmental Air Pollution and Olfactory Decline in Aging. Environ Health Perspect. 2022; 130(2):27005. PMC: 8828267. DOI: 10.1289/EHP9563. View

16.

Gruzieva O, Bellander T, Eneroth K, Kull I, Melen E, Nordling E . Traffic-related air pollution and development of allergic sensitization in children during the first 8 years of life. J Allergy Clin Immunol. 2011; 129(1):240-6. DOI: 10.1016/j.jaci.2011.11.001. View

17.

He S, Klevebro S, Baldanzi G, Pershagen G, Lundberg B, Eneroth K . Ambient air pollution and inflammation-related proteins during early childhood. Environ Res. 2022; 215(Pt 2):114364. DOI: 10.1016/j.envres.2022.114364. View

18.

Rolfhamre P, Jansson A, Arneborn M, Ekdahl K . SmiNet-2: Description of an internet-based surveillance system for communicable diseases in Sweden. Euro Surveill. 2006; 11(5):103-7. View

19.

Stapleton E, Welch J, Ubeda E, Xiang J, Zabner J, Thornell I . Urban Particulate Matter Impairment of Airway Surface Liquid-Mediated Coronavirus Inactivation. J Infect Dis. 2021; 225(2):214-218. PMC: 8689861. DOI: 10.1093/infdis/jiab545. View

20.

Ballering A, van Zon S, Olde Hartman T, Rosmalen J . Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study. Lancet. 2022; 400(10350):452-461. PMC: 9352274. DOI: 10.1016/S0140-6736(22)01214-4. View