Air quality in Germany as a contributing factor to morbidity from COVID-19

Susanne Koch; Christina Hoffmann; Alexandre Caseiro; Marie Ledebur; Mario Menk; Erika von Schneidemesser

doi:10.1016/j.envres.2022.113896

Air quality in Germany as a contributing factor to morbidity from COVID-19

Environ Res. 2022 Nov;214(Pt 2):113896. doi: 10.1016/j.envres.2022.113896. Epub 2022 Jul 13.

Authors

Susanne Koch¹, Christina Hoffmann², Alexandre Caseiro³, Marie Ledebur⁴, Mario Menk⁴, Erika von Schneidemesser³

Affiliations

¹ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anaesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Germany. Electronic address: susanne.koch@charite.de.
² Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Diagnostic Laboratory Medicine, Clinical Chemistry, And Pathobiochemistry, Augustenburger Platz 1, 13353, Berlin, Germany.
³ Institute for Advanced Sustainability Studies e.V. (IASS), Berliner Strasse 130, 14467, Potsdam, Germany.
⁴ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anaesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Germany.

Abstract

Background: The SARS-CoV-2 virus has been spreading in Germany since January 2020, with regional differences in incidence, morbidity, and mortality. Long-term exposure to air pollutants as nitrogen dioxide (NO₂), nitrogen monoxide (NO), ozone (O₃), and particulate matter (<10 μm PM₁₀, <2.5 μm PM_2.5) has a negative impact on respiratory functions. We analyze the association between long-term air pollution and the outcome of SARS-CoV-2 infections in Germany.

Methods: We conducted an observational study in Germany on county-level, investigating the association between long-term (2010-2019) air pollutant exposure (European Environment Agency, AirBase data set) and COVID-19 incidence, morbidity, and mortality rate during the first outbreak of SARS-CoV-2 (open source data Robert Koch Institute). We used negative binominal models, including adjustment for risk factors (age, sex, days since first COVID-19 case, population density, socio-economic and health parameters).

Results: After adjustment for risk factors in the tri-pollutant model (NO₂, O₃, PM_2.5) an increase of 1 μg/m³ NO₂ was associated with an increase of the need for intensive care due to COVID-19 by 4.2% (95% CI 1.011-1.074), and mechanical ventilation by 4.6% (95% CI 1.010-1.084). A tendency towards an association of NO₂ with COVID-19 incidence was indicated, as the results were just outside of the defined statistical significance (+1.6% (95% CI 1.000-1.032)). Long-term annual mean NO₂ level ranged from 4.6 μg/m³ to 32 μg/m³.

Conclusions: Our results indicate that long-term NO₂ exposure may have increased susceptibility for COVID-19 morbidity in Germany. The results demonstrate the need to reduce ambient air pollution to improve public health.

Keywords: Air pollution; Intensive care medicine; Mechanical ventilation; Mortality; Nitrogen dioxide; SARS-CoV-2.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Air Pollutants* / analysis
Air Pollutants* / toxicity
Air Pollution* / adverse effects
Air Pollution* / analysis
COVID-19* / epidemiology
Environmental Exposure / analysis
Germany / epidemiology
Humans
Incidence
Nitrogen Dioxide / analysis
Nitrogen Dioxide / toxicity
Particulate Matter / analysis
Particulate Matter / toxicity
SARS-CoV-2

Substances

Air Pollutants
Particulate Matter
Nitrogen Dioxide